title: Comparison of natamycin and voriconazole for the treatment of fungal keratitis.
abstract: OBJECTIVE
  To conduct a therapeutic exploratory clinical trial comparing clinical outcomes of treatment with topical natamycin vs topical voriconazole for fungal keratitis.
  
  
  METHODS
  The multicenter, double-masked, clinical trial included 120 patients with fungal keratitis at Aravind Eye Hospital in India who were randomized to receive either topical natamycin or topical voriconazole and either had repeated scraping of the epithelium or not.
  
  
  METHODS
  The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 3 months. Other outcomes included scar size, perforations, and a subanalysis of BSCVA at 3 months in patients with an enrollment visual acuity of 20/40 to 20/400.
  
  
  RESULTS
  Compared with those who received natamycin, voriconazole-treated patients had an approximately 1-line improvement in BSCVA at 3 months after adjusting for scraping in a multivariate regression model but the difference was not statistically significant (P = .29). Scar size at 3 months was slightly greater with voriconazole after adjusting for scraping (P = .48). Corneal perforations in the voriconazole group (10 of 60 patients) were not significantly different than in the natamycin-treated group (9 of 60 patients) (P >.99). Scraping was associated with worse BSCVA at 3 months after adjusting for drug (P = .06). Patients with baseline BSCVA of 20/40 to 20/400 showed a trend toward a 2-line improvement in visual acuity with voriconazole (P = .07).
  
  
  CONCLUSIONS
  Overall, there were no significant differences in visual acuity, scar size, and perforations between voriconazole- and natamycin-treated patients. There was a trend toward scraping being associated with worse outcomes. Application to Clinical Practice The benefit seen with voriconazole in the subgroup of patients with baseline visual acuity of 20/40 to 20/400 needs to be validated in a confirmatory clinical trial. Trial Registration clinicaltrials.gov Identifier: NCT00557362.
authors.affiliation: Aravind Eye Care System, Madurai, India.
authors.forename: Namperumalsamy V
authors.initials: NV
authors.lastname: Prajna
authors.forename: Jeena
authors.initials: J
authors.lastname: Mascarenhas
authors.forename: Tiruvengada
authors.initials: T
authors.lastname: Krishnan
authors.forename: P Ravindranath
authors.initials: PR
authors.lastname: Reddy
authors.forename: Lalitha
authors.initials: L
authors.lastname: Prajna
authors.forename: Muthiah
authors.initials: M
authors.lastname: Srinivasan
authors.forename: C M
authors.initials: CM
authors.lastname: Vaitilingam
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Hong
authors.forename: Salena M
authors.initials: SM
authors.lastname: Lee
authors.forename: Stephen D
authors.initials: SD
authors.lastname: McLeod
authors.forename: Michael E
authors.initials: ME
authors.lastname: Zegans
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
authors.forename: Nisha R
authors.initials: NR
authors.lastname: Acharya
mesh_terms: D000287:Administration, Topical; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D003315:Cornea / Q000382:microbiology; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D004311:Double-Blind Method; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D010866:Natamycin / Q000627:therapeutic use*; D009883:Ophthalmic Solutions; D011743:Pyrimidines / Q000627:therapeutic use*; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D014792:Visual Acuity / Q000502:physiology; D065819:Voriconazole
chemical_list: D000891:Anti-Infective Agents, Local; D000935:Antifungal Agents; D009883:Ophthalmic Solutions; D011743:Pyrimidines; D014230:Triazoles; D010866:Natamycin; D065819:Voriconazole