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Comparison of safety and efficacy of Intrastromal Injections of Voriconazole, Amphotericin B and Natamycin In cases of Recalcitrant Fungal Keratitis in a Randomized Controlled Trial

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First Author: G.Saluja INDIA

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Abstract Details

Purpose:

To compare the safety and efficacy of intrastromal voriconazole(ISVCZ),amphotericin B (ISAMB) and natamycin (ISNTM) as an adjunct to topical natamycin (NTM) in cases of recalcitrant fungal keratitis.

Setting:

The study was conducted in a tertiary eye centre

Methods:

Sixty-three eyes of 63patients with microbiologically proven recalcitrant fungal keratitis(larger than 2 mm, more than 50% of the stromal depth, and not responding to topical NTM therapy for two weeks) were recruited. The patients were randomized into three groups (21 eyes each) to receive intrastromal injections of VCZ, 50ug/0.1 ml or AMB, 5ug/0.1 ml or NTM 10ug/0.1 ml (prepared aseptically in ocular pharamacology). The patients in all three groups continued topical NTM 5% every four hours until the ulcer healed.

Results:

The patients in all three groups had comparable baseline parameters. The mean duration of healing was significantly better (p=0.02), in ISNTM group (34±5.2 days), as compared to ISVCZ (36.1±4.8 days) and ISAMB group (39.2±7.2 days). 95%, 90% and 95% patients healed successfully in ISVCZ, ISAMB and ISNTM groups respectively. Healing with deep vascularization was significantly more in ISAMB group (p=0.02) when compared to ISVCZ group.

Conclusions:

Intrastromal injections are a safe and effective adjunct in the management of fungal keratitis. Intrastromal Natamycin (ISNTM) had similar visual outcome with faster healing as compared to ISVCZ and a lower risk of deep vascularization as compared to ISVCZ and ISAMB.

Financial Disclosure:

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