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  • Intrastromal Voriconazole for Filamentous Fungal Keratitis

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, August 2019

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    Managing corneal ulcers is challenging because of limited treatment options and poor outcomes. Although topical natamy­cin is the most common treatment for moderate and severe fungal keratitis, out­comes remain unsatisfactory. Narayana et al. assessed the utility of adjuvant intrastro­mal injection of voriconazole as primary treatment for filamentous fungal keratitis. They found that, when compared with topical natamycin alone, adding intrastromal voriconazole (ISV) did not result in better outcomes.

    This outcome-masked, randomized controlled trial was conducted at Ara­vind Eye Hospital in India. The study population comprised 151 patients (151 eyes) with moderate vision loss resulting from a fungal ulcer. Study eyes were assigned randomly to receive topi­cal natamycin either alone or combined with ISV. The main outcome measure was microbiological cure according to three-day repeat culture analysis. Secondary outcomes were microbio­logical cure on seven-day repeat culture analysis; three-week and three-month best spectacle-corrected visual acuity; infiltrate and/or scar size; perforation rate; need for therapeutic penetrating keratoplasty (TPK); and other adverse events.

    Culture samples were available for 68 of the patients. After controlling for baseline culture status, the odds of three- and seven-day culture positiv­ity were 1.82 and 1.98 times greater, respectively, for eyes that had combi­nation treatment (p = .26 and p = .20, respectively, vs. eyes with natamycin monotherapy). Visual acuity decreased further in eyes with combination treat­ment (p = .75), and scar/infiltrate size was greater in these eyes (p = .11).

    The authors concluded that adding ISV injections to topical natamycin does not improve outcomes of moder­ate or severe filamentous fungal ulcers. Their findings are consistent with those of similar studies.

    The original article can be found here.