Fungal keratitis

Figures & data

Table

Systematic reviews	3
RCTs	7
Others	2

Table 1 RCTs comparing the clinical response of different antifungal medications

RCT	Intervention	Number of patients	Outcome criteria	Outcomes
Mohan 1988^Citation15	Topical Silver sulphadiazine vs Miconazole 1%	40	Clinical response by healing of ulcer	Silver sulphadiazine superior to miconazole
Rahman 1998^Citation16	Topical chlorhexidine 0.2% vs Natamycin 2.5%	70	Response at day 5 and healing by day 21	Chlorhexidine superior at both time points especially with severe ulcers
Prajna 2003^Citation17	Topical econazole 2% vs Topical Natamycin 5%	112	Clinical response by healing of ulcer	No difference
Kalavathy 2005^Citation18	Topical Itraconazole 1% vs Topical Natamycin 5%	100	Clinical response by healing of ulcer	No difference overall but Natamycin superior in Fusarium
Mahdy 2010^Citation19	Topical Amphotericin B 0.05% + subconjunctival injection Fluconazole 0.2% vs Topical Amphotericin 0.05%	48	Clinical response by healing of ulcer	Combination therapy superior to monotherapy
Prajna 2010^Citation20	Topical Voriconazole 1% vs Topical Natamycin 5%	120	Time to re-epithelialization	No difference
Arora 2010^Citation21	Topical Voriconazole 1% vs Topical Natamycin 5%	30	Clinical response by healing of ulcer	No significant difference

Table 2 RCTs evaluating the visual outcomes or adverse outcomes between antifungal medications

RCT	Intervention	Number	Outcome criteria	Outcome
Mahdy 2010^Citation19	Topical Amphotericin B 0.05% + subconjunctival Fluconazole 0.2% vs Topical Amphotericin 0.05%	48	Number of perforations and visual outcome	Both therapies equivalent in both criteria
Prajna 2010^Citation20	Topical Voriconazole 1% vs Topical Natamycin 5%	120	Visual acuity and number of perforations and corneal transplants	Visual acuity slightly superior in Voriconazole but not statistically significant. No difference in rate of complications
Arora 2010^Citation21	Topical Voriconazole 1% vs Topical Natamycin 5%	30	Visual acuity	No significant difference

Table 3 Laboratory studies

Trial	Intervention	Number	Outcome criteria	Outcome
Panda 2003^Citation12	Topical PHMB 0.02% vs povidone iodine 1% vs Natamycin 5%	24 Aspergillus rabbit infections	Healing time and perforations	Natamycin most effective, PHMB less effective, povidone-iodine not effective
Pfaller 2010^Citation22	Fluconazole (25 μg) vs voriconazole (1 μg)	256,882 Candida isolates	80% growth inhibition	Voriconazole slightly superior but resistant organisms common to both

Figure 1 Typical fungal ulcer with feathery borders.

Figure 2 Endothelial plaque, ring infiltrate, and hypopyon indicating a more advanced infection.

MohanMGuptaSKKalraVKVajpayeeRBSachdevMSTopical silver sulphadiazine–a new drug for ocular keratomycosisBr J Ophthalmol1988721921953281706

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RahmanMRJohnsonGJHusainRHowladerSAMinassianDCRandomised trial of 0.2% chlorhexidine gluconate and 2.5% natamycin for fungal keratitis in BangladeshBr J Ophthalmol1998829199259828778

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PrajnaNVJohnRKNirmalanPKLalithaPSrinivasanMA randomised clinical trial comparing 2% econazole and 5% natamycin for the treatment of fungal keratitisBr J Ophthalmol2003871235123714507756

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KalavathyCMParmarPKaliamurthyJComparison of topical itraconazole 1% with topical natamycin 5% for the treatment of filamentous fungal keratitisCornea20052444945215829804

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MahdyRANadaWMWagehMMTopical amphotericin B and subconjunctival injection of fluconazole (combination therapy) versus topical amphotericin B (monotherapy) in treatment of keratomycosisJ Ocul Pharmacol Ther20102628128520565316

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PrajnaNVMascarenhasJKrishnanTComparison of natamycin and voriconazole for the treatment of fungal keratitisArch Ophthalmol201012867267820547942

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AroraRGuptaDGoyalJKaurRVoriconazole versus natamycin as primary treatment in fungal corneal ulcersClin Experiment Ophthalmol2010In press.

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PandaAAhujaRBiswasNRSatpathyGKhokharSRole of 0.02% polyhexamethylene biguanide and 1% povidone iodine in experimental Aspergillus keratitisCornea20032213814112605049

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PfallerMADiekemaDJGibbsDLResults from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10.5-year analysis of susceptibilities of Candida Species to fluconazole and voriconazole as determined by CLSI standardized disk diffusionJ Clin Microbiol2010481366137720164282

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