Natamycin remains treatment of choice for fungal ulcers
CHICAGO — Topical natamycin remains the mainstay of treatment of fungal ulcers, a speaker here said.
“However, Fusarium ulcers may benefit from the addition of oral voriconazole,” Jennifer R. Rose-Nussbaumer, MD, said at Cornea Subspecialty Day preceding the American Academy of Ophthalmology meeting. “That needs to be balanced with the fact that it does have higher adverse events and is expensive.”
Jennifer R. Rose-Nussbaume
Rose-Nussbaumer reported results from the National Eye Institute-funded Mycotic Ulcer Treatment Trial II, a double-masked, placebo-controlled trial that randomized smear-positive fungal corneal ulcers to oral voriconazole or placebo, and all patients were treated with topical antifungals. Oral voriconazole was thought to perhaps be a more effective treatment than natamycin.
In the trial conducted in India and Nepal, Rose-Nussbaumer and colleagues enrolled 240 eyes with large severe fungal ulcers and median best corrected visual acuity of counting fingers. Median infiltrate/scar size was 5.4 mm2.
The researchers found no statistically significant difference between the two groups regarding corneal perforation rates or need for therapeutic penetrating keratoplasty.
“We did find, however, that among those randomized to oral voriconazole there was a higher rate of adverse events, including elevations in liver function tests and visual disturbances. These are well known side effects of oral voriconazole,” she said.
Because it is known that fungal subtype can predict response to treatment, the researchers performed a subgroup analysis of Fusarium ulcers; Fusarium was identified in about 30% of the study ulcers. Statistically significant improvement was seen in visual acuity (P = .05) and scar size (P = .001) in the Fusarium ulcers in patients in the oral voriconazole group vs. those in the placebo group. – by Patricia Nale, ELS
Rose-Nussbaumer JR. Fungal keratitis: What is the latest in diagnosis and management? Presented at: American Academy of Ophthalmology annual meeting; Oct. 14-18, 2016; Chicago.
Disclosure: Rose-Nussbaumer reports no relevant financial disclosures.