Re-appraisal of topical 1% voriconazole and 5% natamycin in the treatment of fungal keratitis in a randomised trial.

To compare the efficacy of topical 1% voriconazole vs 5% natamycin for the treatment of fungal keratitis. In a prospective, double-masked, randomised, controlled, registered clinical trial, 118 patients with fungal keratitis were treated using identical dosage schedule with either voriconazole (58) or natamycin (60) as inpatients for 7 days and followed up weekly. The outcome measures were percentage of patients with healed or resolving ulcer and final visual acuity at last follow-up (primary) and on day 7 (secondary) in each group. More patients (p=0.005) on natamycin (50/56, 89.2%) had healed or resolving ulcer compared with voriconazole (34/51, 66.6%) at last follow-up. The improvement in vision was marginally greater in patients in the natamycin group compared with the voriconazole group at day 7 (p=0.04) and significantly greater at final visit (p=0.01). In univariate analysis, drug, age and mean size of corneal infiltrate and epithelial defect had a significant effect on the final visual outcome. In multivariate analysis, the effect of drug (voriconazole vs natamycin, adjusted coefficient 0.27 (-0.04 to 0.57), p=0.09) was marginal while the effect of age and epithelial defect was significant (p<0.001 for both). In the group treated with natamycin, the final visual acuity was significantly better (p=0.005, Wilcoxon signed-rank test) in patients with Fusarium keratitis but not with Aspergillus keratitis (p=0.714, paired t test). When compared with voriconazole, natamycin was more effective in the treatment of fungal keratitis, especially Fusarium keratitis. Clinical Trial Registry India (2010/091/003041).

Sharma S ，Das S ，Virdi A ，Fernandes M ，Sahu SK ，Kumar Koday N ，Ali MH ，Garg P ，Motukupally SR ... -  《-》

Voriconazole versus natamycin as primary treatment in fungal corneal ulcers.

To evaluate the efficacy of topical 1% voriconazole versus 5% natamycin in treatment of fungal corneal ulcers. A prospective, randomized pilot study in a tertiary care hospital. Thirty patients of microbiologically proven fungal keratitis divided randomly in two groups of 15 patients each. Two groups were treated with either 5% natamycin (group A) or 1% voriconazole (group B) topically as a primary treatment for fungal keratitis. The mean size, depth of infiltrate and LogMAR visual acuity at presentation were comparable in both groups (P > 0.05). Patients were followed up for minimum of 10 weeks or till complete resolution of ulcer, whichever was later. Cultures to identify the causative organisms were performed. Time of resolution of the ulcer. Twenty-nine of the total 30 patients showed complete resolution. Average time of resolution and gain in LogMAR visual acuity was 24.3 days and 1.12 in group A and 27.2 days and 0.77 in group B. These were comparable in the two groups (P > 0.05%). Aspergillus spp. (40%) and Curvularia spp. (30.0%) were found to be most common isolates. Topical 1% voriconazole was found to be safe and effective drug in primary management of fungal keratitis, its efficacy matching conventional natamycin. There was no added advantage of using topical 1% voriconazole over topical natamycin as primary treatment in fungal keratitis.

Arora R ，Gupta D ，Goyal J ，Kaur R ... -  《-》

Adjunctive Oral Voriconazole Treatment of Fusarium Keratitis: A Secondary Analysis From the Mycotic Ulcer Treatment Trial II.

Prajna NV ，Krishnan T ，Rajaraman R ，Patel S ，Shah R ，Srinivasan M ，Devi L ，Das M ，Ray KJ ，O'Brien KS ，Oldenburg CE ，McLeod SD ，Zegans ME ，Acharya NR ，Lietman TM ，Rose-Nussbaumer J ，Mycotic Ulcer Treatment Trial Group ... -  《-》

The mycotic ulcer treatment trial: a randomized trial comparing natamycin vs voriconazole.

Prajna NV ，Krishnan T ，Mascarenhas J ，Rajaraman R ，Prajna L ，Srinivasan M ，Raghavan A ，Oldenburg CE ，Ray KJ ，Zegans ME ，McLeod SD ，Porco TC ，Acharya NR ，Lietman TM ，Mycotic Ulcer Treatment Trial Group ... -  《-》

Comparative evaluation of topical versus intrastromal voriconazole as an adjunct to natamycin in recalcitrant fungal keratitis.

To compare the efficacy of topical voriconazole and topical natamycin with that of intrastromal voriconazole and topical natamycin in patients with recalcitrant fungal keratitis. Randomized clinical trial. Forty eyes of 40 patients with fungal keratitis (positive smear or culture results or both) larger than 2 mm, involving up to two thirds of the stromal depth, and not responding to topical natamycin therapy for 2 weeks were recruited. The patients were randomized to receive either topical 1% voriconazole therapy (n = 20) or intrastromal injections of voriconazole 50 μg/0.1 ml (n = 20). The patients in both groups continued topical natamycin 5% every 4 hours until the ulcer healed. Primary outcome measure was best spectacle-corrected visual acuity (BSCVA) 3 months after intervention, and secondary outcome measures were time to healing and the size of the scar. The patients in both groups had comparable baseline parameters. The mean BSCVA after treatment was 1.295 ± 0.5 logarithm of the minimum angle of resolution (logMAR) units in the topical group and 1.692 ± 0.29 logMAR units in the intrastromal group. The visual acuity after treatment was significantly better in the topical voriconazole group (P = 0.008). Nineteen patients receiving topical voriconazole and 16 patients who were given intrastromal voriconazole healed with therapy. Topical voriconazole seems to be a useful adjunct to natamycin in fungal keratitis not responding to topical natamycin. Intrastromal injections did not offer any beneficial effect over topical therapy.

Sharma N ，Chacko J ，Velpandian T ，Titiyal JS ，Sinha R ，Satpathy G ，Tandon R ，Vajpayee RB ... -  《-》