Corneal transplantation strategies for Acanthamoeba Keratitis: A systematic review and meta-analysis

Acanthamoeba keratitis (AK) is an uncommon yet vision-threatening corneal infection, and the lack of an international consensus on its surgical management often complicates clinical decision-making. To address this gap, a comprehensive literature review was conducted across PubMed, EMBASE, Web of Science, and the Cochrane Library from database inception to July 1, 2025, focusing on clinical studies that reported outcomes of keratoplasty. The analysis included 24 studies encompassing 487 eyes and compared different keratoplasty techniques, specifically therapeutic penetrating keratoplasty (TPK), optical penetrating keratoplasty (OPK), and therapeutic deep anterior lamellar keratoplasty (TDALK). The data indicated that Acanthamoeba infection control sufficient to permit OPK was associated with the most favorable results. In eyes with infection confined to the anterior stroma and thus eligible for TDALK, graft survival was higher and postoperative complications were fewer. In cases with persistent full-thickness infection, TPK was required and was associated with poorer visual recovery and higher rates of graft failure, recurrent infection, and regrafting.