Corticosteroids for Bacterial Keratitis

Srinivasan, Muthiah; Mascarenhas, Jeena; Rajaraman, Revathi; Ravindran, Meenakshi; Lalitha, Prajna; Glidden, David V.; Ray, Kathryn J.; Hong, Kevin C.; Oldenburg, Catherine E.; Lee, Salena M.; Zegans, Michael E.; McLeod, Stephen D.; Lietman, Thomas M.; Acharya, Nisha R.

doi:10.1001/archophthalmol.2011.315

Cited by 176 publications

(69 citation statements)

References 30 publications

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“…SCUT was a randomized, double-masked, placebo-controlled clinical trial that compared adjunctive topical corticosteroids to placebo in the treatment of bacterial corneal ulcers. 61 Five hundred study participants with culture-positive bacterial ulcers were enrolled at Aravind Eye Hospitals in Madurai, Coimbatore, and Tirunelveli, India, the University of California, San Francisco, and at the Dartmouth-Hitchcock Medical Center in New Hampshire. Patients were randomized to receive either topical prednisolone sodium phosphate 1.0% or topical placebo starting after a 48-hour course of topical moxifloxacin 0.5%.…”

Section: Bacterial Keratitismentioning

confidence: 99%

Update on the Management of Infectious Keratitis

2017

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Infectious keratitis is a major global cause of visual impairment and blindness, often affecting marginalized populations. Proper diagnosis of the causative organism is critical, and while culture remains the prevailing diagnostic tool, newer techniques such as in vivo confocal microscopy are helpful for diagnosing fungal keratitis and Acanthameoba. Next generation sequencing holds the potential for early and accurate diagnosis even for organisms that are difficult to culture by conventional methods. Topical antibiotics remain the best treatment for bacterial keratitis, and a recent review found all commonly prescribed topical antibiotics to be equally effective. However outcomes remain poor secondary to corneal melting, scarring and perforation. Adjuvant therapies aimed at reducing the immune response responsible for much of the morbidity associated with keratitis include topical corticosteroids. The large, randomized controlled Steroids for Corneal Ulcers trial found that while steroids provided no significant improvement overall, they did appear beneficial for ulcers that were central, deep or large, non-Nocardia or classically invasive P. aeruginosa, patients with low baseline vision, and when started early after the initiation of antibiotics. Fungal ulcers often have worse clinical outcomes than bacterial ulcers, with no new treatments since the 1960’s when topical natamycin was introduced. The randomized controlled Mycotic Ulcer Treatment Trial showed a benefit of topical natamycin over topical voriconazole for fungal keratitis, particularly among those caused by Fusarium. The second Mycotic Ulcer Treatment Trial showed that oral voriconazole did not improve outcomes overall although there may have been some effect among Fusarium ulcers. Given an increase in non-serious adverse events the authors concluded that they could not recommend oral voriconazole at this time. Viral keratitis differs from bacterial and fungal cases in that is often recurrent and is common in developed countries. The first Herpetic Eye Disease Study (HEDS) showed a significant benefit of topical corticosteroids and oral acyclovir for stromal keratitis. HEDS II showed that oral acyclovir decreased the recurrence of any type of HSV keratitis by approximately half. Future strategies to reduce the morbidity associated with infectious keratitis are likely to be multidimensional with adjuvant therapies aimed at modifying the immune response to infection holding the greatest potential to improve clinical outcomes.

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Section: Bacterial Keratitismentioning

confidence: 99%

Update on the Management of Infectious Keratitis

2017

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“…Topical and systemic steroids were used as adjunctive therapy. Corticosteroids are thought to reduce immune-mediated damage and a recent randomized, placebo-controlled, doublemasked, multicenter clinical trial on 500 patients showed that patients with severe ulcers, who have the most to gain in terms of visual acuity, may benefit from the use of corticosteroids as adjunctive therapy, without major safety concerns [6]. However, in our case despite prompt therapy visual impairment persisted 7 months after PRK.…”

Section: Discussionmentioning

confidence: 55%

Bilateral methicillin-resistant Staphylococcus aureus keratitis following hyperopic photorefractive surgery

et al. 2012

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To report clinical manifestations of a female patient with bilateral bacterial keratitis following photorefractive keratectomy (PRK). Bilateral PRK was performed for moderate hyperopia. Bandage contact lenses were fitted at the conclusion of the surgery. Bilateral infectious keratitis with hypopion was diagnosed within 4 days after surgery. Smear and culture were obtained and showed the presence of methicillin-resistant Staphylococcus aureus (MRSA). The patient was treated with systemic prednisone and topical antibiotics (vancomycin, tobramycin and netylmicin) and betamethasone. After 1 month corneal leukoma was still present and remained unchanged during the following 7 months. Infectious keratitis is a rare complication of PRK that appears early in the postoperative period. MRSA keratitis may determine long-term visual impairment despite prompt therapeutic intervention.

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“…6,7 A potential limitation to the SCUT may have been that corticosteroids or placebo were not administered early enough to show a difference across all degrees of ulcer severity. 1,10 Approximately one-third of SCUT patients received topical antibiotics for longer than 4 days before corticosteroid or placebo administration.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Of the 500 patients included in SCUT, 8 were excluded from the analysis because of missing data specifying the duration of antibiotic treatment before receiving the corticosteroid or placebo. On presentation, screened patients with corneal ulcers were immediately treated with moxifloxacin hydrochloride every hour while awake for the first 48 hours, then every 2 hours until enrolled in the study.…”

Section: Methodsmentioning

confidence: 99%

“…1–5 A recent randomized clinical trial comparing corticosteroids with placebo as an adjunctive therapy found no difference in best spectacle-corrected visual acuity (BSCVA) at 3 months when all patients were analyzed. 6,7 The same trial found benefit with corticosteroid use in the subgroups with more severe ulcers (defined by enrollment visual acuity and the ulcer’s size, depth, or location) and in BSCVA at 12 months among patients with ulcers caused by non- Nocardia species. 8,9 Some argue that the Steroids for Corneal Ulcers Trial (SCUT) started corticosteroid application too late in the course of the ulcer and that an overall difference would have been seen if corticosteroids had been started earlier.…”

mentioning

confidence: 95%

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