Document Detail

Comparative evaluation of topical versus intrastromal voriconazole as an adjunct to natamycin in recalcitrant fungal keratitis.
MedLine Citation:
PMID:  23246119     Owner:  NLM     Status:  MEDLINE    
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 μg/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 ± 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.
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.
Namrata Sharma; Jacob Chacko; Thirumurthy Velpandian; Jeewan S Titiyal; Rajesh Sinha; Gita Satpathy; Radhika Tandon; Rasik B Vajpayee
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-12-12
Journal Detail:
Title:  Ophthalmology     Volume:  120     ISSN:  1549-4713     ISO Abbreviation:  Ophthalmology     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-04     Completed Date:  2013-05-21     Revised Date:  2013-10-15    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  677-81     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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MeSH Terms
Antifungal Agents / administration & dosage
Corneal Stroma
Dose-Response Relationship, Drug
Drug Therapy, Combination
Eye Infections, Fungal / drug therapy*,  microbiology
Follow-Up Studies
Keratitis / drug therapy*,  microbiology
Middle Aged
Natamycin / administration & dosage*
Ophthalmic Solutions
Pyrimidines / administration & dosage*
Treatment Outcome
Triazoles / administration & dosage*
Reg. No./Substance:
0/Antifungal Agents; 0/Ophthalmic Solutions; 0/Pyrimidines; 0/Triazoles; 0/voriconazole; 7681-93-8/Natamycin
Comment In:
Ophthalmology. 2013 Sep;120(9):e63-4   [PMID:  24001542 ]
Ophthalmology. 2013 Sep;120(9):e62-3   [PMID:  24001540 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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