Title : Clinical efficacy and comparative evaluation of topical caspofungin vs Topical natamycin in fungal keratitis
Abstract:
Purpose: To compare the clinical Efficacy of Topical Caspofungin vs Topical Natamycin in Fungal Keratitis.
Methods: Randomised Comparative Trial (Pilot study) of 20 eyes of 20 patients with fungal keratitis (KOH smear/ confocal microscopy / Culture positive fungal keratitis). The patients were randomized to receive either topical Caspofungin 0.5% (n = 10) or topical Natamycin5% (n = 10), both given 1 hourly during the day and night initially, and once the infiltrate started resolving, the frequency reduced to 2-hourly and then tapered according to the clinical response. Primary outcome measure was duration of healing and secondary outcome measures were best corrected visual acuity after complete healing, scar size after complete healing and percentage of healed keratitis [rate of healing].
Results: The total healing time for Caspofungin group was 45.55 ± 3.90 (41-49) days and for Natamycin group was 53.87 ± 3.62 (50-56) days and was comparable in both the groups (p value = 0.273). The best corrected visual acuity after complete healing in the Caspofungin group in logMAR was 0.93± 0.57 (0.36-1.5) and for the patients in Natamycin group was 1.04 ±0.68 (0.36-1.72) and was comparable (p value= 0.700). The scar size in the Caspofungin group was 4.07 x 3.75mm and in the Natamycin group was 3.8 x 3.4mm and was comparable (p value = 0.348). 80% of eyes healed on medical management in each group. In the Caspofungin group, out of the 2 (20%) patients which were medical treatment failure, 1 case of Fusarium keratitis needed therapeutic keratoplasty and another case of Fusarium keratitis resolved on crossover to the Natamycin group. In the Natamycin group, out of the 2 (20%) patients which needed therapeutic keratoplasty, one was Fusarium and the other was Aspergillus.
Conclusion: Topical Caspofungin has comparable duration of healing, percentage of healing and BCVA after healing with topical Natamycin and therefore found to be as good as Natamycin in resolution of fungal keratitis. Although the sample size was very small, this study along with some other reports does indicate towards non-inferiority of Caspofungin to Natamycin. However prospective randomized studies with larger sample size might provide greater insight towards this subject.
