Efficacy of Topical Voriconazole 1% As Compared to Topical Natamycin 5% in the Treatment of Fungal Keratitis

Comparing Voriconazole and Natamycin in Fungal Keratitis Treatment

Abstract

Background: Infectious keratitis is a major cause of monocular blindness globally, with fungal infections accounting for a significant proportion of corneal ulcers. Fungal keratitis is challenging to treat and often results in severe visual impairment.

Objective: To compare the clinical efficacy of topical 1% Voriconazole versus 5% Natamycin in the treatment of fungal keratitis. Study Design: Cross-sectional prospective study. Settings: Ophthalmology Department, Madina Teaching Hospital, Faisalabad Pakistan. Duration: Jul 31, 2025, to Dec 31, 2025. Methods: 120 patients were included in the study. Group A patients having fungal keratitis were treated with topical Voriconazole 1%, while Group B patients having fungal keratitis were treated with topical Natamycin 5%. Best-corrected visual acuity, scar size, and pain perception were assessed at the time of the procedure and after 1 and 3 months of the procedure. Follow-up was done and all the information was recorded on proforma. Results: Mean ulcer scar size in Group A at 0,1, and 3 months post-treatment was 5.035±0.460, 3.506±0.121, and 2.990±0.310 mm, respectively, as compared to 5.051±0.450, 4.143±0.244, and 3.518±0.12 mm, respectively in Group B (p<0.05). Mean modified pain perception score at 0 and 3 months post-treatment in Group A was 4.416±0.497 and 4.483±0.536, respectively, versus 1.283±0.454 and 1.483±0.503 in Group B with statistically significant p-values (p<0.05). Conclusion: Topical 1% Voriconazole was found to be superior to 5% Natamycin in terms of clinical outcomes such as best-corrected visual acuity, ulcer scar size improvement, and pain perception in the treatment of fungal keratitis in patients presenting to Eye OPD.