Use of adjunctive topical corticosteroids in bacterial keratitis

Abstract

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.

Interventions and Outcomes in Patients with Infectious Pseudomonas scleritis: A 10-Year Perspective

“…The role of corticosteroids in the treatment of infectious scleritis remains controversial. 32 There can be a robust inflammatory response after microbial invasion of the eye wall, which itself can cause significant damage 33, 34 However, the timing, dosage, and delivery of corticosteroids in scleritis is not yet known. Our study is encouraging; as similar to the SCUT trial, we found no adverse effects of oral corticosteroids in our population.…”

Challenges of corneal infections

“…No significant benefit nor worsening effects were seen with corticosteroids. However, another sub-group analysis of SCUT focusing on cytotoxic (ExoU) vs invasive (ExoS) subtypes of P. aeruginosa revealed that adjunctive corticosteroid therapy initiated at 48 h after antibiotic treatment is beneficial for resolution of keratitis caused by invasive strains [68, 69]. …”

Acute exacerbation of staphylococcal catarrhal infiltration associated with treatment for Pseudomonas aeruginosa keratitis

“…In addition, the use of steroid eyedrops during hospitalization and the treatment for bacterial keratitis remains controversial, as this may lead to progression of corneal thinning or damage. [9] Two weeks after the initiation of treatment with 1% prednisone acetate eyedrops in the present case, marked thinning of the area in which Pseudomonas keratitis had developed was confirmed using anterior segment optical coherence tomography, although the infiltrates at the corneolimbal junction had not yet completely resolved.…”