Background: Microbial keratitis is a major cause of corneal blindness worldwide. Evidence on the effectiveness of available therapies varies widely. Aim: This systematic review and meta-analysis evaluated the effectiveness of medical and surgical interventions for bacterial and fungal keratitis. Methods: A comprehensive search of databases and grey literature was conducted for studies published between January 2000 and December 2024. Eligible study designs included randomised controlled trials (RCTs) and cohort studies reporting treatment outcomes for microbial keratitis. Data on visual acuity, epithelial healing, microbiological cure and complications were extracted. Random-effects meta-analyses were performed, and heterogeneity was assessed using I 2 statistics. Risk of bias was evaluated using the Joanna Briggs Institute checklist. Results: From 6919 identified records, seven studies (four RCTs, three cohort studies) from five countries were included. The pooled odds ratio (OR) for ulcer healing or meaningful visual improvement across RCTs was 1.31 (95% CI: 1.00–1.72), favouring active treatment with targeted antimicrobial therapy (fourth-generation fluoroquinolones and fortified antibiotics) for bacterial keratitis. Fungal keratitis trials comparing natamycin with voriconazole yielded a pooled OR of 1.11 (95% CI: 0.89–1.39). The cohort studies’ pooled healing proportion was 0.72 (95% CI: 0.58–0.83), increasing to 0.76 after sensitivity exclusion. A Nigerian cohort study reported 45.6% of patients achieving a best-corrected visual acuity of ≥6/18. Conclusion: Evidence suggests generally favourable healing outcomes with current antimicrobial therapies for microbial keratitis. However, comparative effectiveness between specific agents remains uncertain in some contexts. Early presentation, microbiologic evaluation and targeted therapy are crucial to improving outcomes, especially in resource-limited settings.
Adepoju et al. (2026) studied this question.