Anshu Sharma1, Sarita Aggarwal2, Richa Ahluwalia3, Rahul Sahay4, Rimsha5
The main cause of ocular morbidity and mortality in developing countries is fungal keratitis. In developing countries, approximately 50% of corneal ulcers are proven to be fungal. Following trauma with vegetative matter, filamentous fungi is responsible for a large proportion of corneal infections in tropical climate than temperate climate. Fungal keratitis is best managed by timely diagnosis of infection and appropriate administration of antifungal therapy.
The aim of the study is to evaluate the efficacy of topical 5% natamycin and 1% voriconazole in treatment of mycotic corneal ulcers. The fungal corneal ulcer was treated with 1% VRC and 5% natamycin and their efficacy was compared with respect to resolution of infiltrate viz adverse events, example non-healing ulcer perforation.
MATERIALS AND METHODS
Two groups were formed, each group constituted of minimum 15 patients and each were treated topically with either 5% natamycin (group A) or 1% VRC as main primary treatment for mycotic keratitis. Comparison was done in both groups on basis of depth of infiltrate, mean size and LogMAR visual acuity at presentation. There was minimum 8 weeks follow up or till complete resolution of infiltrate, whichever event occurred later. The culture was performed to identify the causative organisms.
Fungal keratitis was found to be more common in males, 60% in group A and 66.7% in group B. Major predisposing factor was trauma, which was present in 17 (56.7%) patients. Twenty-nine of total 30 patients showed complete resolution. 25.86 days and 1.05 in group A and 28 days and 0.58 in group B was the average time of resolution and gain in LogMAR visual acuity. They were compared in two groups (p>0.05%). The most common isolates found were Curvularia spp. (38%) and Aspergillus spp. (38%).
Both 1% voriconazole and 5% natamycin were found to be efficacious agents in primary fungal keratitis management. Average healing time was marginally better with natamycin. Hence, 5% natamycin was more efficacious than 1% VRC in treatment of fungal keratitis curing from 1 to 5 mm of infiltrate in our study.