Risk factors for low vision related functioning in the Mycotic Ulcer Treatment Trial: a randomised trial comparing natamycin with voriconazole

Abstract

Background/aims The Mycotic Ulcer Treatment Trial I (MUTT I) was a double-masked, multicentre, randomised controlled trial, which found that topical natamycin is superior to voriconazole for the treatment of filamentous fungal corneal ulcers. In this study, we determine risk factors for low vision-related quality of life in patients with fungal keratitis. Methods The Indian visual function questionnaire (IND-VFQ) was administered to MUTT I study participants at 3 months. Associations between patient and ulcer characteristics and IND-VFQ subscale score were assessed using generalised estimating equations. Results 323 patients were enrolled in the trial, and 292 (90.4%) completed the IND-VFQ at 3 months. Out of a total possible score of 100, the average VFQ score for all participants was 81.3 (range 0–100, SD 23.6). After correcting for treatment arm, each logMAR line of worse baseline visual acuity in the affected eye resulted in an average 1.2 points decrease on VFQ at 3 months (95% CI −1.8 to 0.6, p<0.001). Those who required therapeutic penetrating keratoplasty had an average of 25.2 points decrease on VFQ after correcting for treatment arm (95% CI −31.8 to −18.5, p<0.001). Study participants who were unemployed had on average 28.5 points decrease on VFQ (95% CI −46.9 to −10.2, p=0.002) after correcting for treatment arm. Conclusions Monocular vision loss from corneal opacity due to fungal keratitis reduced vision-related quality of life. Given the relatively high worldwide burden of corneal opacity, improving treatment outcomes of corneal infections should be a public health priority. Trial registration number Clinicaltrials.gov Identifier: NCT00996736.

Quality-of-Life Outcomes From a Randomized Clinical Trial Comparing Antimetabolites for Intermediate, Posterior, and Panuveitis

“…32,33 Each 5-letter improvement in BCVA corresponded to a 3.2-point improvement in IND-VFQ composite score, a significant change, though thresholds for clinically meaningful change have not been defined in this instrument. This association is comparable to the relationship found between NEI-VFQ scores and BCVA in the Multicenter Uveitis Steroid Treatment (MUST) trial (3.65 points for every line increase in vision, compared to the 3.2 points per line seen in this study).…”

Infectious Keratitis: The Great Enemy

“…However, performing keratoplasty in a "hot eye" is associated with an increased risk of recurrence of the disease and graft rejection/failure [91]. The visual outcomes of infectious keratitis may be poor from various complications such as corneal scarring or perforation, irregular astigmatism, development of glaucoma, cataracts, endophthalmitis, and vision loss [92]. Moreover, the advanced infectious keratitis that required therapeutic keratoplasty had decreased quality of life.…”

Early deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment

“…Fungal involvement of the cornea represents a dramatic clinical event that is an important cause of blindness and visual impairment worldwide. [1][2][3] Managing fungal keratitis is challenging because of several issues. Delay in proper diagnosis and inappropriate treatment foster fungal growth.…”