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Abstract

To describe the evidence for agents with anti-amoebic activity used to treat Acanthamoeba keratitis (AK), two systematic literature reviews (SLRs) were conducted of 1) clinical outcomes for patients with AK and 2) health economic outcomes for patients with AK or microbial keratitis (MK).The intervention of interest was any agent with anti-amoebic activity administered as eye-drops or orally. The main outcome was clinical resolution. Electronic databases (January 1992-July 2022), conference abstracts (2017-2022), and relevant websites were hand-searched. Risk of bias assessments used external assessment tools. A narrative synthesis was conducted.The clinical SLR (37 studies; 2043 patients) identified at least 20 studies reporting clinical resolution, best-corrected visual acuity, and corneal surgery; fewer studies reported other outcomes. Treatment regimes, outcome definitions and assessment timing varied markedly between studies. Studies classified as fair or poor quality appeared to underestimate the burden of AK compared with good quality studies. For health economic outcomes (15 studies; 1878 patients), very limited evidence in AK populations was found.In conclusion, there was a substantial amount of clinical evidence, but scarce economic evidence. Study quality and comparability challenges should be considered when estimating the impact of AK, with substantial betweenstudy heterogeneity limiting options for robust evidence synthesis.