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Association of Postfungal Keratitis Corneal Scar Features With Visual Acuity.

Abstract

Importance

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.

Objective

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.

Design, Setting, and Participants

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.

Main Outcomes and Measures

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.

Results

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.

Conclusions and Relevance

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.

Authors+Show Affiliations

Department of Ophthalmology, University of Washington, Seattle.Department of Cornea and Refractive Surgery, Aravind Eye Care System, Madurai, India.Department of Cornea and Refractive Surgery, Aravind Eye Care System, Madurai, India.Department of Cornea and Refractive Surgery, Aravind Eye Care System, Madurai, India.Department of Ophthalmology, University of California, San Francisco, San Francisco. Francis I. Proctor Foundation, University of California, San Francisco, San Francisco.Department of Ophthalmology, University of California, San Francisco, San Francisco. Francis I. Proctor Foundation, University of California, San Francisco, San Francisco. Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco. Institute for Global Health, University of California, San Francisco, San Francisco.Department of Ophthalmology, University of California, San Francisco, San Francisco. Francis I. Proctor Foundation, University of California, San Francisco, San Francisco.Department of Ophthalmology, University of California, San Francisco, San Francisco. Francis I. Proctor Foundation, University of California, San Francisco, San Francisco.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31804657

Citation

Menda, Shivali A., et al. "Association of Postfungal Keratitis Corneal Scar Features With Visual Acuity." JAMA Ophthalmology, 2019.
Menda SA, Das M, Panigrahi A, et al. Association of Postfungal Keratitis Corneal Scar Features With Visual Acuity. JAMA Ophthalmol. 2019.
Menda, S. A., Das, M., Panigrahi, A., Prajna, N. V., Acharya, N. R., Lietman, T. M., ... Keenan, J. D. (2019). Association of Postfungal Keratitis Corneal Scar Features With Visual Acuity. JAMA Ophthalmology, doi:10.1001/jamaophthalmol.2019.4852.
Menda SA, et al. Association of Postfungal Keratitis Corneal Scar Features With Visual Acuity. JAMA Ophthalmol. 2019 Dec 5; PubMed PMID: 31804657.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Postfungal Keratitis Corneal Scar Features With Visual Acuity. AU - Menda,Shivali A, AU - Das,Manoranjan, AU - Panigrahi,Arun, AU - Prajna,N Venkatesh, AU - Acharya,Nisha R, AU - Lietman,Thomas M, AU - McLeod,Stephen D, AU - Keenan,Jeremy D, Y1 - 2019/12/05/ PY - 2020/12/05/pmc-release PY - 2019/12/6/entrez PY - 2019/12/6/pubmed PY - 2019/12/6/medline JF - JAMA ophthalmology JO - JAMA Ophthalmol N2 - Importance: 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. Objective: 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. Design, Setting, and Participants: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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. SN - 2168-6173 UR - https://www.unboundmedicine.com/medline/citation/31804657/Association_of_Postfungal_Keratitis_Corneal_Scar_Features_With_Visual_Acuity L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2019.4852 DB - PRIME DP - Unbound Medicine ER -