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Randomized Controlled Trial
. 2023 Jun;261(6):1639-1649.
doi: 10.1007/s00417-022-05969-z. Epub 2023 Jan 16.

Continuous voriconazole lavage in managing moderate and severe fungal keratitis: a randomized controlled trial

Yujia Gong  1   2 , Liwei Zhang  1   2 , Shaohua Liu  1   2 , Hongyan Zhang  1   2 , Li Peng  1   2 , Haoyu Li  1   2 , Shirui Dai  1   2 , Baihua Chen  3   4
Affiliations
Randomized Controlled Trial

Continuous voriconazole lavage in managing moderate and severe fungal keratitis: a randomized controlled trial

Yujia Gong et al. Graefes Arch Clin Exp Ophthalmol. 2023 Jun.

Abstract

Purpose: To assess the effectiveness and safety of continuous lavage with 1% voriconazole (CL) for moderate and severe fungal keratitis.

Methods: Thirty-one patients were randomized to receive topical eye drops either alone (T) or combined with continuous 1% voriconazole lavage (CL-T). The primary outcome was the cure rate at 3 months. The secondary outcomes were the 6-day efficacy, 3-day infiltration size and depth, hypopyon height, central corneal thickness (CCT), epithelial defect size, and subject feelings and clinical signs assessment scores.

Results: At 3 months, the cure rate was comparable between the groups in patients with moderate fungal keratitis (66.7% vs. 62.5%, P = 0.60). However, among severe cases, 4 cases (44.4%) in the CL-T group healed successfully, while none in the T group; this difference was not significant (P = 0.08), although it was very close to 0.05. This may be related to the small sample size. After 6 days, the percentage of patients with "worsened" ulcers in the CL-T group was lower than that in the T group (0% vs. 31%, P = 0.043). The infiltration size, infiltration depth, and hypopyon height in the CL-T group were smaller than those in the T group after 3 days (all P < 0.05). There was no difference in CCT, epithelial defect size, subject feelings scores, or clinical signs scores between groups.

Conclusion: These outcomes suggest that CL is an effective and safe adjuvant method for controlling the progression of moderate and severe fungal keratitis.

Trial registration number: ChiCTR2100050565.

Keywords: Continuous lavage; Effectiveness; Fungal keratitis; Safety.

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References

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