PURPOSE: To assess the efficacy of corneal cross-linking (CXL) as an adjuvant to appropriate antifungal therapy in nonresolving deep stromal fungal keratitis. DESIGN: Randomized clinical trial. METHODS:Eyes with culture-positive deep stromal fungal keratitis not responding to appropriate medical therapy for a period of 2 weeks were randomized to receive either adjuvant CXL or no additional treatment. Antifungal medical therapy was continued in both groups. The prespecified primary outcome was treatment failure at 6 weeks after enrollment, defined as perforation and/or increase in ulcer size by ≥2 mm. RESULTS: The trial was stopped before full enrollment because of a marked difference in the rate of perforation between the 2 groups. Of the 13 cases enrolled in the study, 6 were randomized to the CXL group and 7 to the non-CXL group. Five eyes in the CXL group and 3 eyes in the non-CXL group experienced treatment failure by 6 weeks (P = .56). In a secondary analysis, the CXL group experienced more perforations than the non-CXL group (4 vs 0, respectively; P = .02). CONCLUSION:CXL used as adjuvant therapy for recalcitrant deep stromal fungal keratitis did not improve outcomes.
RCT Entities:
PURPOSE: To assess the efficacy of corneal cross-linking (CXL) as an adjuvant to appropriate antifungal therapy in nonresolving deep stromal fungal keratitis. DESIGN: Randomized clinical trial. METHODS: Eyes with culture-positive deep stromal fungal keratitis not responding to appropriate medical therapy for a period of 2 weeks were randomized to receive either adjuvant CXL or no additional treatment. Antifungal medical therapy was continued in both groups. The prespecified primary outcome was treatment failure at 6 weeks after enrollment, defined as perforation and/or increase in ulcer size by ≥2 mm. RESULTS: The trial was stopped before full enrollment because of a marked difference in the rate of perforation between the 2 groups. Of the 13 cases enrolled in the study, 6 were randomized to the CXL group and 7 to the non-CXL group. Five eyes in the CXL group and 3 eyes in the non-CXL group experienced treatment failure by 6 weeks (P = .56). In a secondary analysis, the CXL group experienced more perforations than the non-CXL group (4 vs 0, respectively; P = .02). CONCLUSION:CXL used as adjuvant therapy for recalcitrant deep stromal fungal keratitis did not improve outcomes.
Authors: N Venkatesh Prajna; Naveen Radhakrishnan; Prajna Lalitha; Ariana Austin; Kathryn J Ray; Jeremy D Keenan; Travis C Porco; Thomas M Lietman; Jennifer Rose-Nussbaumer Journal: Ophthalmology Date: 2019-09-04 Impact factor: 12.079
Authors: Andrea Naranjo; Alejandro Arboleda; Jaime D Martinez; Heather Durkee; Mariela C Aguilar; Nidhi Relhan; Neda Nikpoor; Anat Galor; Sander R Dubovy; Roger Leblanc; Harry W Flynn; Darlene Miller; Jean-Marie Parel; Guillermo Amescua Journal: Am J Ophthalmol Date: 2019-09-05 Impact factor: 5.258
Authors: Patrick B Rapuano; Alexandra H Scanameo; Daeryl E Amponin; Sefy A Paulose; Mariya Zyablitskaya; Anna Takaoka; Leejee H Suh; Takayuki Nagasaki; Stephen L Trokel; David C Paik Journal: Invest Ophthalmol Vis Sci Date: 2018-01-01 Impact factor: 4.799