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- Title
Association of Postfungal Keratitis Corneal Scar Features With Visual Acuity.
- Authors
Menda, Shivali A; Das, Manoranjan; Panigrahi, Arun; Prajna, N Venkatesh; Acharya, Nisha R; Lietman, Thomas M; McLeod, Stephen D; Keenan, Jeremy D
- Abstract
<bold>Importance: </bold>Corneal opacity is a leading cause of visual impairment worldwide; however, the specific features of corneal scars, which decrease visual acuity, have not been well characterized.<bold>Objective: </bold>To investigate which features of a postfungal keratitis corneal scar contribute to decreased visual acuity after an episode of infectious keratitis and evaluate whether any corneal features may be used as outcomes for clinical trials.<bold>Design, Setting, and Participants: </bold>In this ancillary, prospective cross-sectional study, a subset of study participants treated for fungal keratitis (n = 71) as part of the Mycotic Ulcer Treatment Trial I (MUTT I) underwent best spectacle-corrected visual acuity (BSCVA) and best contact lens-corrected visual acuity examination, Scheimpflug imaging, and anterior segment optical coherence tomography at a referral hospital in India approximately 2 years after enrollment. Data were collected from December 3, 2012, to December 19, 2012, and analyses were performed from December 2, 2013, to October 2, 2019.<bold>Main Outcomes and Measures: </bold>Linear regression models were used to evaluate the importance of various corneal features for BSCVA and to assess whether these features could be used to differentiate the 2 treatment arms of the MUTT I trial.<bold>Results: </bold>Seventy-one patients (42 men [59.1%]; median age, 48 [range, 39-60] years) were examined at a median (IQR) time of 1.8 (1.4-2.2) years after enrollment. The mean (SD) logMAR BSCVA was 0.17 (0.19) (Snellen equivalent, 20/32). In multivariable linear regression models, BSCVA was most associated with irregular astigmatism (1.0 line of worse BSCVA per 1-line difference between BSCVA and contact lens visual acuity; 95% CI, 0.6-1.4) and corneal scar density (1.5 lines of worse vision per 10-unit increase in the mean central corneal density; 95% CI, 0.8-2.3). The thinnest point of the cornea was the metric that best discriminated between the natamycin- and voriconazole-treated ulcers in MUTT I, with 29.3 μm (95% CI, 7.1-51.6 μm) less thinning in natamycin-treated eyes.<bold>Conclusions and Relevance: </bold>Both irregular astigmatism and corneal scar density may be important risk factors for BSCVA in a population with relatively mild, healed fungal corneal ulcers. The thinnest point of the corneal scar may be a cornea-specific outcome that could be used to evaluate treatments for corneal ulcers.
- Subjects
CORNEA injuries; RESEARCH; CROSS-sectional method; RESEARCH methodology; EVALUATION research; MEDICAL cooperation; COMPARATIVE studies; VISUAL acuity; MYCOSES; EYE infections; RESEARCH funding; KERATITIS; LONGITUDINAL method; CORNEA
- Publication
JAMA Ophthalmology, 2020, Vol 138, Issue 2, p113
- ISSN
2168-6165
- Publication type
journal article
- DOI
10.1001/jamaophthalmol.2019.4852