ArticleClinical ophthalmology (Auckland, N.Z.)2021
Comparison of Safety and Efficacy of Intrastromal Injections of Voriconazole, Amphotericin B and Natamycin in Cases of Recalcitrant Fungal Keratitis: A Randomized Controlled Trial.
Article in Clinical ophthalmology (Auckland, N.Z.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 28 citations in OpenAlex.
- Evaluation of corneal intrastromal voriconazole injection as an adjuvant approach in recalcitrant fungal keratitis.Journal of ophthalmic inflammation and infection · 2026Article
- Natamycin in Food and Ophthalmology: Knowledge Gaps and Emerging Insights from Zebrafish Models.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Comprehensive insights into the role of nanocarriers in advancing azole-based ocular therapeutics.RSC advances · 2025Review
- First Isolation of a Multi-azole-Resistant Aspergillus fumigatus cyp51A TRMycopathologia · 2025Article
- Recent Advances in Diagnosis and Treatment Approaches in Fungal Keratitis: A Narrative Review.Microorganisms · 2024Review
- Debulking corneal biopsy with tectonic amniotic membrane transplantation in refractory clinically presumed fungal keratitis.Scientific reports · 2024Article
- Fungal Keratitis: Diagnosis, Management, and Recent Advances.Clinical ophthalmology (Auckland, N.Z.) · 2024Review
- Clinical and in vivo confocal microscopy characteristics of Candida keratitis following keratoplasty.BMC ophthalmology · 2023Article
- Intrastromal Injections in the Management of Infectious Keratitis.Pharmaceutics · 2023Review
- Local application of silver nitrate as an adjuvant treatment before deep lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment.Frontiers in medicine · 2023Article
- Management of Filamentous Fungal Keratitis: A Pragmatic Approach.Journal of fungi (Basel, Switzerland) · 2022Review
- Ocular Drug Delivery: Advancements and Innovations.Pharmaceutics · 2022Review
- Review
- Recent Perspectives in the Management of Fungal Keratitis.Journal of fungi (Basel, Switzerland) · 2021Review
- Intrastromal antimicrobial injections in microbial keratitis: Current evidence and clinical perspectives.Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological SocietyArticle
- Emerging treatments in fungal keratitis.Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological SocietyArticle
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Authors and funding
11 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo compare the safety and efficacy of intrastromal voriconazole (IS-VCZ), amphotericin B (IS-AMB) and natamycin (IS-NTM) as an adjunct to topical natamycin (NTM) in cases of recalcitrant fungal keratitis.
designProspective randomized trial.
settingTertiary eye centre.
participantsSixty eyes of 60 patients with microbiologically proven recalcitrant fungal keratitis (ulcer size >2 mm, depth >50% of stroma, and not responding to topical NTM therapy for two weeks) were recruited.
methodspatients were randomized into three groups of 20 eyes, each receiving ISVCZ 50ug/0.1 mL, ISAMB, 5ug/0.1 mL and ISNTM 10ug/0.1 mL (prepared aseptically in ocular pharmacology). The patients in all three groups continued topical NTM 5% every four hours until the ulcer healed. Primary outcome measure was time taken till complete clinical resolution of infection, and secondary outcome measure was best corrected visual acuity (BCVA) at six months.
resultsAll three groups had comparable baseline parameters. The mean duration of healing was significantly better (p=0.02) in the ISNTM group (34±5.2 days) as compared to the ISVCZ group (36.1±4.8 days) and the ISAMB group (39.2±7.2 days). About 95%, 90% and 95% patients healed successfully in the ISVCZ, ISAMB and ISNTM groups, respectively. In terms of healing, deep vascularization was significantly greater in the ISAMB group (55%, p=0.02) when compared to the ISVCZ and ISNTM groups (31% and 26%, respectively). There were fewer repeat injections in the ISNTM group (7/20 vs 8/20 and 9/20 in the ISVCZ and ISNTM groups, respectively).
conclusionIntrastromal injections are a safe and effective adjunct to conventional therapy in the management of recalcitrant fungal keratitis. ISNTM had a similar visual outcome with faster healing while ISAMB had a higher rate of deep vascularization after healing.
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