Table 3.
GRADE summary of findings for various treatment outcomes of adjuvant amniotic membrane transplantation for infectious keratitis.
| Adjuvant amniotic membrane transplantation (AMT) compared to standard antimicrobial treatment (SAT) for infectious keratitis | |||||
|---|---|---|---|---|---|
|
Patient or population: Infectious keratitis Intervention: Adjuvant amniotic membrane transplantation (AMT) Comparison: Standard antimicrobial treatment (SAT) | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of eyes (studies) | Certainty of the evidence (GRADE) | |
| Risk with SAT | Risk with AMT | ||||
| Time to complete healing (days) | 10.2–30.7 days | MD 4.08 days shorter (6.27 shorter to 1.88 shorter) | – | 169 (3 RCTs) |
⨁◯◯◯ VERY LOWa,b,c |
| UDVA (logMAR) at 1 months | 1.27–1.88 logMAR | MD 0.26 logMAR better (0.50 better to 0.02 better) | – | 119 (2 RCTs) |
⨁◯◯◯ VERY LOWa,b,c |
| CDVA (logMAR) at 6 months | 1.55 logMAR | MD 0.43 logMAR better (0.68 better to 0.17 better) | – | 99 (1 RCT) |
⨁⨁◯◯ LOWb,c |
| Size of corneal scar (mm2) at 6 months | 22.8 mm2 | MD 5.17 mm2 smaller (7.53 smaller to 2.8 smaller) | – | 99 (1 RCT) |
⨁⨁◯◯ LOWb,c |
| Corneal vascularization (%) at 6 months | 7% | MD 4% smaller (6 smaller to 3 smaller) | – | 99 (1 RCT) |
⨁⨁◯◯ LOWb,c |
| Adverse events at 1–6 months | 23 per 100 | 18 per 100 (11–32) | RR 0.80 (0.46–1.38) | 209 (4 RCTs) |
⨁◯◯◯ VERY LOWa,b,c,d,e |
GRADE Working Group grades of evidence.
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
Explanations.
aHigh risk of bias due to lack of randomization and allocation concealment in ≥ 50% of the included studies.
bPotential risk of bias due to the lack of blinding in participants and assessors.
cThe total number of participants is less than the number generated by a conventional sample size calculation.
dThere are few events and the confidence interval includes appreciable benefit and harm.
eDifferences in final follow-up duration.
CI confidence interval, MD mean difference, RR risk ratio, UDVA uncorrected-distance-visual-acuity, CDVA corrected-distance-visual-acuity.
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).