PURPOSE: To identify risk factors at diagnosis that can serve as prognostic indicators of primary treatment failure in cases of fungal keratitis. DESIGN: Prospective, nonrandomized, interventional, comparative study. PARTICIPANTS: A total of 115 consecutive patients with fungal keratitis treated at one center during a 6-month period. METHODS: Patients with a microscopic corneal ulcer smear that was positive for fungus were enrolled and treated with 5% natamycin monotherapy according to the protocol of the hospital. Treatment responses were assessed at the end of 4 weeks. The prognostic indicators were used in a Poisson model for multiple regression analysis to estimate the relative risk of the main prognostic variables. MAIN OUTCOME MEASURES: Response of the ulcer to treatment. RESULTS: Of the 115 patients analyzed in the study, 52 (45.2%) were treatment successes, 27 (23.5%) had slow-healing ulcers, and 36 (31.3%) were refractory to primary treatment. Multivariate analysis showed that the predictors of treatment failure were ulcers that exceeded 14 mm(2) (P = 0.009), the presence of hypopyon (P = 0.003), and identification of Aspergillus (P = 0.003). CONCLUSION: In patients with fungal keratitis treated with 5% natamycin monotherapy, larger ulcer size and infection with Aspergillus were predictors of a poor outcome.
PURPOSE: To identify risk factors at diagnosis that can serve as prognostic indicators of primary treatment failure in cases of fungal keratitis. DESIGN: Prospective, nonrandomized, interventional, comparative study. PARTICIPANTS: A total of 115 consecutive patients with fungal keratitis treated at one center during a 6-month period. METHODS:Patients with a microscopic corneal ulcer smear that was positive for fungus were enrolled and treated with 5% natamycin monotherapy according to the protocol of the hospital. Treatment responses were assessed at the end of 4 weeks. The prognostic indicators were used in a Poisson model for multiple regression analysis to estimate the relative risk of the main prognostic variables. MAIN OUTCOME MEASURES: Response of the ulcer to treatment. RESULTS: Of the 115 patients analyzed in the study, 52 (45.2%) were treatment successes, 27 (23.5%) had slow-healing ulcers, and 36 (31.3%) were refractory to primary treatment. Multivariate analysis showed that the predictors of treatment failure were ulcers that exceeded 14 mm(2) (P = 0.009), the presence of hypopyon (P = 0.003), and identification of Aspergillus (P = 0.003). CONCLUSION: In patients with fungal keratitis treated with 5% natamycin monotherapy, larger ulcer size and infection with Aspergillus were predictors of a poor outcome.
Authors: Lisa J Keay; Emily W Gower; Alfonso Iovieno; Rafael A Oechsler; Eduardo C Alfonso; Alice Matoba; Kathryn Colby; Sonal S Tuli; Kristin Hammersmith; Dwight Cavanagh; Salena M Lee; John Irvine; R Doyle Stulting; Thomas F Mauger; Oliver D Schein Journal: Ophthalmology Date: 2011-02-04 Impact factor: 12.079
Authors: Prajna Lalitha; N Venkatesh Prajna; Catherine E Oldenburg; Muthiah Srinivasan; Tiruvengada Krishnan; Jeena Mascarenhas; C M Vaitilingam; Stephen D McLeod; Michael E Zegans; Travis C Porco; Nisha R Acharya; Thomas M Lietman Journal: Cornea Date: 2012-06 Impact factor: 2.651
Authors: Prajna Lalitha; Catherine Q Sun; N Venkatesh Prajna; Rajarathinam Karpagam; Manoharan Geetha; Kieran S O'Brien; Vicky Cevallos; Stephen D McLeod; Nisha R Acharya; Thomas M Lietman Journal: Am J Ophthalmol Date: 2013-10-22 Impact factor: 5.258
Authors: Palanisamy Manikandan; János Varga; Sándor Kocsubé; Rajaraman Revathi; Raghavan Anita; Ilona Dóczi; Tibor Mihály Németh; Venkatapathy Narendran; Csaba Vágvölgyi; Madhavan Bhaskar; Chockaiya Manoharan; Robert A Samson; László Kredics Journal: J Med Case Rep Date: 2010-02-24
Authors: N Venkatesh Prajna; T Krishnan; J Mascarenhas; M Srinivasan; C E Oldenburg; C M Toutain-Kidd; A Sy; S D McLeod; M E Zegans; N R Acharya; T M Lietman; T C Porco Journal: Eye (Lond) Date: 2012-06-29 Impact factor: 3.775