The Mycotic Ulcer Treatment Trial

Prajna, N Venkatesh; Krishnan, Tiruvengada; Mascarenhas, Jeena; Rajaraman, Revathi; Lalitha, Prajna; Srinivasan, Muthiah; Raghavan, Anita; Oldenburg, Catherine E.; Ray, Kathryn J.; Zegans, Michael E.; McLeod, Stephen D.; Porco, Travis C.; Acharya, Nisha R.; Lietman, Thomas M.

doi:10.1001/jamaophthalmol.2013.1497

Cited by 253 publications

(163 citation statements)

References 17 publications

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“…1 This and other recent trials 2,3 suggest that natamycin should be the treatment of choice for filamentous fungal keratitis. A survey of experts (~800 surveyed; N=92 respondents) conducted in 2007 found that a majority of clinicians identified voriconazole as their preferred treatment.…”

Section: Introductionmentioning

confidence: 80%

“…4 The MUTT I result was driven primarily by Fusarium ulcers, which had the worst response to voriconazole. 1 Following the results of MUTT I and two subsequent trials, only a minority of experts indicated that they would prefer to treat Fusarium keratitis with voriconazole. Limitations of this study include that respondents self-reported practice patterns, and it was not possible to validate the survey against actual practice patterns.…”

Section: Discussionmentioning

confidence: 99%

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Evolution of Practice Patterns for the Treatment of Fungal Keratitis

et al. 2017

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Section: Introductionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Evolution of Practice Patterns for the Treatment of Fungal Keratitis

et al. 2017

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“…The recent prospective studies by Prajna et al [24,25] compared topical natamycin with voriconazole in the treatment of fungal keratitis, although the fact that voriconazole is a solution and natamycin a suspension raises some concern for unmasking [24]. Furthermore, the primary outcome was visual acuity and not the safety profile.…”

Section: Discussionmentioning

confidence: 99%

“…Secondary outcomes included, among others, scar size and time to healing. The scar size at 3 months was slightly greater with voriconazole after adjusting for scraping [24], but the reepithelialization time was not significantly different between the two treatments [24,25]. However, the detailed description of reepithelialization time in each group was not shown.…”

Section: Discussionmentioning

confidence: 99%

Cytotoxic Effect of Voriconazole on Human Corneal Epithelial Cells

Sobolewska

Guerel²,

Hofmann³

et al. 2015

Ophthalmic Res

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Background: To assess the cytotoxic properties of voriconazole and sulfobutylether-β-cyclodextrin (SBECD) on cultured primary human corneal epithelial cells. Methods: Human corneal epithelial cells were cultured and exposed to various concentrations of SBECD (0.016-32 mg/ml) and voriconazole (0.001-2 mg/ml). Cellular cytotoxicity of SBECD and voriconazole on human corneal epithelial cells was evaluated using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide test and the LIVE/DEAD Viability/Cytotoxicity Assay with fluorescence microscopy analysis. Cell damage was assessed with phase-contrast microscopy after 24 h of exposure to SBECD and voriconazole. Results: The cytotoxicity tests and the morphological characteristic demonstrated the dose-dependent toxic effect of SBECD and voriconazole on human corneal epithelial cells. No corneal epithelial cytotoxicity was observed below the concentration of 0.08 and 0.025 mg/ml after 24-hour exposure to SBECD and voriconazole, respectively. Conclusions: The results of the study reveal the dose-dependent cytotoxic effect of SBECD and voriconazole on cultured human corneal epithelial cells. Therefore, voriconazole eye drops should be used cautiously in the treatment of fungal corneal ulcers.

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“…Filamentous fungi are frequently implicated in fungal keratitis in humans, especially species of Fusarium and Aspergillus (11). However, numerous organisms have been associated with keratitis, especially with contact lens wear (12).…”

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confidence: 99%

First Human Case of Fungal Keratitis Caused by a Putatively Novel Species of Lophotrichus

et al. 2015

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We report an aggressive fungal keratitis caused by a putatively novel species of Lophotrichus in a patient with traumatic injury to the cornea from a dog paw. The organism was isolated from the patient's necrotic cornea, which perforated despite coverage with hourly fortified broad-spectrum topical antibiotic therapy. This report represents the first case of human infection caused by this species. CASE REPORTA 50-year-old woman from rural Maryland, USA, presented to the Johns Hopkins Emergency Department in April 2011 5 days after her dog stepped on her right eye during sleep. She experienced foreign body sensation and blurry vision at the time but experienced a rapid decrease in vision on day 4. When she presented on day 5, she could see only light and dark in the right eye. She had no known history of contact lens use. She had undergone cataract surgery in both eyes 1 year prior to presentation and did not wear glasses except for reading.The physical examination conducted 5 days after the injury revealed uncorrected visual acuity of light perception in the right eye and 20/25 at distance in the left eye. There was no afferent pupillary defect present. Slit-lamp examination of the right eye revealed upper and lower eyelid erythema and edema. The conjunctiva was 3ϩ injected, and the cornea demonstrated a large central ulceration measuring 6 mm in diameter with yellow-green discharge (Fig. 1A). The anterior chamber demonstrated a robust fibrinous reaction, with no view of the lens or posterior segment. The patient immediately started treatment with a fortified topical 25-mg/ml vancomycin and 14-mg/ml tobramycin ophthalmic solution hourly to the right eye. Corneal scrapings were obtained and inoculated onto three culture media: blood agar containing 5% sheep blood, chocolate agar, and Sabouraud dextrose agar with gentamicin.On day 6 after the injury, the patient added oral doxycycline at 100 mg twice daily and ciprofloxacin ointment nightly to her regimen. Ultrasonography revealed no choroidal or retinal detachment. When the patient returned on day 10, she complained of severe pain. Despite frequent drop use, the infiltrate and ulceration persisted, with formation of significant corneal neovascularization and inferior thinning. The eye was soft to palpation, and 360-degree shallow choroidal detachments were noted, consistent with microperforation of the cornea.At this point, 4 days after corneal scrapings and cultures, preliminary results demonstrated the presence of a filamentous fungus (on the chocolate agar) and very light growth (on the first quadrant of the culture plate) of Corynebacterium macginleyi. Topical voriconazole at 1% was started hourly in the right eye, in addition to continuing fortified vancomycin and tobramycin. She was taken to the operating room, where a corneal biopsy was conducted and an Ambio5 (IOP Ophthalmics, Costa Mesa, CA, USA) amniotic membrane patch was grafted onto the ocular surface.On day 17 after the initial injury, the infiltrate began to clear superiorly and the cornea had part...

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The Mycotic Ulcer Treatment Trial

Cited by 253 publications

References 17 publications

Evolution of Practice Patterns for the Treatment of Fungal Keratitis

Evolution of Practice Patterns for the Treatment of Fungal Keratitis

Cytotoxic Effect of Voriconazole on Human Corneal Epithelial Cells

First Human Case of Fungal Keratitis Caused by a Putatively Novel Species of Lophotrichus

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