Conditions: Fungal Keratitis
Keywords: Keratitis Eye Infection, Fungal Fungal Eye Infection Ocular Infection, Fungal Fungal Keratitis Mycotic Infections, Ocular Voriconazole Natamycin
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 120
Healthy volunteers: no

Brief summary:
We evaluated whether voriconazole is a superior treatment to natamycin for filamentous fungal keratitis in a randomized, masked, controlled trial. This is a therapeutic exploratory study to investigate the safety and feasibility of conducting a larger study and to generate preliminary data.

Detailed description:
Fungal ulcers tend to have very poor outcomes with the most common treatments, amphotericin B and natamycin. There has been only a single randomized trial of anti-fungal therapy for fungal ulcers and no new medications have been approved by the FDA since the 1960s. There are studies that indicate that the newer triazoles, such as voriconazole, are more effective in vitro against filamentous fungi such as Aspergillus spp., a common cause of fungal keratitis1-3. Despite a number of case reports and in vitro studies, there has been no systematic attempt to determine whether it is more or less effective clinically than natamycin, the only commercially available FDA-approved agent. There is little data available for physicians to make an informed, evidence-based decision on choice of antifungal.

We evaluated whether voriconazole is a superior treatment to natamycin for filamentous fungal keratitis in a randomized, masked, controlled trial. This is a therapeutic exploratory study to investigate the safety and feasibility of conducting a larger study and to generate preliminary data. The primary outcome is visual acuity at 3 months from enrollment. A subset of patients will be followed at 4 years from enrollment.

Arms:
arm 1: Topical voriconazole with corneal de-epithelialization arm 2: Topical voriconazole without corneal de-epithelialization arm 3: Topical natamycin with corneal de-epithelialization arm 4: Topical natamycin without corneal de-epithelialization

Interventions: intervention 1: Natamycin 5% intervention 2: Voriconazole intervention 3: Corneal de-epithelialization
Intervention descriptions: intervention 1: One drop of medication will be given every one hour while awake for one week. For another 2 weeks, one drop of medication should be given every 2 hours while awake intervention 2: Voriconazole (VFEND® I.V., Pfizer, New York, NY) will be prepared as a 1% solution.

One drop of medication should be given every one hour while awake for one week. For another 2 weeks, one drop of medication should be given every 2 hours while awake intervention 3: Corneal de-epithelialization at 1 week and 2 weeks from enrollment to increase epithelial penetration of antifungal medications.

Protocol document: