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June 2011

Natamycin and Voriconazole in Fungal Keratitis—Reply

Author Affiliations

Author Affiliations: Aravind Eye Care System, Madurai, India (Drs N. V. Prajna, Mascarenhas, L. Prajna, and Srinivasan); Aravind Eye Care System, Pondicherry, India (Drs Krishnan and Reddy, and Mr Vaitilingam); F. I. Proctor Foundation (Drs Lee, McLeod, Porco, Lietman, and Acharya, and Mr Hong), Departments of Ophthalmology (Drs McLeod, Lietman, and Acharya) and Epidemiology and Biostatistics (Drs Porco and Lietman), and the Institute for Global Health (Dr Lietman), University of California, San Francisco; Departments of Surgery (Ophthalmology) and Microbiology and Immunology (Dr Zegans), Dartmouth Medical School, Lebanon, New Hampshire.

Arch Ophthalmol. 2011;129(6):805-820. doi:10.1001/archophthalmol.2011.98

In reply

We thank Das and colleagues for their comments on our article.1 Below are our responses to their 3 comments/questions.

We acknowledge that natamycin leaves a white residue on the surface of the eye, raising issues of whether treatment arm is truly masked in our trial. To overcome this, patients were examined first thing in the morning, prior to administration of medication, and ward nurses rinsed the eye with sterile saline prior to examination by the study ophthalmologist. More importantly, we were able to completely mask the primary outcome of 3-month best spectacle-corrected visual acuity. Certified visual acuity examiners measured the visual acuity at this time point and otherwise had no role in patient care. In addition, patients were no longer taking study medication at that time, so no residue was present.

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