title: Comparison of antibiotic-only and antibiotic-steroid combination treatment in corneal ulcer patients: double-blinded randomized clinical trial.
abstract: OBJECTIVE
  To determine the benefit of early addition of corticosteroids to antibiotics in the treatment of corneal ulcers.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  Thirty eyes of 30 patients, over the age of 12 years, with bacterial corneal ulcer confirmed by culture.
  
  
  METHODS
  Patients were randomized before enrollment; 15 were treated with gatifloxacin (Zymar) and a masked placebo and the other 15 were treated with gatifloxacin and masked dexamethasone 0.1% (Maxidex). Primary outcome was residual ulcer size at 10 weeks based on digital photographs. Secondary outcomes included residual ulcer area by clinician estimate, visual acuity, VF-14 score, and time to healing.
  
  
  RESULTS
  All subjects (n = 30) demonstrated a reduction in ulcer size over the study period. There was no significant difference between the 2 groups in terms of the primary outcome. There was a significant difference between the 2 groups in 1 of the secondary outcomes. The mean residual ulcer size compared with the baseline by clinician estimate (slit-lamp) was -0.789 mm2 for the antibiotic-only group and -4.206 mm2 for the antibiotic-steroid group (p = 0.05). Among the other secondary outcomes there were no significant differences between the 2 groups.
  
  
  CONCLUSIONS
  No benefit was demonstrated in our primary outcome for using steroids in combination with antibiotic therapy in treatment of corneal ulcers. This study suggests that the early addition of steroids to the antibiotic treatment of corneal ulcers does not seem to be harmful when employed in a closely monitored clinical setting.
authors.affiliation: Department of Ophthalmology, University of Ottawa, Ottawa, Ont.
authors.forename: Jason
authors.initials: J
authors.lastname: Blair
authors.forename: William
authors.initials: W
authors.lastname: Hodge
authors.forename: Saeed
authors.initials: S
authors.lastname: Al-Ghamdi
authors.forename: Rita
authors.initials: R
authors.lastname: Balabanian
authors.forename: Beth
authors.initials: B
authors.lastname: Lowcock
authors.forename: Yi Irene
authors.initials: YI
authors.lastname: Pan
authors.forename: Hesham
authors.initials: H
authors.lastname: Sherif
authors.forename: Tahra
authors.initials: T
authors.lastname: AlMahmoud
authors.forename: Dean
authors.initials: D
authors.lastname: Fergusson
authors.forename: Allan
authors.initials: A
authors.lastname: Slomovic
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D003907:Dexamethasone / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D000077734:Gatifloxacin; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D005938:Glucocorticoids; D003907:Dexamethasone; D000077734:Gatifloxacin