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    Natamycin still the best bet for fungal keratitis


    No marked improvement

    In the first Mycotic Ulcer Treatment Trial, the investigators found that the organism subtypes present in an ulcer are predictive of the therapeutic response. Among the patients with a Fusarium infection in the second Mycotic Ulcer Treatment Trial, the investigators found no marked improvement in the patients treated with placebo at 3 weeks after the start of treatment.

    In contrast, the patients treated with oral voriconazole showed marked improvement in their corneal ulcers. The same findings were true at the 3-month time point.

    “Overall, in the subgroup of patients with Fusarium infections and randomized to oral voriconazole, the rate of corneal perforation or the need for a therapeutic PK deceased (hazard ratio, 0.43; 95% confidence interval, 0.22-0.84; P = 0.01), Dr. Rose-Nussbaumer said.

    Among the secondary outcomes, the BSCVA and the 3-month infiltrate/scar size in the patients treated with voriconazole were superior to those who received placebo (P =0.05 and P =0.001, respectively). The BSCVA improved by about 3 lines and the infiltrate/scar size was almost 1 mm smaller. The times to re-epithelialization did not differ between the groups.

    “Topical natamycin remains the mainstay of treatment of fungal keratitis,” Dr. Rose-Nussbaumer outlined. “However, Fusarium corneal ulcers might benefit from the addition of oral voriconazole to the treatment regimen. It is important to note that oral voriconazole is associated with more adverse events and higher costs.”



    Jennifer Rose-Nussbaumer, MD

    E: [email protected]

    This article was adapted from a presentation Dr. Rose-Nussbaumer delivered at the Cornea Subspecialty Day prior to the 2016 American Academy of Ophthalmology meeting. Dr. Rose-Nussbaumer has no financial interest in any aspect of this report.


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