Topical Steroids and Antibiotics for Adult Blepharokeratoconjunctivitis (BKC): A Meta-Analysis of Randomized Clinical Trials

Abstract

Purpose. A meta-analysis was conducted to evaluate the efficacy and safety of topical treatments (including steroids and antibiotics) for adults with blepharokeratoconjunctivitis (BKC). Methods. The following databases were searched for relevant randomised controlled trials (RCTs): China National Knowledge Infrastructure (CNKI), Web of Science, MEDLINE, PubMed, Embase, and Cochrane Central Register of Controlled Trials database (CENTRAL). Two reviewers selected studies and analyzed the risk of bias independently. The treatments were loteprednol 0.5%/tobramycin 0.3% (LE/T) and dexamethasone 0.1%/tobramycin 0.3% (DM/T). The efficacy outcome measures were change from baseline (CFB) in composite scores of ocular symptoms and signs; the CFB in the signs composite scores for blepharitis, conjunctivitis, and keratitis at each visit; the total ocular adverse event incidence (AEs); and the incidence of intraocular pressure (IOP) increase after treatment. Prepost mean differences (MDs) were compared for continuous outcome variables, and incidences were analyzed for dichotomous data. The pooled effect sizes were analyzed using 95% confidence intervals (CIs) in a fixed-effect model. Heterogeneity was evaluated using the Q-test and I2 statistic. Results. The CFB to final visit in ocular symptoms and signs of BKC was not statistically different between the two treatments (95% CI, −0.33 to 1.50; MD = 0.58; P = 0.21 ). The CFB in signs composite scores for blepharitis (95% CI, −0.16 to 0.48; MD = 0.16; P = 0.32 ), conjunctivitis (95% CI, −0.55 to 1.76; MD = 0.61; P = 0.30 ), and keratitis (95% CI, 0.00–0.28; MD = 0.14; P = 0.05 ) was also similar with the two treatments. LE/T was a safer intervention than DM/T, with fewer overall adverse events (95% CI, 0.34–0.80; RR = 0.52; P = 0.003 ) and significantly less elevation of intraocular pressure (IOP) (95% CI, 0.32–0.70; RR = 0.47; P = 0.0002 ). Conclusions. DM/T and LE/T are both effective treatments for BKC, but LE/T may be a safer intervention.

Review of Loteprednol Etabonate 0.5%/Tobramycin 0.3% in the Treatment of Blepharokeratoconjunctivitis

“…The literature search identified ten relevant journal articles, six of which featured clinical trials [21][22][23][24][25][26], while three featured pooled analyses or metaanalyses of study data [11,27,28]. An additional conference abstract was identified featuring a study not found in full manuscript form [29].…”

“…Zhao and colleagues (2021) performed a meta-analysis of published randomized controlled trials of topical steroid and antibiotics for adults with BKC [ 28 ]. Of the 43 studies considered, only the 2 summarized above [ 24 , 25 ] met the authors’ inclusion criteria.…”

“…Two large randomized studies demonstrated comparable anti-inflammatory effects of LE/T and DM/T instilled QID in adults with BKC [ 24 , 25 ]. In addition, a pooled analysis of blepharitis data from these two studies showed similar efficacy of LE/T and DM/T, both given QID, for reducing signs of blepharitis [ 27 ], while a recent meta-analysis of all data from these two studies confirmed no differences in improvements in BKC signs and symptoms composite score or in individual blepharitis, keratitis, and conjunctivitis scores between treatments, but fewer IOP elevations with LE/T [ 28 ]. Findings from a small single-center study did not replicate the outcomes of these multicenter trials but utilized a reduced dosing regimen inconsistent with the FDA approved dosing recommendations [ 21 ].…”

Liposomal ozonated oil effectiveness in the signs and symptoms of blepharitis in usual clinical practice

“…2 Topical antibiotics are used in acute blepharitis and anterior blepharitis providing symptomatic relief and bacteria eradication from the lid margin, while oral antibiotics are used to treat posterior blepharitis for their anti-inflammatory and lipid regulating properties. [3][4][5] Topical steroids are beneficial in patients with ocular inflammation due to their anti-inflammatory effect and are usually used in combination with antibiotics in moderate to severe blepharitis. 3 Thermal pulsation and intense pulsed light (IPL) therapy are also used to treat posterior blepharitis due to meibomian gland dysfunction, and a recent study on the combination of IPL and Low-Level light Therapy has shown superior efficacy and safety compared to topical treatment with hyaluronate sodium after 6 months of treatment.…”

Safety and Feasibility of Low Fluence Intense Pulsed Light for Treating Pediatric Patients with Moderate-to-Severe Blepharitis

“…However, some methods can cause great discomfort, such as eyelid massage and topical cyclosporine drops, which hardly gets full cooperation from both children and parents. Topical antibiotics/steroids are common usage for the treatment of BKC [ 5 , 6 ]. Nevertheless, the elevation of intraocular pressure and other side effects of steroids restrict their further applications [ 7 ].…”