June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Predictors of outcome in fungal keratitis using data from the Mycotic Ulcer Treatment Trial I
Author Affiliations & Notes
  • Catherine Sun
    F.I. Proctor Foundation, University of California San Francisco, San Francisco, CA
  • Namperumalsamy Prajna
    Cornea, Aravind Eye Care System, Madurai, India
  • Tiruvengada Krishnan
    Cornea, Aravind Eye Care System, Pondicherry, India
  • Muthiah Srinivasan
    Cornea, Aravind Eye Care System, Madurai, India
  • Kathryn Ray
    F.I. Proctor Foundation, University of California San Francisco, San Francisco, CA
  • Stephen McLeod
    F.I. Proctor Foundation, University of California San Francisco, San Francisco, CA
    Department of Ophthalmology, University of California San Francisco, San Francisco, CA
  • Travis Porco
    F.I. Proctor Foundation, University of California San Francisco, San Francisco, CA
    Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
  • Nisha Acharya
    F.I. Proctor Foundation, University of California San Francisco, San Francisco, CA
    Department of Ophthalmology, University of California San Francisco, San Francisco, CA
  • Thomas Lietman
    F.I. Proctor Foundation, University of California San Francisco, San Francisco, CA
    Department of Ophthalmology, University of California San Francisco, San Francisco, CA
  • Footnotes
    Commercial Relationships Catherine Sun, None; Namperumalsamy Prajna, None; Tiruvengada Krishnan, None; Muthiah Srinivasan, None; Kathryn Ray, None; Stephen McLeod, None; Travis Porco, NIH NEI (F); Nisha Acharya, None; Thomas Lietman, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 2900. doi:
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    • Get Citation

      Catherine Sun, Namperumalsamy Prajna, Tiruvengada Krishnan, Muthiah Srinivasan, Kathryn Ray, Stephen McLeod, Travis Porco, Nisha Acharya, Thomas Lietman, ; Predictors of outcome in fungal keratitis using data from the Mycotic Ulcer Treatment Trial I. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2900.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To determine baseline factors that are predictive of outcome in fungal keratitis using data collected in the Mycotic Ulcer Treatment Trial 1 (MUTT I).

 
Methods
 

MUTT I was a multicenter, randomized, double-masked, NEI-funded clinical trial comparing clinical outcomes in 323 patients with fungal keratitis receiving 5% topical natamycin or 1% topical voriconazole. Demographics, ocular medical history and clinical characteristics were collected at the enrollment visit for all patients, and were used as predictors in our analysis. Pre-specified outcomes included best spectacle-corrected visual acuity (BSCVA) at 3 months, infiltrate/scar size at 3 months, corneal perforation or transplant and re-epithelialization time. Separate univariate and multivariable analyses were performed for all predictors with each of the above four outcome variables. We adjusted for multiple comparisons using the Bonferroni correction.

 
Results
 

In our multivariable model, significant predictors of worse 3-month visual acuity were worse presentation visual acuity (P<0.001), larger epithelial defect size at presentation (P<0.001) and randomization to voriconazole instead of natamycin in the trial (P=0.007). For 3-month infiltrate/scar size, significant predictors at presentation include larger infiltrate size (P<0.001), larger epithelial defect size (P<0.001), worse presentation visual acuity (P=0.003) and use of topical antifungals prior to trial enrollment (P<0.001). Worse presentation visual acuity (P<0.001), older age (P=0.011) and randomization to voriconazole instead of natamycin (P=0.008) were predictive of perforation. Epithelial defect size (P=0.001) and presentation ulcer depth (P=0.012) were significant predictors of longer time to re-epithelialization.

 
Conclusions
 

Ulcer severity at presentation is highly predictive of worse outcomes. In our analysis, we found that clinical characteristics at presentation, such as epithelial defect size and visual acuity, seem to provide more information about prognosis than patient demographics or ocular medical history. Although our findings suggest that it is difficult to change the course of an ulcer even with proper treatment, better understanding of predictive factors may help guide future management and treatment decisions. Nevertheless, prevention of corneal ulcers still remains highly important.

 
Keywords: 573 keratitis • 479 cornea: clinical science • 464 clinical (human) or epidemiologic studies: risk factor assessment  
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