Cho J, et al. - Experts compared oral voriconazole vs placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. They randomized the study participants to oral voriconazole vs oral placebo; all received topical antifungal drops. They included the patients with smear-positive filamentous fungal ulcers and visual acuity of 20/400 or worse who eventuated to therapeutic penetrating keratoplasty (TPK). In the treatment of severe filamentous fungal ulcers, adding oral voriconazole to topical antifungal agents seems to produce no effect. In many of these patients, the reason for the worsening clinical picture was infection rather than inflammation. A 10.64-fold more likeliness to be culture positive was seen in those who underwent TPK for lack of response to medical therapy than if the indication for surgery was perforation and this was statistically significant