To systematically evaluate the efficacy and safety of different antifungal medications for fungal keratitis (FK).

A network meta-analysis was conducted.Four databases including PubMed, Cochrane Library, Embase, Web of Science were searched.The publication period was from inception to March 16, 2023.Two researchers followed the inclusion and exclusion criteria to screen randomized controlled trial (RCT), completed the quality assessment and extracted the information.Literature quality assessment was performed using Review Manager 5.4 bias risk assessment tool, and network meta-analysis was performed using Stata 14.0 software for cure rate, healing time, visual acuity improvement and safety of different antifungal drugs for fungal keratitis.

A total of 14 RCTs involving 1 681 patients were finally included in this study.The network meta-analysis showed that 0.2% chlorhexidine eye drops and 5% natamycin eye drops+ oral voriconazole had better efficacy than other interventions in cure rate, and the surface under the cumulative ranking (SUCRA) were 86.1% and 63.3%, respectively.The cure rate of 1% voriconazole eye drops was lower than that of 0.2% chlorhexidine eye drops, 5% natamycin eye drops+ oral voriconazole, 0.05% chlorhexidine eye drops, 0.1% chlorhexidine eye drops, 5% natamycin eye drops+ oral ketoconazole and 5% natamycin eye drops, showing statistically significant differences (all at P<0.05).1% voriconazole eye drops and 5% natamycin eye drops+ oral voriconazole showed better efficacy than other interventions in terms of healing time (SUCRA=66.9%, 55.7%).The combination of 5% natamycin eye drops, 1% voriconazole eye drops and oral voriconazole showed a better efficacy than others in improving visual acuity and safety (SUCRA=74.8%, 79.7%).For safety, 5% natamycin eye drops was superior to 1% voriconazole eye drops and 0.2% chlorhexidine eye drops, with statistically significant differences (both at P<0.05).In addition, there may be potential publication bias in this analysis.

0.2% chlorhexidine eye drops and 1% voriconazole eye drops are effective in the treatment of FK.The combination use of 5% natamycin eye drops, 1% voriconazole eye drops and oral voriconazole can improve visual acuity and had good safety.

Fungal keratitis; Drug therapy; Network meta-analysis