Practice patterns in the management of fungal corneal ulcers.
OBJECTIVE
The purpose of this study was to determine the practice patterns of ophthalmologists in the management of fungal corneal ulcers.


METHODS
In December 2007, a survey of 13 questions addressing the actual and preferred treatment of fungal ulcers was sent to the kera-net e-mail listserv facilitated by the Cornea Society.


RESULTS
Ninety-two respondents from North America, South America, Asia, Europe, and Australia participated by completing the electronic questionnaire. Natamycin was the most commonly used topical treatment for ulcers caused by filamentous fungi (96%) followed by amphotericin (75%) and voriconazole (63%). However, voriconazole was most often listed as the preferred topical treatment in an ideal world (79%) compared with 55% for natamycin. Approximately half of the respondents use combination topical therapy (56%) and the remainder monotherapy. The majority of respondents rescrape the epithelium at some time during the course of treatment, but the frequency of rescraping varied among the different topical treatments. The most common reasons cited for not using their preferred treatment were cost and a desire for further evidence to support preferred treatment.


CONCLUSIONS
There appears to be significant variation in the management of fungal corneal ulcers. Although natamycin was the most commonly used treatment for ulcers caused by filamentous fungi, voriconazole was the most preferred as the ideal treatment. These results highlight the need for more evidence regarding the efficacy of the newer topical antifungals.
Loh
Allison R
AR
University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Hong
Kevin
K
Lee
Salena
S
Mannis
Mark
M
Acharya
Nisha R
NR
D000287:Administration, Topical; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D003320:Corneal Ulcer / Q000382:microbiology* / Q000601:surgery; D003646:Debridement; D016527:Drug Costs; D004359:Drug Therapy, Combination; D006801:Humans; D009181:Mycoses / Q000188:drug therapy*; D010866:Natamycin / Q000008:administration & dosage; D009885:Ophthalmology / Q000379:methods*; D010361:Patients / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011743:Pyrimidines / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D010866:Natamycin; D065819:Voriconazole