Voriconazole versus natamycin as primary treatment in fungal corneal ulcers

Clin Exp Ophthalmol. 2011 Jul;39(5):434-40. doi: 10.1111/j.1442-9071.2010.02473.x. Epub 2011 Jun 28.

Abstract

Background: To evaluate the efficacy of topical 1% voriconazole versus 5% natamycin in treatment of fungal corneal ulcers.

Design: A prospective, randomized pilot study in a tertiary care hospital.

Participants: Thirty patients of microbiologically proven fungal keratitis divided randomly in two groups of 15 patients each.

Methods: Two groups were treated with either 5% natamycin (group A) or 1% voriconazole (group B) topically as a primary treatment for fungal keratitis. The mean size, depth of infiltrate and LogMAR visual acuity at presentation were comparable in both groups (P > 0.05). Patients were followed up for minimum of 10 weeks or till complete resolution of ulcer, whichever was later. Cultures to identify the causative organisms were performed.

Main outcome measure: Time of resolution of the ulcer.

Results: Twenty-nine of the total 30 patients showed complete resolution. Average time of resolution and gain in LogMAR visual acuity was 24.3 days and 1.12 in group A and 27.2 days and 0.77 in group B. These were comparable in the two groups (P > 0.05%). Aspergillus spp. (40%) and Curvularia spp. (30.0%) were found to be most common isolates.

Conclusion: Topical 1% voriconazole was found to be safe and effective drug in primary management of fungal keratitis, its efficacy matching conventional natamycin. There was no added advantage of using topical 1% voriconazole over topical natamycin as primary treatment in fungal keratitis.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Topical
  • Adult
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use*
  • Corneal Ulcer / drug therapy*
  • Corneal Ulcer / microbiology
  • Double-Blind Method
  • Eye Infections, Fungal / drug therapy*
  • Eye Infections, Fungal / microbiology
  • Female
  • Fungi / isolation & purification
  • Humans
  • Male
  • Microbiological Techniques
  • Middle Aged
  • Mycoses / drug therapy*
  • Mycoses / microbiology
  • Natamycin / administration & dosage
  • Natamycin / therapeutic use*
  • Ophthalmic Solutions / administration & dosage
  • Ophthalmic Solutions / therapeutic use
  • Pilot Projects
  • Prospective Studies
  • Pyrimidines / administration & dosage
  • Pyrimidines / therapeutic use*
  • Time Factors
  • Treatment Outcome
  • Triazoles / administration & dosage
  • Triazoles / therapeutic use*
  • Visual Acuity
  • Voriconazole

Substances

  • Antifungal Agents
  • Ophthalmic Solutions
  • Pyrimidines
  • Triazoles
  • Natamycin
  • Voriconazole