Mycotic Keratitis in the Middle East: A Systematic Review and Meta-Analysis

Background and objectives: Mycotic keratitis is a fungal infection of the cornea that can cause blindness. Its incidence, risk factors, and the etiological agents vary worldwide and nationwide. Therefore, proper documentation of these data is essential for better disease management. In this review, we aimed to make a clear picture of this infection in the Middle East. Methods: Data on fungal keratitis from 1986 to 2018 in the Middle East were systematically collected from five English databases (PubMed, Scopus, Science Direct, Web of Science, and Google Scholar) and four Persian databases (Magiran, Scientific Information Database, IranMedex, and Irandoc). A total of 35 studies were included in the review. Result: The pooled prevalence of fungal keratitis in the Middle East was estimated at 26% (95% confidence interval: 19-32%; I 2 = 98.88%, 𝑝 < 0.001) using random-effect model, with considerable variation among the countries. The prevalence of fungal keratitis was highest in Egypt (36%) and Iran (34%) and lowest in Oman (9%). Aspergillus and Fusarium spp. were the most common causative agents (28%) among filamentous fungi, and Candida (13%) was the predominant yeast species causing fungal keratitis. Based on the data, fungal keratitis was more prevalent in males (39%) than in females (23%). Conclusion: Our study is the first systematic review on mycotic keratitis among the Middle Eastern countries. These epidemiological estimates can be used by policy makers to improve treatment strategies, especially in this part of the world.