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 leading cause of monocular blindness worldwide. In some settings, as many as 50% of all corneal ulcers are due to fungal infection. Various centers have reported that an increasing proportion of infectious keratitis is caused by fungus. Treatment of fungal keratitis is generally more difficult than that of bacterial ulcers, and resulting visual impairment is, on average, more severe.

Methods: After taking approval from Hospital Ethical Review Committee, patients coming through Eye OPD who fulfill the inclusion criteria were enrolled 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 was assessed at the time of procedure and after 1 and 3 months of procedure. Follow up was done by taking patient’s contact number and all the information was recorded on performa.

Results: Independent sample t test comparison suggests that topical Voriconazole is more effective in improving BCVA in fungal keratitis patients when compared to topical Natamycin.(p<0.05) 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 respectively in Group B with statistically significant p-value (p<0.05).

Conclusion: Topical 1% Voriconazole was found to be superior than 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.