Comparative Evaluation of Topical Monotherapy (Natamycin or Natasol) and Combination Therapy (Natamycin and Voriconazole) in Mild-Moderate Fungal Keratitis

Abstract

Purpose: To compare the efficacy of monotherapy (natamycin 5% or Natasol 1%) versus combination therapy (natamycin 5% and voriconazole 1%) in the treatment of mild-moderate fungal keratitis.

Methods: In a prospective, comparative, interventional study, 60 eyes of 60 patients with mild-moderate fungal keratitis were included and randomized in 3 groups based on the topical antifungal therapy received: group 1, natamycin 5%; group 2, Natasol 1% (1% w/v aqueous natamycin); and group 3, combination of natamycin 5% and voriconazole 1%.

Results: 51 of 60 cases (85%) resolved with medical management only. Trauma was the major predisposing factor. Aspergillus species was the most common organism isolated. There was comparable decrease in the corneal infiltrate area from 16.92 ± 7.24, 15.12 ± 7.15, and 20.39 ± 4.81 mm 2 in groups 1, 2, and 3, respectively ( P > 0.05) at all follow-ups [days 3, 7, 30, 60, and 90]. There was a trend of early reepithelization in the Natasol group. The area of epithelial defect was comparable at baseline among all 3 groups ( P = 0.24) and was statistically smaller in the Natasol group at 1-month follow-up ( P = 0.01). The duration to complete epithelization was shortest in the Natasol group (37 ± 10 days; P = 0.02) compared with group 1 (45 ± 12 days) and group 3 (49 ± 12 days). The corrected distance visual acuity improved significantly and comparably in all groups ( P = 0.4).

Conclusions: Topical Natasol 1% tends to shorten the time to complete epithelization in cases of mild-moderate fungal keratitis compared with topical natamycin 5% and combination therapy of natamycin 5% and voriconazole 1%.

Keywords: Natasol; fungal keratitis; natamycin; voriconazole.