Risk factors for low vision related functioning in the Mycotic Ulcer Treatment Trial: a randomised trial comparing natamycin with voriconazole
Jennifer Rose-Nussbaumer, N Venkatesh Prajna, Tiruvengada Krishnan, Jeena Mascarenhas, Revathi Rajaraman, Muthiah Srinivasan, Anita Raghavan, Catherine E Oldenburg, Kieran S O'Brien, Kathryn J Ray, Travis C Porco, Stephen D McLeod, Nisha R Acharya, Jeremy D Keenan, Thomas M Lietman, Mycotic Ulcer Treatment Trial Group, Jennifer Rose-Nussbaumer, N Venkatesh Prajna, Tiruvengada Krishnan, Jeena Mascarenhas, Revathi Rajaraman, Muthiah Srinivasan, Anita Raghavan, Catherine E Oldenburg, Kieran S O'Brien, Kathryn J Ray, Travis C Porco, Stephen D McLeod, Nisha R Acharya, Jeremy D Keenan, Thomas M Lietman, Mycotic Ulcer Treatment Trial Group
Abstract
Background/aims: The Mycotic Ulcer Treatment Trial I (MUTT I) was a double-masked, multicentre, randomised controlled trial, which found that topical natamycin is superior to voriconazole for the treatment of filamentous fungal corneal ulcers. In this study, we determine risk factors for low vision-related quality of life in patients with fungal keratitis.
Methods: The Indian visual function questionnaire (IND-VFQ) was administered to MUTT I study participants at 3 months. Associations between patient and ulcer characteristics and IND-VFQ subscale score were assessed using generalised estimating equations.
Results: 323 patients were enrolled in the trial, and 292 (90.4%) completed the IND-VFQ at 3 months. Out of a total possible score of 100, the average VFQ score for all participants was 81.3 (range 0-100, SD 23.6). After correcting for treatment arm, each logMAR line of worse baseline visual acuity in the affected eye resulted in an average 1.2 points decrease on VFQ at 3 months (95% CI -1.8 to 0.6, p<0.001). Those who required therapeutic penetrating keratoplasty had an average of 25.2 points decrease on VFQ after correcting for treatment arm (95% CI -31.8 to -18.5, p<0.001). Study participants who were unemployed had on average 28.5 points decrease on VFQ (95% CI -46.9 to -10.2, p=0.002) after correcting for treatment arm.
Conclusions: Monocular vision loss from corneal opacity due to fungal keratitis reduced vision-related quality of life. Given the relatively high worldwide burden of corneal opacity, improving treatment outcomes of corneal infections should be a public health priority.
Trial registration number: Clinicaltrials.gov Identifier: NCT00996736.
Keywords: Cornea; Infection.
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Source: PubMed