Meta-analysis On Effectiveness And Safety Of Voriconazole Or Natamycin In The Treatment Of Fungal Keratitis

Objective:To evaluate the efficacy and safety of local application of voriconazole in the treatment of fungal keratitis by Meta-analysis.Methods:Pubmed database,Embase database and Wanfang database were searched by computer.Chinese Journal Full-text Database.Find out all the literature about local treatment of fungal keratitis with voriconazole,and screen and extract all the randomized controlled trials collected.The patients in the control group were treated with natamycin locally.The Jadad scale was used to evaluate the risk of bias in the study.The risk of bias was evaluated according to the Cochrane manual.Finally,the Meta-analysis was performed with Revman5.2 software.The main analysis parameters included:effective rate,final visual acuity,and visual acuity.cases of therapeutic keratoplasty.Results:Six randomized controlled trials were selected,of which 2 were Chinese and 4 were Indian.A total of 797 patients with fungal keratitis were included.There was no significant difference in the heterogeneity test among the various studies.Therefore,the fixed effect model was used to analyze the effect volume.Meta-analysis showed that there was no significant difference between the two studies.The effective rate of the radiation group(natamycin)was significantly higher than that of the experimental group(voriconazole)(RR,0.89;95%CI,0.80-0.99).The difference between the two groups was statistically significant(P<0.1).The final visual acuity of the natamycin group was significantly higher than that of the voriconazole group.The results of meta-analysis showed that the final visual acuity of the control group(natamycin)was significantly higher than that of the experimental group(voriconazole),and the difference between the two groups was statistically significant(WMD,0.13;95%CI,0.00-0.27;P<0.1).There was no significant difference in heterogeneity test between the two groups(P=0.45,I~2=0%).The results of meta-analysis showed that the corneal transplantation rate in the test group (voriconazole)was significantly higher than that in the control group(natamycin)(RR,1.77;95%CI,1.08-2.88;P<0.1),and the difference between the two groups was statistically significant(P<0.1).The risk of corneal transplantation was significantly higher than that of natamycin.Conclusion:1.The effective rate of local use of voriconazole in the treatment of fungal keratitis is significantly lower than that of local use of natamycin.2.The final visual acuity of local use of voriconazole in the treatment of fungal keratitis is lower than that of natamycin.3.The risk of therapeutic keratoplasty after the treatment of fungal keratitis with voriconazole is higher than that of natamycin.