Topical Natamycin Versus Voriconazole for Fungal Corneal Ulcer

2020 ◽  
pp. 21-26
Author(s):  
Alan D. Penman ◽  
Kimberly W. Crowder ◽  
William M. Watkins
Keyword(s):  
Clinical Trial ◽  
Visual Acuity ◽  
Topical Treatment ◽  
South India ◽  
Corneal Ulcer ◽  
Fungal Keratitis ◽  
Treatment Trial ◽  
Active Comparator ◽  
The Difference ◽  
Ulcer Treatment

The Mycotic Ulcer Treatment Trial (MUTT) was a randomized, active comparator–controlled, double-masked, clinical trial carried out in South India to determine whether topical treatment with natamycin gave better clinical and microbiological outcomes than voriconazole in patients with smear-positive filamentous fungal keratitis and visual acuity of 20/40 to 20/400. Treatments were applied topically every hour while awake until reepithelialization, then 4 times daily for at least 3 weeks. The study showed that natamycin treatment was associated with significantly better clinical and microbiological outcomes than voriconazole treatment for smear-positive filamentous fungal keratitis, with much of the difference attributed to improved results in Fusarium cases.

Atropine or Patching for Treatment of Moderate Amblyopia in Children

2020 ◽  
pp. 291-296
Author(s):  
Alan D. Penman ◽  
Kimberly W. Crowder ◽  
William M. Watkins
Keyword(s):  
Clinical Trial ◽  
Visual Acuity ◽  
Randomized Clinical Trial ◽  
Initial Treatment ◽  
Mean Difference ◽  
Treatment Groups ◽  
The Difference

The Patching Versus Atropine Trial was a randomized clinical trial in children less than seven years of age with moderate amblyopia and a visual acuity in the amblyopic eye between 20/40 and 20/100, to determine whether treatment with atropine drops was as effective as patching. The study found that patching and atropine were equally effective in the initial treatment of moderate amblyopia. Visual acuity in the amblyopic eye improved in both groups (improvement from baseline to 6 months was 3.16 lines in the patching group and 2.84 lines in the atropine group). Improvement was initially faster in the patching group, but, after 6 months, the difference in visual acuity between treatment groups was small and clinically inconsequential (mean difference at 6 months, 0.034 logMAR units).

scholarly journals Efficacy of Voriconazole Corneal Intrastromal Injection for the Treatment of Fungal Keratitis

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Chenshuang Li ◽  
Kunpeng Pang ◽  
Liqun Du ◽  
Xinyi Wu
Keyword(s):  
Visual Acuity ◽  
Corneal Stroma ◽  
Fungal Keratitis ◽  
Antifungal Treatment ◽  
Treatment Modalities ◽  
Control Group ◽  
Significant Difference ◽  
The Difference ◽  
Contralateral Eye ◽  
Intrastromal Injection

Purpose. To evaluate efficacy and safety of novel tricyclic corneal stroma injection (TCSI) voriconazole for the treatment of fungal keratitis. Methods. This retrospective cohort study included data of 57 patients (57 eyes) with fungal keratitis. The TCSI group consisted of 27 patients (27 eyes) who were injected voriconazole once via TCSI procedure within one week after enrollment, in addition to conventional antifungal treatment. The control group consisted of 30 patients (30 eyes) who were treated using conventional antifungal treatment modalities. The outcome measures consist of the 3-week and 3-month best-corrected visual acuity (BCVA) values and size of infiltrate or scar, time to re-epithelialization, corneal perforation rate and/or therapeutic penetrating keratoplasty (TPK) requirement, the preoperative and post-TCSI corneal endothelial cell density (ECD), and the intraocular pressure (IOP) of the treated eye and the respective contralateral eye. Results. There were no significant differences in the baseline demographic and clinical characteristics between the two groups. 3 weeks and 3 months after enrollment, the TCSI group exhibited an increase in visual acuity ( P < 0.05 ), and there was no significant difference in the size of infiltrate or scar between two groups ( P > 0.05 ). Time to re-epithelialization was shorter in the TCSI group than in the control group ( P < 0.05 ). There was no statistically significant difference between corneal ECD on the day before and 7 days after TCSI and the IOP of treated and contralateral healthy eyes on the day before and 1 day, 3 days, 7 days, and 1 month after TCSI ( P > 0.05 ). The difference in the risk of perforation and/or TPK requirement was not statistically significant between two groups ( P > 0.05 ). Conclusion. Localized injection of voriconazole using TCSI may be a minimally invasive, safe, and effective adjuvant treatment modality for fungal keratitis.

scholarly journals Effect of Oral Voriconazole on Fungal Keratitis in the Mycotic Ulcer Treatment Trial II (MUTT II)

2016 ◽  
Vol 134 (12) ◽  
pp. 1365 ◽  
Author(s):  
N. Venkatesh Prajna ◽  
Tiruvengada Krishnan ◽  
Revathi Rajaraman ◽  
Sushila Patel ◽  
Muthiah Srinivasan ◽  
...  
Keyword(s):  
Fungal Keratitis ◽  
Treatment Trial ◽  
Ulcer Treatment

scholarly journals Intrastromal Injection of Voriconazole in the Treatment of Deep Fungal Keratitis - A Prospective Study in a Tertiary Care Centre in South India

2021 ◽  
Vol 8 (20) ◽  
pp. 1505-1509
Author(s):  
Bindu Madhavi R ◽  
Manjula Y.M ◽  
Suma C ◽  
Soumya Basanth ◽  
Nibedita Acharya
Keyword(s):  
Topical Treatment ◽  
South India ◽  
Tertiary Care ◽  
Fungal Keratitis ◽  
Antifungal Drugs ◽  
Care Centre ◽  
Mycotic Keratitis ◽  
Tertiary Care Centre ◽  
Case Series Study ◽  
Intrastromal Injection

BACKGROUND Treatment of fungal ulcers is one of the most challenging tasks. Various topical antifungal drugs have poor corneal stromal penetration. Voriconazole is a broad spectrum drug and is an effective agent for the treatment of fungal keratitis as a topical preparation. It is potent against a broad range of clinically significant fungal infections both in the eye as well systemically. In tropical climatic conditions filamentous fungi commonly cause eye infections and are associated with poor visual outcomes. The treatment options for mycotic ulcers are limited, therefore direct intrastromal injections are helpful in the management of these deep mycotic keratitis. We wanted to evaluate the role of intrastromal injection of voriconazole in the management of deep fungal keratitis not responding to conventional therapy. METHODS This an interventional case series study done at a tertiary care centre in south India from the year April 2019 to August 2020. Eight eyes of eight patients with microbiologically proven deep stromal recalcitrant mycotic keratitis not responding to topical antifungal medications were evaluated. Voriconazole 50 microgram / 0.1 ml was injected around the infiltrate in the corneal stroma as an adjunctive to the topical antifungal treatment. Main outcome measure was a reduction of the size of the infiltrate and ulcer and decrease in infection on regular follow ups. RESULTS Before injecting voriconazole, all the cases were of either gradually worsening of lesions on topical treatment, or not responding to topical treatment. After the injection a rapid decrease in the size of corneal ulcer, hypopyon, and infiltration was seen within 3 weeks. CONCLUSIONS Targeted delivery of intrastromal voriconazole may be a safe and effective way in the management of deep seated fungal ulcers which respond poorly to conventional treatment procedures, thus reducing the need for further surgical treatment. KEYWORDS Intrastromal Injection, Voriconazole, Fungal Keratitis, Deep Mycotic Keratitis

scholarly journals FUNGAL KERATITIS WITH CORNEAL ULCER IN FARMER

2020 ◽  
Vol 3 (1) ◽  
pp. 58
Author(s):  
Nugraha Wahyu Cahyana
Keyword(s):  
Visual Acuity ◽  
Corneal Ulcer ◽  
Fungal Keratitis ◽  
Eye Drops ◽  
Slit Lamp ◽  
Good Clinical Response ◽  
Specific Diagnosis ◽  
The World ◽  
Corneal Blindness ◽  
Test Result

Fungal keratitis is an important cause of corneal blindness all over the world, especially in developing countries. Fungal Keratitis can diagnosis by slit-lamp biomicroscopic examination and culture is essential for early specific diagnosis and must be taken into consideration to establish the most effective treatment and avoid severe complications. The study was present a case of Fungal Keratitis in Farmer with a corneal ulcer caused by rice seeds corneal corpus allienum. A corneal ulcer is a complication was caused by ineffective therapy especially Steroid topical that should be avoided. The culture test result was C. Albicans and was treated with natamycin 5% Eye drops. Finally, patients have a good clinical response, however with the sequel of decreased visual acuity.  

scholarly journals Antifungal activity of Propranolol against Fusarium keratitis isolates from the Mycotic Ulcer Treatment Trial (MUTT) and the United States

2021 ◽  
Author(s):  
Ruina Bao ◽  
Brandon S. Ross ◽  
Cecilia G. Perez ◽  
Galini Poimenidou ◽  
N. Venkatesh Prajna ◽  
...  
Keyword(s):  
Antifungal Activity ◽  
Fungicidal Activity ◽  
Inhibitory Concentration ◽  
The United States ◽  
Fungal Keratitis ◽  
Treatment Trial ◽  
Beta Adrenergic ◽  
Adrenergic Antagonists ◽  
Ulcer Treatment

SYNOPSISBackgroundFusarium keratitis is an infection of the cornea that often results in corneal perforation requiring corneal transplantation even with topical ocular antifungal therapy. The polyene natamycin remains the current antifungal of choice for Fusarium keratitis, but prompt sterilization of the cornea is often not achieved with contemporary therapy. Recently, natamycin synergy with the beta-adrenergic antagonist timolol against Fusarium species was reported.ObjectiveOur objective in this study was to characterize the in vitro antifungal effects of additional beta-adrenergic antagonists alone or in combination with natamycin on Fusarium keratitis isolates from the Mycotic Ulcer Treatment Trial (MUTT) and USA.MethodsMicrobroth dilution assays were used to determine the minimal inhibitory concentration (MIC) of beta-adrenergic antagonists against 18 Fusarium spp. keratitis (10 from MUTT, 8 from USA) and 3 Aspergillus fumigatus isolates. The fractional inhibitory concentration index (FICI) was calculated to assess interactions with natamycin.ResultsMost beta-blockers did not show antifungal activity or synergy with natamycin with the exception of propranolol. A racemic mix of propranolol had fungicidal activity with MIC between 31 and 83 μg/mL for the Fusarium isolates. The MIC of the less cardioactive R enantiomer was lower (27-83 μg/mL) than the MIC of the S enantiomer (42-104 μg/mL). The MICs of both propranolol and natamycin were lower in combination but were not synergistic. The MIC of propranolol was 156 μg/mL for the A. fumigatus isolates.ConclusionsPropranolol has intrinsic in vitro fungicidal activity and lowers the MIC of natamycin. Both the R and S enantiomers of propranolol had antifungal activity with the MIC modestly but significantly lower for R-propranolol. These findings have relevance both for the treatment of fungal keratitis and of glaucoma in the setting of fungal keratitis. Further study of propranolol’s antifungal activity may lead to a novel treatment for fungal keratitis and possibly other fungal infections.Trial RegistrationClinicalTrials.gov Identifier: NCT00997035 (MUTT Trial)

Convergence Insufficiency Treatment Trial – Attention and Reading Trial (CITT-ART): Design and Methods

2015 ◽  
pp. 214-228 ◽  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Health Care Providers ◽  
Developmental Disorders ◽  
Attention Problems ◽  
Secondary Outcome ◽  
Care Providers ◽  
Treatment Trial ◽  
Additional Hypothesis ◽  
Convergence Insufficiency

Objective: To describe the design and methodology of the Convergence Insufficiency Treatment Trial: Attention and Reading Trial (CITT-ART), the first randomized clinical trial evaluating the effect of vision therapy on reading and attention in school-age children with symptomatic convergence insufficiency (CI). Methods: CITT-ART is a multicenter, placebo-controlled, randomized clinical trial of 324 children ages 9 to 14 years in grades 3 to 8 with symptomatic CI. Participants are randomized to 16 weeks of office-based vergence/accommodative therapy (OBVAT) or placebo therapy (OBPT), both supplemented with home therapy. The primary outcome measure is the change in the Wechsler Individual Achievement Test-Version 3 (WIAT-III) reading comprehension subtest score. Secondary outcome measures are changes in attention as measured by the Strengths and Weaknesses of Attention (SWAN) as reported by parents and teachers, tests of binocular visual function, and other measures of reading and attention. The long-term effects of treatment are assessed 1 year after treatment completion. All analyses will test the null hypothesis of no difference in outcomes between the two treatment groups. The study is entering its second year of recruitment. The final results will contribute to a better understanding of the relationship between the treatment of symptomatic CI and its effect on reading and attention. Conclusion: The study will provide an evidence base to help parents, eye professionals, educators, and other health care providers make informed decisions as they care for children with CI and reading and attention problems. Results may also generate additional hypothesis and guide the development of other scientific investigations of the relationships between visual disorders and other developmental disorders in children.

Comparison of the Effectiveness of Intravitreal Ranibizumab for Diabetic Macular Edema in Vitrectomized and Nonvitrectomized Eyes

2016 ◽  
Vol 236 (2) ◽  
pp. 67-73 ◽  
Author(s):  
Yoshito Koyanagi ◽  
Shigeo Yoshida ◽  
Yoshiyuki Kobayashi ◽  
Yuki Kubo ◽  
Muneo Yamaguchi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Treatment Option ◽  
Central Macular Thickness ◽  
Intravitreal Ranibizumab ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
The Difference ◽  
Best Corrected Visual Acuity

Purpose: To compare the effectiveness of intravitreal ranibizumab (IVR) for diabetic macular edema (DME) between eyes with and without previous vitrectomy. Procedures: We prospectively assessed the best-corrected visual acuity (BCVA) and central macular thickness (CMT) after IVR for 6 months. Results: There were no significant differences in the baseline BCVA and CMT between both groups. In the nonvitrectomized group (n = 15), the mean changes of BCVA and CMT from baseline to month 6 were significant (p < 0.01). In the vitrectomized group (n = 10), the improvement appeared to be slower, and the mean BCVA improvement was not significant (p = 0.5), although the mean CMT decrease was significant (p < 0.05). There were no significant differences in the mean changes of BCVA and CMT between both groups at 6 months. Conclusions: The difference in the effectiveness of IVR between both groups was not significant. IVR can be a treatment option even for vitrectomized DME eyes.

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