Clinical Trial: Mycotic Antimicrobial Localized Injection for Treatment of Corneal Ulcers

Study Status: Enrolling by invitation
Recruit Status: Enrolling by invitation
Study Type: Interventional

Official Title:

Brief Summary: Mycotic Antimicrobial Localized Injection (MALIN) is a randomized, masked, two-arm clinical trial investigating intrastromal voriconazole in the treatment of fungal corneal ulcers. There is currently little evidence to guide the treatment of fungal keratitis beyond topical anti-fungal drops, though intrastromal voriconazole and oral antifungal treatments are used as well. This study will provide evidence to guide the treatment of fungal keratitis in the future. The purpose of this study is to determine differences in microbiological cure for 3-day repeat cultures between different antifungal treatments. For this study, there will be 1:1 randomization to one of these two treatment groups: 1) topical natamycin plus intrastromal voriconazole injection or 2) topical natamycin alone.

Detailed Summary:

The proposed study is a randomized controlled trial to determine whether intrastromal voriconazole improves outcomes in fungal keratitis. Patients presenting to the Aravind Eye Hospitals in Pondicherry, India for treatment of fungal keratitis will be recruited for the proposed study. Approximately 70 patients will be enrolled in the study. Subjects presenting with fungal keratitis will be randomized to receive topical natamycin plus intrastromal voriconazole or to receive topical natamycin alone. Subjects may also receive oral antifungals after day 3 at the discretion of the treating clinician. All study subjects will be followed for 3 months to evaluate response to treatment.

Investigators from the University of California, San Francisco (UCSF) will assist Aravind Eye Hospital with the study design, implementation, and analysis of the research, and will help fund the study. The investigators will visit Aravind to help with the study implementation. UCSF will play an important role in this study by assisting with the study design, implementation, analysis, and funding.


Sponsor: University of California, San Francisco

Current Primary Outcome: Culture positivity at day 3 using potassium hydroxide (KOH) wet mount to test for fungus [ Time Frame: 3 days ]

Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Best spectacle-corrected visual acuity, as measured by a refractionist [ Time Frame: 3 months ]
  • Scar size, as measured by clinical exam, slit lamp photographs, and optical coherence tomography (OCT) [ Time Frame: 6 months ]
  • Scar depth, as measured by clinical exam, slit lamp photographs, and OCT [ Time Frame: 6 months ]
  • Adverse events including rate of perforation/need for therapeutic penetrating keratoplasty (TPK) [ Time Frame: 6 months ]
  • Corneal thinning, as measured by pachymetry and OCT [ Time Frame: 6 months ]
  • Corneal topography, as measured by a non-contact imaging topographer [ Time Frame: 6 months ]
  • Change in quality of life, measured by the Indian Vision Function Questionnaire (IND-VFQ) [ Time Frame: 3 months ]
  • Corneal neovascularization, as measured by clinical examination and slit lamp photographs [ Time Frame: 6 months ]


Original Secondary Outcome: Same as current

Information By: University of California, San Francisco

Dates:
Date Received: March 14, 2016
Date Started: September 2016
Date Completion: August 2020
Last Updated: April 18, 2017
Last Verified: April 2017