Trial reportJAMA ophthalmology2013
The mycotic ulcer treatment trial: a randomized trial comparing natamycin vs voriconazole.
Trial report in JAMA ophthalmology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00996736 (Mycotic Ulcer Treatment Trial), which is not on this map. Cited by 166 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Mycotic Ulcer Treatment Trial
Who cites it
166 citing papers in PubMed, 4 syntheses or guidelines pooled it, 326 citations in OpenAlex.
- Favorable outcome of Lasiodiplodia theobromae keratomycosis : a clinical case and systematic review.BMC ophthalmology · 2024Pooled it
- Non-GVHD ocular complications after hematopoietic cell transplantation: expert review from the Late Effects and Quality of Life Working Committee of the CIBMTR and Transplant Complications Working Party of the EBMT.Bone marrow transplantation · 2019Pooled it
- Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Guideline
- Medical interventions for fungal keratitis.The Cochrane database of systematic reviews · 2015Pooled it
- Adjunctive povidone-iodine forAntimicrobial agents and chemotherapy · 2026Trial
- Continuous voriconazole lavage in managing moderate and severe fungal keratitis: a randomized controlled trial.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2023Trial
- Topical Chlorhexidine 0.2% versus Topical Natamycin 5% for the Treatment of Fungal Keratitis in Nepal: A Randomized Controlled Noninferiority Trial.Ophthalmology · 2022Trial
- Cross-Linking-Assisted Infection Reduction: A Randomized Clinical Trial Evaluating the Effect of Adjuvant Cross-Linking on Outcomes in Fungal Keratitis.Ophthalmology · 2020Trial
- Mycotic Antimicrobial Localized Injection: A Randomized Clinical Trial Evaluating Intrastromal Injection of Voriconazole.Ophthalmology · 2019Trial
- Regression Discontinuity and Randomized Controlled Trial Estimates: An Application to The Mycotic Ulcer Treatment Trials.Ophthalmic epidemiology · 2018Trial
- The Significance of Repeat Cultures in the Treatment of Severe Fungal Keratitis.American journal of ophthalmology · 2018Trial
- The Utility of Repeat Culture in Fungal Corneal Ulcer Management: A Secondary Analysis of the MUTT-I Randomized Clinical Trial.American journal of ophthalmology · 2017Trial
- Adjunctive Oral Voriconazole Treatment of Fusarium Keratitis: A Secondary Analysis From the Mycotic Ulcer Treatment Trial II.JAMA ophthalmology · 2017Trial
- Effect of pretreatment with antifungal agents on clinical outcomes in fungal keratitis.Clinical & experimental ophthalmology · 2016Trial
- Effect of Oral Voriconazole on Fungal Keratitis in the Mycotic Ulcer Treatment Trial II (MUTT II): A Randomized Clinical Trial.JAMA ophthalmology · 2016Trial
- Risk factors for low vision related functioning in the Mycotic Ulcer Treatment Trial: a randomised trial comparing natamycin with voriconazole.The British journal of ophthalmology · 2016Trial
- Changing Azole Resistance: A Secondary Analysis of the MUTT I Randomized Clinical Trial.JAMA ophthalmology · 2016Trial
- Association of pretreatment with antifungal medication and fungal resistance in the mycotic ulcer treatment trial I.JAMA ophthalmology · 2015Trial
- Vision-Related Quality-of-Life Outcomes in the Mycotic Ulcer Treatment Trial I: A Randomized Clinical Trial.JAMA ophthalmology · 2015Trial
- Association between in vitro susceptibility to natamycin and voriconazole and clinical outcomes in fungal keratitis.Ophthalmology · 2014Trial
106 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors at 1 institution in 1 country.
Funding
Abstract
objectiveTo compare topical natamycin vs voriconazole in the treatment of filamentous fungal keratitis.
methodsThis phase 3, double-masked, multicenter trial was designed to randomize 368 patients to voriconazole (1%) or natamycin (5%), applied topically every hour while awake until reepithelialization, then 4 times daily for at least 3 weeks. Eligibility included smear-positive filamentous fungal ulcer and visual acuity of 20/40 to 20/400.
main outcome measuresThe primary outcome was best spectacle-corrected visual acuity at 3 months; secondary outcomes included corneal perforation and/or therapeutic penetrating keratoplasty.
resultsA total of 940 patients were screened and 323 were enrolled. Causative organisms included Fusarium (128 patients [40%]), Aspergillus (54 patients [17%]), and other filamentous fungi (141 patients [43%]). Natamycintreated cases had significantly better 3-month best spectacle-corrected visual acuity than voriconazole-treated cases (regression coefficient=0.18 logMAR; 95% CI, 0.30 to 0.05; P=.006). Natamycin-treated cases were less likely to have perforation or require therapeutic penetrating keratoplasty (odds ratio=0.42; 95% CI, 0.22 to 0.80; P=.009). Fusarium cases fared better with natamycin than with voriconazole (regression coefficient=0.41 logMAR; 95% CI,0.61 to 0.20; P<.001; odds ratio for perforation=0.06; 95% CI, 0.01 to 0.28; P<.001), while non-Fusarium cases fared similarly (regression coefficient=0.02 logMAR; 95% CI, 0.17 to 0.13; P=.81; odds ratio for perforation=1.08; 95% CI, 0.48 to 2.43; P=.86).
conclusionsNatamycin treatment was associated with significantly better clinical and microbiological outcomes than voriconazole treatment for smear-positive filamentous fungal keratitis, with much of the difference attributable to improved results in Fusarium cases. APPLICATION TO CLINICAL PRACTICE: Voriconazole should not be used as monotherapy in filamentous keratitis.
trial registrationclinicaltrials.gov Identifier: NCT00996736
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.