Cao Binh, Gonugunta Vishnu Teja, Radhakrishnan Naveen, Lalitha Prajna, Gurnani Bharat, Kaur Kirandeep, Iyer Geetha, Agarwal Shweta, Srinivasan Bhaskar, Keenan Jeremy D, Prajna N Venkatesh
Francis I Proctor Foundation, University of California, San Francisco, USA.
Department of Cornea and Refractive Surgery, Aravind Eye Hospital Madurai, India.
Curr Ophthalmol Rep. 2022 Dec;10(4):198-208. doi: 10.1007/s40135-022-00302-7. Epub 2022 Nov 10.
Pythium keratitis is a difficult-to-treat corneal infection.
A meta-analysis of individual patient data from observational studies of Pythium keratitis was performed. The outcomes of interest were therapeutic penetrating keratoplasty (TPK) and globe removal (evisceration, enucleation, or exenteration); the main exposures were linezolid and azithromycin use.
Of 46 eligible articles, individual patient data were available for 306 eyes (34 studies). Pythium keratitis was associated with high rates of TPK (80%, 95%CI 70-87%) and globe removal (25%, 95%CI 13-43). In multivariable models adjusting for age and country, fewer TPKs were performed in patients treated with azithromycin (RR=0.80, 95%CI 0.67-0.96; =0.04) and linezolid (RR=0.82, 95%CI 0.67-0.99; =0.02).
Studies of Pythium keratitis reported high rates of TPK and globe removal. Use of azithromycin and linezolid was associated with a lower rate of TPK. While promising, these results should be interpreted with caution given the biases inherent to observational studies.
腐霉菌角膜炎是一种难以治疗的角膜感染。
对腐霉菌角膜炎观察性研究的个体患者数据进行荟萃分析。感兴趣的结局是治疗性穿透性角膜移植术（TPK）和眼球摘除术（眼内容剜除术、眼球摘除术或眶内容剜除术）；主要暴露因素是使用利奈唑胺和阿奇霉素。
在46篇符合条件的文章中，306只眼（34项研究）有个体患者数据。腐霉菌角膜炎与高比例的TPK（80%，95%CI 70 - 87%）和眼球摘除术（25%，95%CI 13 - 43）相关。在调整年龄和国家的多变量模型中，接受阿奇霉素治疗的患者进行TPK的比例较低（RR = 0.80，95%CI 0.67 - 0.96；P = 0.04），接受利奈唑胺治疗的患者也是如此（RR = 0.82，95%CI 0.67 - 0.99；P = 0.02）。
关于腐霉菌角膜炎的研究报告了高比例的TPK和眼球摘除术。使用阿奇霉素和利奈唑胺与较低的TPK发生率相关。虽然有前景，但鉴于观察性研究固有的偏倚，这些结果应谨慎解读。
