title: Corticosteroids for bacterial keratitis: the Steroids for Corneal Ulcers Trial (SCUT).
abstract: OBJECTIVE
  To determine whether there is a benefit in clinical outcomes with the use of topical corticosteroids as adjunctive therapy in the treatment of bacterial corneal ulcers.
  
  
  METHODS
  Randomized, placebo-controlled, double-masked, multicenter clinical trial comparing prednisolone sodium phosphate, 1.0%, to placebo as adjunctive therapy for the treatment of bacterial corneal ulcers. Eligible patients had a culture-positive bacterial corneal ulcer and received topical moxifloxacin for at least 48 hours before randomization.
  
  
  METHODS
  The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 3 months from enrollment. Secondary outcomes included infiltrate/scar size, reepithelialization, and corneal perforation.
  
  
  RESULTS
  Between September 1, 2006, and February 22, 2010, 1769 patients were screened for the trial and 500 patients were enrolled. No significant difference was observed in the 3-month BSCVA (-0.009 logarithm of the minimum angle of resolution [logMAR]; 95% CI, -0.085 to 0.068; P = .82), infiltrate/scar size (P = .40), time to reepithelialization (P = .44), or corneal perforation (P > .99). A significant effect of corticosteroids was observed in subgroups of baseline BSCVA (P = .03) and ulcer location (P = .04). At 3 months, patients with vision of counting fingers or worse at baseline had 0.17 logMAR better visual acuity with corticosteroids (95% CI, -0.31 to -0.02; P = .03) compared with placebo, and patients with ulcers that were completely central at baseline had 0.20 logMAR better visual acuity with corticosteroids (-0.37 to -0.04; P = .02).
  
  
  CONCLUSIONS
  We found no overall difference in 3-month BSCVA and no safety concerns with adjunctive corticosteroid therapy for bacterial corneal ulcers.
  
  
  CONCLUSIONS
  Adjunctive topical corticosteroid use does not improve 3-month vision in patients with bacterial corneal ulcers.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00324168.
authors: Departments of Cornea and External Diseases, Aravind Eye Care System, Madurai, India.
authors: Muthiah
authors: M
authors: Srinivasan
authors: Jeena
authors: J
authors: Mascarenhas
authors: Revathi
authors: R
authors: Rajaraman
authors: Meenakshi
authors: M
authors: Ravindran
authors: Prajna
authors: P
authors: Lalitha
authors: David V
authors: DV
authors: Glidden
authors: Kathryn J
authors: KJ
authors: Ray
authors: Kevin C
authors: KC
authors: Hong
authors: Catherine E
authors: CE
authors: Oldenburg
authors: Salena M
authors: SM
authors: Lee
authors: Michael E
authors: ME
authors: Zegans
authors: Stephen D
authors: SD
authors: McLeod
authors: Thomas M
authors: TM
authors: Lietman
authors: Nisha R
authors: NR
authors: Acharya
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001372:Aza Compounds / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D003315:Cornea / Q000382:microbiology; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011804:Quinolines / Q000627:therapeutic use*; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D000890:Anti-Infective Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D005938:Glucocorticoids; D011804:Quinolines; C009022:prednisolone phosphate; D011239:Prednisolone; D000077266:Moxifloxacin