Shivali A Menda1, Manoranjan Das2, Arun Panigrahi2, N Venkatesh Prajna2, Nisha R Acharya3,4, Thomas M Lietman3,4,5,6, Stephen D McLeod3,4, Jeremy D Keenan3,4. 1. Department of Ophthalmology, University of Washington, Seattle. 2. Department of Cornea and Refractive Surgery, Aravind Eye Care System, Madurai, India. 3. Department of Ophthalmology, University of California, San Francisco, San Francisco. 4. Francis I. Proctor Foundation, University of California, San Francisco, San Francisco. 5. Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco. 6. Institute for Global Health, University of California, San Francisco, San Francisco.
Abstract
Importance: Corneal opacity is a leading cause of visual impairment worldwide; however, the specific features of corneal scars, which decrease visual acuity, have not been well characterized. Objective: To investigate which features of a postfungal keratitis corneal scar contribute to decreased visual acuity after an episode of infectious keratitis and evaluate whether any corneal features may be used as outcomes for clinical trials. Design, Setting, and Participants: In this ancillary, prospective cross-sectional study, a subset of study participants treated for fungal keratitis (n = 71) as part of the Mycotic Ulcer Treatment Trial I (MUTT I) underwent best spectacle-corrected visual acuity (BSCVA) and best contact lens-corrected visual acuity examination, Scheimpflug imaging, and anterior segment optical coherence tomography at a referral hospital in India approximately 2 years after enrollment. Data were collected from December 3, 2012, to December 19, 2012, and analyses were performed from December 2, 2013, to October 2, 2019. Main Outcomes and Measures: Linear regression models were used to evaluate the importance of various corneal features for BSCVA and to assess whether these features could be used to differentiate the 2 treatment arms of the MUTT I trial. Results: Seventy-one patients (42 men [59.1%]; median age, 48 [range, 39-60] years) were examined at a median (IQR) time of 1.8 (1.4-2.2) years after enrollment. The mean (SD) logMAR BSCVA was 0.17 (0.19) (Snellen equivalent, 20/32). In multivariable linear regression models, BSCVA was most associated with irregular astigmatism (1.0 line of worse BSCVA per 1-line difference between BSCVA and contact lens visual acuity; 95% CI, 0.6-1.4) and corneal scar density (1.5 lines of worse vision per 10-unit increase in the mean central corneal density; 95% CI, 0.8-2.3). The thinnest point of the cornea was the metric that best discriminated between the natamycin- and voriconazole-treated ulcers in MUTT I, with 29.3 μm (95% CI, 7.1-51.6 μm) less thinning in natamycin-treated eyes. Conclusions and Relevance: Both irregular astigmatism and corneal scar density may be important risk factors for BSCVA in a population with relatively mild, healed fungal corneal ulcers. The thinnest point of the corneal scar may be a cornea-specific outcome that could be used to evaluate treatments for corneal ulcers.
Importance: Corneal opacity is a leading cause of visual impairment worldwide; however, the specific features of corneal scars, which decrease visual acuity, have not been well characterized. Objective: To investigate which features of a postfungal keratitis corneal scar contribute to decreased visual acuity after an episode of infectious keratitis and evaluate whether any corneal features may be used as outcomes for clinical trials. Design, Setting, and Participants: In this ancillary, prospective cross-sectional study, a subset of study participants treated for fungal keratitis (n = 71) as part of the Mycotic Ulcer Treatment Trial I (MUTT I) underwent best spectacle-corrected visual acuity (BSCVA) and best contact lens-corrected visual acuity examination, Scheimpflug imaging, and anterior segment optical coherence tomography at a referral hospital in India approximately 2 years after enrollment. Data were collected from December 3, 2012, to December 19, 2012, and analyses were performed from December 2, 2013, to October 2, 2019. Main Outcomes and Measures: Linear regression models were used to evaluate the importance of various corneal features for BSCVA and to assess whether these features could be used to differentiate the 2 treatment arms of the MUTT I trial. Results: Seventy-one patients (42 men [59.1%]; median age, 48 [range, 39-60] years) were examined at a median (IQR) time of 1.8 (1.4-2.2) years after enrollment. The mean (SD) logMAR BSCVA was 0.17 (0.19) (Snellen equivalent, 20/32). In multivariable linear regression models, BSCVA was most associated with irregular astigmatism (1.0 line of worse BSCVA per 1-line difference between BSCVA and contact lens visual acuity; 95% CI, 0.6-1.4) and corneal scar density (1.5 lines of worse vision per 10-unit increase in the mean central corneal density; 95% CI, 0.8-2.3). The thinnest point of the cornea was the metric that best discriminated between the natamycin- and voriconazole-treated ulcers in MUTT I, with 29.3 μm (95% CI, 7.1-51.6 μm) less thinning in natamycin-treated eyes. Conclusions and Relevance: Both irregular astigmatism and corneal scar density may be important risk factors for BSCVA in a population with relatively mild, healed fungal corneal ulcers. The thinnest point of the corneal scar may be a cornea-specific outcome that could be used to evaluate treatments for corneal ulcers.
Authors: Muthiah Srinivasan; Jeena Mascarenhas; Revathi Rajaraman; Meenakshi Ravindran; Prajna Lalitha; David V Glidden; Kathryn J Ray; Kevin C Hong; Catherine E Oldenburg; Salena M Lee; Michael E Zegans; Stephen D McLeod; Thomas M Lietman; Nisha R Acharya Journal: Arch Ophthalmol Date: 2011-10-10
Authors: Namperumalsamy V Prajna; Jeena Mascarenhas; Tiruvengada Krishnan; P Ravindranath Reddy; Lalitha Prajna; Muthiah Srinivasan; C M Vaitilingam; Kevin C Hong; Salena M Lee; Stephen D McLeod; Michael E Zegans; Travis C Porco; Thomas M Lietman; Nisha R Acharya Journal: Arch Ophthalmol Date: 2010-06
Authors: N Venkatesh Prajna; Tiruvengada Krishnan; Jeena Mascarenhas; Revathi Rajaraman; Lalitha Prajna; Muthiah Srinivasan; Anita Raghavan; Catherine E Oldenburg; Kathryn J Ray; Michael E Zegans; Stephen D McLeod; Travis C Porco; Nisha R Acharya; Thomas M Lietman Journal: JAMA Ophthalmol Date: 2013-04 Impact factor: 7.389
Authors: J Katz; S K Khatry; M D Thapa; O D Schein; E Kimbrough Pradhan; S C LeClerq; K P West Journal: Br J Ophthalmol Date: 2004-12 Impact factor: 4.638
Authors: Manoranjan Das; Shivali A Menda; Arun K Panigrahi; N Venkatesh Prajna; Michael Yen; Betty Tsang; Alisha Kumar; Jennifer Rose-Nussbaumer; Nisha R Acharya; Charles E McCulloch; Thomas M Lietman; Stephen D McLeod; Jeremy D Keenan Journal: Ophthalmic Epidemiol Date: 2019-04-25 Impact factor: 1.648