June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Effect of pretreatment with antifungals on clinical outcomes in the Mycotic Ulcer Treatment Trial I
Author Affiliations & Notes
  • Catherine Sun
    Proctor Foundation, University of California, San Francisco, San Francisco, CA
  • Namperumalsamy Venkatesh Prajna
    Aravind Eye Care System, Madurai, India
  • Lalitha Prajna
    Aravind Eye Care System, Madurai, India
  • Muthiah Srinivasan
    Aravind Eye Care System, Madurai, India
  • Michael E Zegans
    Dartmouth Medical School, Hanover, NH
  • Stephen D McLeod
    Ophthalmology, University of California San Francisco, San Francisco, CA
  • Nisha Acharya
    Proctor Foundation, University of California, San Francisco, San Francisco, CA
    Ophthalmology, University of California San Francisco, San Francisco, CA
  • Thomas M Lietman
    Proctor Foundation, University of California, San Francisco, San Francisco, CA
    Ophthalmology, University of California San Francisco, San Francisco, CA
  • Jennifer Rose-Nussbaumer
    Proctor Foundation, University of California, San Francisco, San Francisco, CA
    Ophthalmology, University of California San Francisco, San Francisco, CA
  • Footnotes
    Commercial Relationships Catherine Sun, None; Namperumalsamy Venkatesh Prajna, None; Lalitha Prajna, None; Muthiah Srinivasan, None; Michael Zegans, None; Stephen McLeod, None; Nisha Acharya, Santan (C), Xoma (C); Thomas Lietman, None; Jennifer Rose-Nussbaumer, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 1882. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to Subscribers Only
      Sign In or Create an Account ×
    • Get Citation

      Catherine Sun, Namperumalsamy Venkatesh Prajna, Lalitha Prajna, Muthiah Srinivasan, Michael E Zegans, Stephen D McLeod, Nisha Acharya, Thomas M Lietman, Jennifer Rose-Nussbaumer, Mycotic Ulcer Treatment Trial Group; Effect of pretreatment with antifungals on clinical outcomes in the Mycotic Ulcer Treatment Trial I. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1882.

      Download citation file:


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

      ×
  • Supplements
Abstract

Purpose: To determine if pretreatment with antifungal medications is predictive of worse clinical outcome in a fungal keratitis clinical trial.

Methods: The Mycotic Ulcer Treatment Trial I was a randomized, double-masked, NEI-funded trial to determine the optimal treatment for filamentous fungal keratitis. 323 smear-positive fungal ulcer cases with enrollment visual acuity of 20/40 (0.3 logMAR) to 20/400 (1.3 logMAR) were randomized to receive 5% topical natamycin or 1% topical voriconazole at the Aravind Eye Care System in India. Prior topical and systemic antifungal use, dose and duration were collected at enrollment. Corneal scrapings were obtained for smears and cultures at enrollment and day 7 of treatment. Enrolled patients had positive smears for filamentous fungus and negative Gram stain for bacteria. Pre-specified outcomes included 3-month visual acuity (primary), 3-month infiltrate or scar size, corneal perforation and/or transplant, and re-epithelialization time.

Results: Of the 323 patients enrolled, 44% presented on an antifungal with 24% using only topical natamycin, 5% using only topical or systemic azole, and 15% using both topical natamycin and an azole. At enrollment, patients pretreated had on average 9 days of symptoms compared to 6 days for those not pretreated (P<0.001). Pretreated patients had larger mean baseline infiltrate size (P<0.001) and larger mean baseline epithelial defect size (P=0.02) compared to those not pretreated. Pretreated ulcers were significantly less likely to be fungal-culture positive at day 1 (P=0.04) and day 7 (P=0.046) compared to ulcers not pretreated. Multivariate regression analysis demonstrated that pretreatment with an antifungal was associated with significantly worse 3-month visual acuity (0.36 logMAR, 95% CI 0.11 to 0.62, P=0.006), larger 3-month scar size (1.47mm, 95% CI 0.82 to 2.13, P<0.001) and an increased odds of perforation and/or corneal transplant (OR 12.87, 95% CI 2.68 to 61.70, P=0.001). Pretreatment was not significantly associated with longer time to re-epithelialization.

Conclusions: In our analysis, we found that patients who were pretreated had longer duration of symptoms, had worse clinical characteristics at presentation, and were more likely to be fungal-culture negative. Study participants who were pretreated had significantly worse clinical outcomes, likely as a result of initial ulcer severity.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×