Trial reportAmerican journal of ophthalmology2018
The Significance of Repeat Cultures in the Treatment of Severe Fungal Keratitis.
Trial report in American journal of ophthalmology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
What it found
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
9 citing papers in PubMed, 19 citations in OpenAlex.
- Cross-Linking-Assisted Infection Reduction: A Randomized Clinical Trial Evaluating the Effect of Adjuvant Cross-Linking on Outcomes in Fungal Keratitis.Ophthalmology · 2020Trial
- Steroids and Cross-Linking for Ulcer Treatment: The SCUT II Randomized Clinical Trial.JAMA ophthalmology · 2025Article
- Recent Advances in Diagnosis and Treatment Approaches in Fungal Keratitis: A Narrative Review.Microorganisms · 2024Review
- Review
- Recent Perspectives in the Management of Fungal Keratitis.Journal of fungi (Basel, Switzerland) · 2021Review
- The use of in vivo confocal microscopy to track treatment success in fungal keratitis and to differentiate between Fusarium and Aspergillus keratitis.International ophthalmology · 2020Article
- Anti-inflammatory effects of astaxanthin against fungal keratitis.International journal of ophthalmology · 2020Article
- Commentary: Timing of therapeutic keratoplasty.Indian journal of ophthalmology · 2019Article
- An Omics Approach to Diagnosing or Investigating Fungal Keratitis.International journal of molecular sciences · 2019Review
Corrections and comments
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Authors and funding
15 authors at 5 institutions in 3 countries.
Funding
Abstract
purposeTo identify fungal keratitis patients who are at risk of a poor outcome and may benefit from closer follow-up or more aggressive treatment.
designSecondary analysis of randomized clinical trial data.
methodsWe compared the clinical outcomes of patients who had positive 6-day fungal cultures with those who did not, using backward stepwise regression with covariates for all baseline clinical characteristics. SUBJECTS: Patients presenting with a smear-positive filamentous fungal ulcer and visual acuity of 20/400 or worse, and who subsequently had a 6-day fungal culture performed at the Aravind Eye Care system (India), Lumbini Eye Hospital (Nepal), or Bharatpur Eye Hospital (Nepal).
main outcome measuresThe primary outcome is rate of corneal perforation and/or the need for therapeutic penetrating keratoplasty. Secondary outcomes include 3-month best spectacle-corrected visual acuity (BSCVA), 3-month infiltrate and/or scar size, and rate of re-epithelialization.
resultsPatients who tested positive at their 6-day culture had twice the hazard of experiencing a corneal perforation or the need for therapeutic penetrating keratoplasty (P = .002) than those who tested negative, even after controlling for baseline ulcer characteristics. These patients also had on average 0.26 logMAR lines worse BSCVA at 3 months (P = .001). Culture positivity at day 6 was not a statistically significant predictor of 3-month infiltrate/scar-size (-0.24 mm
conclusionsHere we identify a uniquely valuable clinical tool, day 6 culture results, for the treatment of severe fungal keratitis. Risk stratification based on repeat culture positivity is an objective way to assess response to medical therapy and identify patients who are at high risk of a poor clinical outcome. This establishes a new standard of care for severe fungal keratitis management.
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