Corticosteroids as a therapy for bacterial keratitis: an evidence-based review of ‘who, when and why’

Tallab, Raghad; Stone, Donald U.

doi:10.1136/bjophthalmol-2015-307955

Cited by 22 publications

(17 citation statements)

References 71 publications

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“…Corticosteroid therapy is used with the aim of reducing the host inflammatory response initiated by bacterial toxins and the lytic enzymes released by PMN, which obstructs corneal healing after infection [66]. However in P. aeruginosa keratitis, corticosteroid treatment may slow corneal wound healing, extend the infection period and induce stromal thinning and perforation.…”

Section: Corticosteroidsmentioning

confidence: 99%

Challenges of corneal infections

Hazlett

Suvas

McClellan

et al. 2016

Expert Review of Ophthalmology

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Introduction Ocular infections remain an important cause of blindness worldwide and represent a challenging public health concern. In this regard, microbial keratitis due to fungal, bacterial, or viral infection can result in significant vision loss secondary to corneal scarring or surface irregularity. Left untreated corneal perforation and endophthalmitis can result, leading to loss of the eye. Rigorously studied animal models of disease pathogenesis have provided novel information that suggests new modes of treatment that may be efficacious clinically and emerging clinical data is supportive of some of these discoveries. Areas covered This review focuses on advances in our understanding of disease pathogenesis in animal models and clinical studies and how these relate to improved clinical treatment. We also discuss a novel approach to treatment of microbial keratitis due to infection with these bacterial pathogens using PACK-CXL and recommend increased basic and clinical studies to address and refine the efficacy of this procedure. Expert commentary Because resistance to antibiotics has developed over time to these bacterial pathogens, caution must be exercised in treatment. Attractive novel modes of treatment that hold new promise for further investigation include lipid based therapy, as well as use of small molecules that bind deleterious specific host responsive molecules and use of microRNA based therapies.

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Section: Corticosteroidsmentioning

confidence: 99%

Challenges of corneal infections

Hazlett

Suvas

McClellan

et al. 2016

Expert Review of Ophthalmology

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“…In particular, topical corticosteroids are often used to reduce the host inflammatory response. Yet, controversy remains regarding the benefits and risks associated with this immunosuppressive therapy [ 9 , 10 ]. To this end, treatments are needed that both regulate the inflammatory response and promote corneal wound healing to resolve visual disturbances and improve quality of life.…”

Section: Introductionmentioning

confidence: 99%

Thymosin Beta-4 and Ciprofloxacin Adjunctive Therapy Improves Pseudomonas aeruginosa-Induced Keratitis

Carion

Ebrahim

Kracht

et al. 2018

Cells

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With increasing multidrug resistance and contraindication for corticosteroid use, the goal of this study was to develop thymosin beta-4 (Tβ4) as an adjunctive therapy to antibiotics for the treatment of bacterial keratitis that effectively promotes enhanced wound healing, host defense, and inflammation resolution. Disease outcome was assessed by clinical score, slit lamp photography, and histopathology. Cytokine profile, bacterial load, PMN infiltration, and Griess and reactive oxygen species (ROS) levels were determined. Adjunct Tβ4 treatment resulted in a significant improvement compared to PBS, Tβ4, and most remarkably, ciprofloxacin, correlating with changes in mediators of inflammation and wound healing. Collectively, these data provide evidence that wound healing is an essential aspect in the development of new therapies to treat corneal infection. Use of adjunctive Tβ4 provides a more efficacious approach for bacterial keratitis by addressing both the infectious pathogen and deleterious host response.

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“…Based on results of this pilot study, the Steroids for Corneal Ulcers Trial (SCUT) was initiated and published in 2012, and remains the largest randomized controlled trial on the topic to date [21]. In a recent review by Tallab and Stone [22], the authors concluded that, based on SCUT, there was level I evidence for a small benefit with the use of steroids in culture-proven non- Nocardia bacterial keratitis.…”

Section: Key Studiesmentioning

confidence: 99%

Use of adjunctive topical corticosteroids in bacterial keratitis

Srinivasan

McLeod

et al. 2016

Current Opinion in Ophthalmology

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Purpose of review 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. Recent findings 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. Summary 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.

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Corticosteroids as a therapy for bacterial keratitis: an evidence-based review of ‘who, when and why’

Cited by 22 publications

References 71 publications

Challenges of corneal infections

Challenges of corneal infections

Thymosin Beta-4 and Ciprofloxacin Adjunctive Therapy Improves Pseudomonas aeruginosa-Induced Keratitis

Use of adjunctive topical corticosteroids in bacterial keratitis

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