Comparative Evaluation of Topical versus Intrastromal Voriconazole as an Adjunct to Natamycin in Recalcitrant Fungal Keratitis

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• 作者：Namrata Sharma ; MD¹ ; ^{namrata.sharma@gmail.com} ; Jacob Chacko ; MD¹ ; Thirumurthy Velpandian ; PhD² ; Jeewan S. Titiyal ; MD¹ ; Rajesh Sinha ; MD¹ ; Gita Satpathy ; MD³ ; Radhika Tandon ; MD¹ ; Rasik B. Vajpayee ; FRCSEd ; FRANZCO¹ ; ⁴
• 刊名：Ophthalmology
• 出版年：2013
• 出版时间：April, 2013
• 年：2013
• 卷：120
• 期：4
• 页码：677-681
• 全文大小：212 K

文摘

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Objective

To compare the efficacy of topical voriconazole and topical natamycin with that of intrastromal voriconazole and topical natamycin in patients with recalcitrant fungal keratitis.

Design

Randomized clinical trial.

Participants

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.

Intervention

The patients were randomized to receive either topical 1 % voriconazole therapy (n = 20) or intrastromal injections of voriconazole 50 ¦Ìg/0.1 ml (n = 20). The patients in both groups continued topical natamycin 5 % every 4 hours until the ulcer healed.

Main Outcome Measures

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.

Results

The patients in both groups had comparable baseline parameters. The mean BSCVA after treatment was 1.295¡À0.5 logarithm of the minimum angle of resolution (logMAR) units in the topical group and 1.692¡À0.29 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.

Conclusions

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.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.