Making Better Keratoplasty Decisions for Acanthamoeba Keratitis: A Meta-analysis

Acanthamoeba keratitis (AK) is a blinding disease with increasing incidence. Keratoplasty is the common therapy method for AK; however, the suitable times and types of keratoplasty for AK remains unclear. These systemic review intended to assess the outcomes of AK undergoing different keratoplasty procedures. Literature searches were conducted in Pubmed, EMBASE, Web of Science, and the Cochrane. Eleven studies with 216 eyes were included. The meta-analysis showed optical keratoplasty had better best corrected visual acuity (BCVA), higher graft survival rate, lower recurrence and multiple keratoplasties rate than therapeutic keratoplasty. The occurrence rate of postoperative complications were similar between optical keratoplasty and therapeutic keratoplasty. The AK patients performed therapeutic keratoplasty within 5 months of AK onset had significant better final BCVA than those who after 5 months of AK duration. Moreover, therapeutic deep anterior lamellar keratoplasty (TDALK) reserved better BCVA than therapeutic penetrating keratoplasty (TPK). The eyes performed TPK were prone to need multiple keratoplasties than those with TDALK. These results suggested optical keratoplasty was superior to therapeutic keratoplasty in AK patients. The drug-resistant AK patients should be underwent therapeutic keratoplasty promptly, especially within 5 months of AK onset. TDALK was a preferable therapeutic keratoplasty option for AK patients where possible.