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Topical 5% Natamycin With Oral Ketoconazole in Filamentous Fungal Keratitis: A Randomized Controlled Trial

Topical 5% Natamycin With Oral Ketoconazole in Filamentous Fungal Keratitis: A Randomized... Downloaded from http://journals.lww.com/apjoo by BhDMf5ePHKbH4TTImqenVA5KvPVPZ0P5BEgU+IUTEfzO/GUWifn2IfwcEVVH9SSn on 06/03/2020 LETTER TO THE EDITOR current practice patterns of treatment of deep given systemically, the recommended Topical 5% Natamycin With fungal ulcers. dosage is much higher than the 500 mg Oral Ketoconazole twice daily dose we used in our study. A Sasya Ravuri, MD more recent study by Cho et al on the in Filamentous Fungal Rashmi Mittal, MD role of systemic vitamin C in corneal ul- Keratitis: A Randomized Fellow in Cornea and Anterior segment services cers also suggested a dose of 3 g/d orally LV Prasad Eye Institute Controlled Trial or 20 g/d intravenously. Moreover, in the Hyderabad, India presence of an active infection of fungal Bhupesh Bagga, MD To the Editor: etiology, it is doubtful whether the re- Consultant e read with interest the article enti- generative role of vitamin C alone can LV Prasad Eye Institute W tled “Topical 5% Natamycin With play a significant part in healing. In de- Hyderabad, India Oral Ketoconazole in Filamentous Fun- scribing our endpoint, we have taken into bhupesh@lvpei.org gal Keratitis: A Randomized Controlled account stromal infiltration as an impor- Trial” by Rajaraman et al. Although the REFERENCES tant event. authors concluded that oral ketoconazole 1. Rajaraman R, Bhat P, Vaidee V, et al. Topical 2. We agree that the majority of our ulcers did not add significant benefits to topical 5% natamycin with oral ketoconazole in were classified as up to the mid-stroma, natamycin therapy in treating deep fungal filamentous fungal keratitis: a randomized which was due to the size of the ulcers to keratitis, we would like to draw attention controlled trial. Asia Pac J Ophthalmol (Phila). some extent. In our article, we noted that to the following issues: 2015;4:146–150. our data did not show any additional ben- 1. The authors chose one of the best study 2. Boyd TA, Campbell FW. Influence of ascorbic efit of oral ketoconazole, and we ex- designs possible to answer the study ques- acid on the healing of corneal ulcers in man. plained that low serum concentrations tion, but the use of a vitamin C placebo Br Med J. 1950;2:1145–1148. after oral therapy and the emergence of (of an unknown dosage) in the control resistance patterns should be considered 3. Cho YW, Yoo WS, Kim SJ, et al. Efficacy of arm was not the best choice. Vitamin C in evaluating the efficacy of oral therapy. systemic vitamin C supplementation in reducing (ascorbic acid) is known to affect corneal corneal opacity resulting from infectious We also proved that oral ketoconazole wound healing and has been shown to keratitis. Medicine (Baltimore). 2014;93:e125. given for 3 weeks was not associated accelerate the healing of deep corneal with any adverse effects. 2,3 ulcers. This could be a major con- We strongly feel that newer antifun- founding factor affecting the results gal agents and newer modes of drug of the study. administration must be studied to tackle Topical 5% Natamycin With 2. Moreover, this trial aimed to study the ef- this challenging infection. Oral Ketoconazole in fectiveness of oral ketoconazole as an adjuvant to topical treatment of deep fun- Filamentous Fungal Keratitis: gal keratitis. However, only a small pro- A Randomized portion of eyes had posterior stromal Revathi Rajaraman, MS (deep) involvement (13.8% in the control Controlled Trial arm and 22.8% in the study arm). Most eyes hadonlyhalf ofthe anterior stroma e thank the authors for taking interest involved, where systemic antifungal ther- REFERENCES W in our article and for raising relevant apy might not be of much added benefit. questions. We would like to address the 1. Cho YW, Yoo WS, Kim SJ, et al. Efficacy of Thus, it is difficult to conclude whether queries as follows: systemic vitamin C supplementation in reducing oral ketoconazole has any added benefit 1. The authors considered the use of vita- corneal opacity resulting from infectious in the treatment of deep ulcers. keratitis. Medicine (Baltimore). 2014;93:e125. min C as a placebo to be an inappro- priate choice, as this could have affected 2. Xie L, Zhai H, Zhao J, et al. Antifungal Although the authors studied an impor- the healing of corneal wounds. The role susceptibility for common pathogens of fungal tant question, the investigation failed to pro- of vitamin C in corneal healing after keratitis in Shandong Province, China. Am J vide convincing evidence for changing the burns is well established. However, when Ophthalmol. 2008;146:260–265. Asia-Pacific Journal of Ophthalmology  Volume 4, Number 6, November/December 2015 www.apjo.org 399 Copyright © 2015 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited. Downloaded from http://journals.lww.com/apjoo by BhDMf5ePHKbH4TTImqenVA5KvPVPZ0P5BEgU+IUTEfzO/GUWifn2IfwcEVVH9SSn on 06/03/2020 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Asia-Pacific Journal of Ophthalmology Wolters Kluwer Health

Topical 5% Natamycin With Oral Ketoconazole in Filamentous Fungal Keratitis: A Randomized Controlled Trial

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Publisher
Wolters Kluwer Health
ISSN
2162-0989
eISSN
2475-5028
DOI
10.1097/APO.0000000000000161
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Abstract

Downloaded from http://journals.lww.com/apjoo by BhDMf5ePHKbH4TTImqenVA5KvPVPZ0P5BEgU+IUTEfzO/GUWifn2IfwcEVVH9SSn on 06/03/2020 LETTER TO THE EDITOR current practice patterns of treatment of deep given systemically, the recommended Topical 5% Natamycin With fungal ulcers. dosage is much higher than the 500 mg Oral Ketoconazole twice daily dose we used in our study. A Sasya Ravuri, MD more recent study by Cho et al on the in Filamentous Fungal Rashmi Mittal, MD role of systemic vitamin C in corneal ul- Keratitis: A Randomized Fellow in Cornea and Anterior segment services cers also suggested a dose of 3 g/d orally LV Prasad Eye Institute Controlled Trial or 20 g/d intravenously. Moreover, in the Hyderabad, India presence of an active infection of fungal Bhupesh Bagga, MD To the Editor: etiology, it is doubtful whether the re- Consultant e read with interest the article enti- generative role of vitamin C alone can LV Prasad Eye Institute W tled “Topical 5% Natamycin With play a significant part in healing. In de- Hyderabad, India Oral Ketoconazole in Filamentous Fun- scribing our endpoint, we have taken into bhupesh@lvpei.org gal Keratitis: A Randomized Controlled account stromal infiltration as an impor- Trial” by Rajaraman et al. Although the REFERENCES tant event. authors concluded that oral ketoconazole 1. Rajaraman R, Bhat P, Vaidee V, et al. Topical 2. We agree that the majority of our ulcers did not add significant benefits to topical 5% natamycin with oral ketoconazole in were classified as up to the mid-stroma, natamycin therapy in treating deep fungal filamentous fungal keratitis: a randomized which was due to the size of the ulcers to keratitis, we would like to draw attention controlled trial. Asia Pac J Ophthalmol (Phila). some extent. In our article, we noted that to the following issues: 2015;4:146–150. our data did not show any additional ben- 1. The authors chose one of the best study 2. Boyd TA, Campbell FW. Influence of ascorbic efit of oral ketoconazole, and we ex- designs possible to answer the study ques- acid on the healing of corneal ulcers in man. plained that low serum concentrations tion, but the use of a vitamin C placebo Br Med J. 1950;2:1145–1148. after oral therapy and the emergence of (of an unknown dosage) in the control resistance patterns should be considered 3. Cho YW, Yoo WS, Kim SJ, et al. Efficacy of arm was not the best choice. Vitamin C in evaluating the efficacy of oral therapy. systemic vitamin C supplementation in reducing (ascorbic acid) is known to affect corneal corneal opacity resulting from infectious We also proved that oral ketoconazole wound healing and has been shown to keratitis. Medicine (Baltimore). 2014;93:e125. given for 3 weeks was not associated accelerate the healing of deep corneal with any adverse effects. 2,3 ulcers. This could be a major con- We strongly feel that newer antifun- founding factor affecting the results gal agents and newer modes of drug of the study. administration must be studied to tackle Topical 5% Natamycin With 2. Moreover, this trial aimed to study the ef- this challenging infection. Oral Ketoconazole in fectiveness of oral ketoconazole as an adjuvant to topical treatment of deep fun- Filamentous Fungal Keratitis: gal keratitis. However, only a small pro- A Randomized portion of eyes had posterior stromal Revathi Rajaraman, MS (deep) involvement (13.8% in the control Controlled Trial arm and 22.8% in the study arm). Most eyes hadonlyhalf ofthe anterior stroma e thank the authors for taking interest involved, where systemic antifungal ther- REFERENCES W in our article and for raising relevant apy might not be of much added benefit. questions. We would like to address the 1. Cho YW, Yoo WS, Kim SJ, et al. Efficacy of Thus, it is difficult to conclude whether queries as follows: systemic vitamin C supplementation in reducing oral ketoconazole has any added benefit 1. The authors considered the use of vita- corneal opacity resulting from infectious in the treatment of deep ulcers. keratitis. Medicine (Baltimore). 2014;93:e125. min C as a placebo to be an inappro- priate choice, as this could have affected 2. Xie L, Zhai H, Zhao J, et al. Antifungal Although the authors studied an impor- the healing of corneal wounds. The role susceptibility for common pathogens of fungal tant question, the investigation failed to pro- of vitamin C in corneal healing after keratitis in Shandong Province, China. Am J vide convincing evidence for changing the burns is well established. However, when Ophthalmol. 2008;146:260–265. Asia-Pacific Journal of Ophthalmology  Volume 4, Number 6, November/December 2015 www.apjo.org 399 Copyright © 2015 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited. Downloaded from http://journals.lww.com/apjoo by BhDMf5ePHKbH4TTImqenVA5KvPVPZ0P5BEgU+IUTEfzO/GUWifn2IfwcEVVH9SSn on 06/03/2020

Journal

The Asia-Pacific Journal of OphthalmologyWolters Kluwer Health

Published: Dec 1, 2015

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