title: Nocardia keratitis: clinical course and effect of corticosteroids.
abstract: OBJECTIVE
  To compare the clinical course of Nocardia species keratitis with keratitis resulting from other bacterial organisms and to assess the effect of corticosteroids as adjunctive therapy using data collected from the Steroids for Corneal Ulcers Trial.
  
  
  METHODS
  Subgroup analysis of a randomized controlled trial.
  
  
  METHODS
  setting: Multicenter randomized controlled trial. study population: Five hundred patients with bacterial keratitis randomized 1:1 to topical corticosteroid or placebo who had received at least 48 hours of topical moxifloxacin. intervention/observation procedure: Topical prednisolone phosphate 1% or placebo and clinical course of Nocardia keratitis. main outcome measures: Best spectacle-corrected visual acuity and infiltrate or scar size at 3 months from enrollment.
  
  
  RESULTS
  Of 500 patients enrolled in the trial, 55 (11%) had a Nocardia corneal ulcer. Patients with Nocardia ulcers had better presentation visual acuity compared with non-Nocardia ulcers (median Snellen visual acuity, 20/45, compared with 20/145; P < .001) and comparable 3-month visual acuity (median, 20/25, vs 20/40; P = .25). Nocardia ulcers had approximately 2 lines less of improvement in visual acuity compared with non-Nocardia ulcers (0.21 logarithm of the minimal angle of resolution; 95% confidence interval, 0.09 to 0.33 logarithm of the minimal angle of resolution; P = .001). This difference may reflect the better starting visual acuity in patients with Nocardia ulcers. In Nocardia ulcers, corticosteroids were associated with an average 0.4-mm increase in 3-month infiltrate or scar size (95% confidence interval, 0.03 to 0.77 mm; P = .03).
  
  
  CONCLUSIONS
  Nocardia ulcers responded well to treatment. They showed less overall improvement in visual acuity than non-Nocardia ulcers, but had better presentation acuity. Corticosteroids may be associated with worse outcomes.
authors.affiliation: Aravind Eye Care System, Madurai, India.
authors.forename: Prajna
authors.initials: P
authors.lastname: Lalitha
authors.forename: Muthiah
authors.initials: M
authors.lastname: Srinivasan
authors.forename: Revathi
authors.initials: R
authors.lastname: Rajaraman
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Ravindran
authors.forename: Jeena
authors.initials: J
authors.lastname: Mascarenhas
authors.forename: Jeganathan Lakshmi
authors.initials: JL
authors.lastname: Priya
authors.forename: Aileen
authors.initials: A
authors.lastname: Sy
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Ray
authors.forename: Michael E
authors.initials: ME
authors.lastname: Zegans
authors.forename: Stephen D
authors.initials: SD
authors.lastname: McLeod
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
authors.forename: Nisha R
authors.initials: NR
authors.lastname: Acharya
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001372:Aza Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D004311:Double-Blind Method; D015818:Eye Infections, Bacterial / Q000175:diagnosis / 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; D009615:Nocardia / Q000235:genetics / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016133:Polymerase Chain Reaction; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000890:Anti-Infective Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D005938:Glucocorticoids; D011804:Quinolines; C009022:prednisolone phosphate; D011239:Prednisolone; D000077266:Moxifloxacin