Ray Kathryn J, Srinivasan Muthiah, Mascarenhas Jeena, Rajaraman Revathi, Ravindran Meenakshi, Glidden David V, Oldenburg Catherine E, Sun Catherine Q, Zegans Michael E, McLeod Stephen D, Acharya Nisha R, Lietman Thomas M
F. I. Proctor Foundation, University of California, San Francisco2Department of Epidemiology and Biostatistics, University of California, San Francisco.
Aravind Eye Care System, Madurai, India.
JAMA Ophthalmol. 2014 Jun;132(6):737-41. doi: 10.1001/jamaophthalmol.2014.292.
Scarring from bacterial keratitis remains a leading cause of visual loss.
To determine whether topical corticosteroids are beneficial as an adjunctive therapy for bacterial keratitis if given early in the course of infection.
DESIGN, SETTING, AND PARTICIPANTS: The Steroids for Corneal Ulcers Trial (SCUT) was a randomized, double-masked, placebo-controlled trial that overall found no effect of adding topical corticosteroids to topical moxifloxacin hydrochloride in bacterial keratitis. Here, we assess the timing of administration of corticosteroids in a subgroup analysis of the SCUT. We define earlier administration of corticosteroids (vs placebo) as addition after 2 to 3 days of topical antibiotics and later as addition after 4 or more days of topical antibiotics.
We assess the effect of topical corticosteroids (vs placebo) on 3-month best spectacle-corrected visual acuity in patients who received corticosteroids or placebo earlier vs later. Further analyses were performed for subgroups of patients with non-Nocardia keratitis and those with no topical antibiotic use before enrollment.
Patients treated with topical corticosteroids as adjunctive therapy within 2 to 3 days of antibiotic therapy had approximately 1-line better visual acuity at 3 months than did those given placebo (-0.11 logMAR; 95% CI, -0.20 to -0.02 logMAR; P = .01). In patients who had 4 or more days of antibiotic therapy before corticosteroid treatment, the effect was not significant; patients given corticosteroids had 1-line worse visual acuity at 3 months compared with those in the placebo group (0.10 logMAR; 95% CI, -0.02 to 0.23 logMAR; P = .14). Patients with non-Nocardia keratitis and those having no topical antibiotic use before the SCUT enrollment showed significant improvement in best spectacle-corrected visual acuity at 3 months if corticosteroids were administered earlier rather than later.
There may be a benefit with adjunctive topical corticosteroids if application occurs earlier in the course of bacterial corneal ulcers.
细菌性角膜炎造成的瘢痕仍是视力丧失的主要原因。
确定在感染早期给予局部用皮质类固醇作为细菌性角膜炎辅助治疗是否有益。
设计、地点和参与者：角膜溃疡类固醇试验（SCUT）是一项随机、双盲、安慰剂对照试验，总体上发现细菌性角膜炎患者在局部用盐酸莫西沙星基础上加用局部用皮质类固醇无效果。在此，我们在SCUT的亚组分析中评估皮质类固醇的给药时机。我们将早期给予皮质类固醇（与安慰剂相比）定义为在局部用抗生素2至3天后加用，而晚期定义为在局部用抗生素4天或更长时间后加用。
我们评估局部用皮质类固醇（与安慰剂相比）对早期或晚期接受皮质类固醇或安慰剂治疗患者3个月最佳矫正视力的影响。对非诺卡菌性角膜炎患者亚组以及入组前未使用局部用抗生素的患者进行了进一步分析。
在抗生素治疗2至3天内接受局部用皮质类固醇作为辅助治疗的患者，3个月时的视力比接受安慰剂的患者大约好1行（-0.11对数最小分辨角；95%置信区间，-0.20至-0.02对数最小分辨角；P = 0.01）。在皮质类固醇治疗前接受4天或更长时间抗生素治疗的患者中，效果不显著；接受皮质类固醇治疗的患者在3个月时的视力比安慰剂组患者差1行（0.10对数最小分辨角；95%置信区间，-0.02至0.23对数最小分辨角；P = 0.14）。非诺卡菌性角膜炎患者以及在SCUT入组前未使用局部用抗生素的患者，如果早期而非晚期给予皮质类固醇，3个月时最佳矫正视力有显著改善。
如果在细菌性角膜溃疡病程早期应用局部用皮质类固醇作为辅助治疗可能有益。
