Early addition of topical corticosteroids in the treatment of bacterial keratitis.
OBJECTIVE
Scarring from bacterial keratitis remains a leading cause of visual loss.


OBJECTIVE
To determine whether topical corticosteroids are beneficial as an adjunctive therapy for bacterial keratitis if given early in the course of infection.


METHODS
The Steroids for Corneal Ulcers Trial (SCUT) was a randomized, double-masked, placebo-controlled trial that overall found no effect of adding topical corticosteroids to topical moxifloxacin hydrochloride in bacterial keratitis. Here, we assess the timing of administration of corticosteroids in a subgroup analysis of the SCUT. We define earlier administration of corticosteroids (vs placebo) as addition after 2 to 3 days of topical antibiotics and later as addition after 4 or more days of topical antibiotics.


METHODS
We assess the effect of topical corticosteroids (vs placebo) on 3-month best spectacle-corrected visual acuity in patients who received corticosteroids or placebo earlier vs later. Further analyses were performed for subgroups of patients with non-Nocardia keratitis and those with no topical antibiotic use before enrollment.


RESULTS
Patients treated with topical corticosteroids as adjunctive therapy within 2 to 3 days of antibiotic therapy had approximately 1-line better visual acuity at 3 months than did those given placebo (-0.11 logMAR; 95% CI, -0.20 to -0.02 logMAR; P = .01). In patients who had 4 or more days of antibiotic therapy before corticosteroid treatment, the effect was not significant; patients given corticosteroids had 1-line worse visual acuity at 3 months compared with those in the placebo group (0.10 logMAR; 95% CI, -0.02 to 0.23 logMAR; P = .14). Patients with non-Nocardia keratitis and those having no topical antibiotic use before the SCUT enrollment showed significant improvement in best spectacle-corrected visual acuity at 3 months if corticosteroids were administered earlier rather than later.


CONCLUSIONS
There may be a benefit with adjunctive topical corticosteroids if application occurs earlier in the course of bacterial corneal ulcers.
F. I. Proctor Foundation, University of California, San Francisco2Department of Epidemiology and Biostatistics, University of California, San Francisco.
Kathryn J
KJ
Ray
Aravind Eye Care System, Madurai, India.
Muthiah
M
Srinivasan
Aravind Eye Care System, Madurai, India.
Jeena
J
Mascarenhas
Aravind Eye Care System, Coimbatore, India.
Revathi
R
Rajaraman
Aravind Eye Care System, Tirunelveli, India.
Meenakshi
M
Ravindran
Department of Epidemiology and Biostatistics, University of California, San Francisco.
David V
DV
Glidden
F. I. Proctor Foundation, University of California, San Francisco.
Catherine E
CE
Oldenburg
F. I. Proctor Foundation, University of California, San Francisco.
Catherine Q
CQ
Sun
Department of Surgery (Ophthalmology), Dartmouth Medical School, Lebanon, New Hampshire7Department of Microbiology and Immunology, Dartmouth Medical School, Lebanon, New Hampshire.
Michael E
ME
Zegans
F. I. Proctor Foundation, University of California, San Francisco8Department of Ophthalmology, University of California, San Francisco.
Stephen D
SD
McLeod
F. I. Proctor Foundation, University of California, San Francisco8Department of Ophthalmology, University of California, San Francisco.
Nisha R
NR
Acharya
F. I. Proctor Foundation, University of California, San Francisco2Department of Epidemiology and Biostatistics, University of California, San Francisco8Department of Ophthalmology, University of California, San Francisco.
Thomas M
TM
Lietman
D000287:Administration, Topical; D000328:Adult; D001372:Aza Compounds / Q000008:administration & dosage*; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D024841:Fluoroquinolones; D005500:Follow-Up Studies; D006801:Humans; D007634:Keratitis / Q000188:drug therapy* / Q000382:microbiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D015999:Multivariate Analysis; D011239:Prednisolone / Q000008:administration & dosage*; D011804:Quinolines / Q000008:administration & dosage*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D011239:Prednisolone; D000077266:Moxifloxacin