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Research Letter
December 2017

Evolution of Practice Patterns for the Treatment of Fungal Keratitis

Author Affiliations
  • 1Francis I. Proctor Foundation, University of California, San Francisco
  • 2Department of Ophthalmology, University of California, San Francisco
  • 3Department of Epidemiology and Biostatistics, University of California, San Francisco
  • 4Aravind Eye Care System, Madurai, India
  • 5Programme FSS, Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger
  • 6Department of Ophthalmology, Oregon Health Sciences University, Portland
  • 7Department of Ophthalmology & Vision Science, Eye Center, University of California, Davis
JAMA Ophthalmol. 2017;135(12):1448-1449. doi:10.1001/jamaophthalmol.2017.4763

The Mycotic Ulcer Treatment Trial I (MUTT I) demonstrated the superiority of natamycin compared with voriconazole for the treatment of filamentous fungal keratitis.1 This and other recent trials2,3 suggest that natamycin should be the treatment of choice for filamentous fungal keratitis. A survey of experts (approximately 800 surveyed; 92 respondents) conducted in 2007 found that most clinicians identified voriconazole as their preferred treatment.4 We present results of a subsequent survey with identical questions that was conducted to examine changes in practice patterns for fungal keratitis.

The 2007 (N = 92) and 2017 (N = 110) surveys were administered using internet-based survey tools to the Cornea Society’s kera-net listserv.4 Questions asked in 2007 and 2017 were identical and included subjects related to practice (eg, type, location, and number of fungal keratitis cases managed in the previous 5 years), actual use of topical and systemic treatments, and preferences for topical treatments. The surveys were self-report and not validated against actual practice. In 2007 and 2017, participants were allowed to select multiple actual and preferred topical and systemic therapies. In 2017, participants were additionally asked what their preference for topical therapy would be if they could only choose a single therapy and what that preference would be for ulcers caused by Fusarium and Aspergillus species. Ethical approval was obtained from the institutional review board at the University of California, San Francisco, which determined that informed consent was not required because no identifying data were collected.