Topical 5% Natamycin With Oral Ketoconazole in Filamentous Fungal Keratitis

Rajaraman, Revathi; Bhat, Parameshwar; Vaidee, Vikram; Maskibail, Sowmyalatha; Raghavan, Anita; Sivasubramaniam, Siddharthan; Namperumalsamy, Venkatesh Prajna

doi:10.1097/apo.0000000000000035

Cited by 14 publications

(7 citation statements)

References 29 publications

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“…On average, it took 6 weeks to 6 months to treat a case of fungal keratitis. Our observation did not match the study by Rajaram et al 19 which found that oral antifungal therapy did not add significant benefit to topical natamycin therapy in treating deep fungal keratitis. The diagnostic validity of traditional clinical features such as dry, raised, leathery ulcers with thick and immobile hypopyon (Fig.…”

Section: Discussioncontrasting

confidence: 99%

Profile of fungal keratitis in a Sub-Himalayan territory of north India

et al. 2021

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Aim: To study the microbiological and epidemiological profile of patients with suppurative corneal ulcer presenting in a rural referral center situated in a Sub-Himalayan territory of north India. The study was conducted to evaluate the epidemiology and frequency of mycotic keratitis among the patients of suppurative corneal ulcer and to identify various fungal species as etiological agents. Methods: Corneal scrapings from 56 patients of suppurative corneal ulcers were subjected to direct microscopy and culture. Results: Of the 56 cases of suppurative corneal ulcer investigated, fungal etiology was identified in 18 (32%) cases. Most of the patients (82.1%) worked in agriculture. Trivial trauma with vegetative matter was the most common predisposing factor. Fusarium and Acremonium species were the most common fungi isolated, followed by Aspergillus. Four cases of rare mycotic keratitis caused by Paecilomyces lilacinus, Scedosporium apiospermum, Monilia sitophila, and Ulocladium species were detected. Four cases were smear positive (10% KOH wet mount) but culture negative. Analysis of KOH wet mount was done using culture as gold standard. The sensitivity and specificity of KOH wet mount was 71.43% and 90.48%, respectively. Conclusion: Direct microscopy and culture has a greater diagnostic value in the management of suppurative corneal ulcer. The authors have observed changes in the pattern of organisms identified as cause of fungal keratitis in the region. Rare species of fungi may also be detected if corneal scrapings are collected for direct microscopy and culture from all the cases of suppurative corneal ulcers greater than 2 mm.

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Section: Discussioncontrasting

confidence: 99%

Profile of fungal keratitis in a Sub-Himalayan territory of north India

et al. 2021

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“…We had earlier published a study which revealed no added benefit in supplementing oral ketoconazole to topical antifungals in fungal keratitis. [ 25 ] Since systemic Voriconazole is being widely used for systemic aspergillosis, we decided to perform a randomized clinical trial using oral Voriconazole supplementation to arrive at a definitive conclusion. This prospective study, termed MUTT II, was performed in India and Nepal and compared oral Voriconazole with placebo in addition to topical antifungals in the treatment of severe fungal keratitis.…”

Section: Drug Trialsmentioning

confidence: 99%

Fungal keratitis: The Aravind experience

Prajna

Lalitha

Srinivasan

2017

Indian J Ophthalmol

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Research becomes very significant and meaningful when it addresses a significant public health problem of a region. Fungal keratitis is a serious problem affecting the agrarian poor and hence requires attention from public health specialists. The approach to a public health issue should focus not only on treatment but also prevention or at least show a significant thrust to reduce the morbidity of the problem. At our institution, we have developed a special interest in fungal keratitis and tried to study it in a multitude of aspects. As we put the pieces of the puzzle together, we believe that interest will be rekindled among policymakers, clinicians, microbiologists, pharmaceutical industry, and basic scientists to work together to join forces and take up an integrative approach to managing this problem. It is also believed that the article underscores the need and importance of having a focused approach to ensuring a successful career in clinical research.

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“…Although single case reports show some promising results, they were never replicated in larger clinical trials. Most recent studies suggest that 5% natamycin is a drug of choice, although it is not commercially available in Poland [20,21,24,25,26]. Due to pregnancy, in the presented patient treatment was limited to topical medications; therefore, medication commenced with voriconazole, with natamycin added as soon as was possible to import it from a foreign pharmacy.…”

Section: Case Reportmentioning

confidence: 99%

“…Both agents have limited ability to penetrate the corneal epithelium; therefore, some authors suggest repeatable epithelial debridement before eyedrop application [13]. Synergistic effect has been pursued in several studies, combining both topical natamycin with voriconazole [14,20], topical natamycin with systemic ketoconazole [21], topical and systemic voriconazole [22], voriconazole with micafungin [23]. Although single case reports show some promising results, they were never replicated in larger clinical trials.…”

Section: Case Reportmentioning

confidence: 99%

Fusarium keratitis as a growing problem – case report and literature review

Winiarczyk¹,

Borkowska²,

Mackiewicz³

2021

Ann Agric Environ Med.

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Introduction and objectives. With the rising number of contact lens users, there has been observed an increasing number of patients admitted to ophthalmology wards with severe keratitis, including those of fungal etiology. One of the most devastating specimens is Fusarium spp. If not diagnosed and treated from the onset of the symptoms, it can lead to severe visual loss, or even blindness. Case report. This a retrospective case report of a 36-year-old pregnant female diagnosed with Fusarium keratitis, not responding to topical treatment. The problem is discussed and includes the most relevant literature review. Results. Primary therapeutic keratoplasty is prone to failure due to an ongoing inflammation process in the eye, as happened in the described patient. Spread of the infection to the vitreous body necessitated the procedure of penetrating keratoplasty with lens removal, pars plana vitrectomy and silicone oil. After treatment, the inflammation resolved, and best corrected visual acuity at the 6 months follow-up was 0.5 (Snellen charts). Conclusions. There is currently no treatment for Fusarium keratitis that would offer similar results to those observed in bacterial infection treated early with antibiotics. As systemic therapy with antifungal agents is not an option in pregnant women, they are even more of a challenge. Diagnosis is quite often delayed, leading to deeper infiltration of the cornea, sometimes with vitreous involvement. For such cases, a combined approach is proposed with vitrectomy, lens removal and penetrating keratoplasty. Early surgical intervention may rescue some of the eyes non-responsive to topical and systemic treatment.

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Topical 5% Natamycin With Oral Ketoconazole in Filamentous Fungal Keratitis

Abstract: Although safe, oral ketoconazole did not add significant benefit to topical natamycin therapy in treating deep fungal keratitis. The efficacy of newer antifungal agents and drug delivery routes needs to be explored.

Cited by 14 publications

References 29 publications

Profile of fungal keratitis in a Sub-Himalayan territory of north India

Profile of fungal keratitis in a Sub-Himalayan territory of north India

Fungal keratitis: The Aravind experience

Fusarium keratitis as a growing problem – case report and literature review

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