Table 1.
Inclusion criteria (all must be met) | Exclusion criteria (any of the following) |
Stage 1 | |
1. Acute MK characterised by: | 1. Patients aged less than 18 years |
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2. Patients unable or unwilling to provide informed consent |
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3. Patients who do not have acute MK or where there is a more likely alternative diagnosis |
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2. Adults (18 years and older) | |
3. Able to provide informed consent | |
Stage 2 | |
1. Acute MK characterised by: | 1. Unwilling/unable to participate in trial and/or attend follow-up |
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2. Aged less than 18 years |
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3. Pregnancy: self-reported, or by urine pregnancy test if uncertain. |
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4. Breast feeding: self-reported |
2. Filamentous fungal hyphae visualised on smear microscopy and/or IVCM | 5. Prior topical antifungal treatment |
3. Agree to be randomised to either treatment arm and are able to give informed consent | 6. No light perception in the affected eye |
4. Agree to be followed up at 2 days, 1 week, 2 weeks, 3 weeks, 2 months and 3 months | 7. Fellow eye visual acuity <6/60 |
5. Adults (18 years and older) | 8. Acanthamoebic infection visualised by smear microscopy or IVCM |
9. Clinical evidence of herpetic keratitis | |
10. Known allergy to study medication (including preservatives) | |
11. Previous keratoplasty in the affected eye | |
12. Bilateral corneal ulcers | |
13. Very severe ulcers warranting immediate evisceration or conjunctival flap | |
14. Endophthalmitis |
IVCM, in vivo confocal microscopy; MK, microbial keratitis.