Use of adjunctive topical corticosteroids in bacterial keratitis.
OBJECTIVE
Topical corticosteroid use in the setting of infectious keratitis has been a controversial issue. The aim of this review is to provide an update on the evidence for use of topical corticosteroids in addition to antibiotics in bacterial keratitis.


RESULTS
Judicious use of steroids is postulated to limit the inflammatory component of bacterial keratitis, but can theoretically retard healing. Three small randomized controlled trials and one large-scale trial, the Steroids for Corneal Ulcers Trial, have provided the most recent evidence to address this debate. Adjunctive topical corticosteroids initiated after at least 48 h of antibiotic usage in cases of culture-proven bacterial keratitis appear generally safe in the treatment of bacterial keratitis. They may be beneficial in cases of severe ulcers especially when initiated early in the course of the infection, in non-Nocardia ulcers, and in certain Pseudomonas ulcers.


CONCLUSIONS
Several randomized controlled trials have greatly contributed to our understanding of the controversy over steroid use in the management of bacterial keratitis. Future studies are needed to confirm subgroup analysis findings and define optimal timing, dosage, and the most appropriate treatment populations.
aFrancis I. Proctor Foundation bDepartment of Ophthalmology, University of California San Francisco, San Francisco, California, USA cAravind Eye Hospital, Madurai, India dDepartment of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
Nina
N
Ni
Muthiah
M
Srinivasan
Stephen D
SD
McLeod
Nisha R
NR
Acharya
Thomas M
TM
Lietman
Jennifer
J
Rose-Nussbaumer
D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000188:drug therapy / Q000382:microbiology; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007634:Keratitis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D014792:Visual Acuity
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents