Corneal Ulcer Clinical Trial
Official title:
The Mycotic Ulcer Treatment Trial II: A Randomized Trial Comparing Oral Voriconazole vs Placebo
The purpose of this study is to determine if the addition of oral voriconazole to topical treatment regimens results in lower rates of perforation in severe fungal corneal ulcers.
Fungal corneal ulcers tend to have very poor outcomes with commonly used treatments. There
has only been a single randomized trial of anti-fungal therapy for mycotic keratitis, and no
new ocular anti-fungal medications have been approved by the FDA since the 1960s. The
triazole voriconazole has recently become the treatment of choice for systemic fungal
infections such as pulmonary aspergillosis. The use of topical ophthalmic preparations of
voriconazole has been described in numerous case reports, however there has been no
systematic attempt to determine whether it is more or less clinically effective than
natamycin. Additionally, there have been many case reports of the use of oral voriconazole in
the treatment of fungal corneal ulcers, however there has been no systematic attempt to
determine if it improves outcomes in severe ulcers.
This study is a randomized, double-masked, placebo-controlled trial to determine if the use
of oral voriconazole in severe ulcers reduces the rate of perforations. 240 fungal corneal
ulcers with baseline visual acuity worse than 6/120 presenting to the Aravind Eye Hospitals
and the UCSF Proctor Foundation will be randomized to receive oral voriconazole plus topical
voriconazole and topical natamycin, or oral placebo plus topical voriconazole and topical
natamycin. The primary outcome is the rate of perforation over the three month follow-up
period.
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