Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India.
Department of Ophthalmology, College of Veterinary Medicine and Mason Eye Institute, School of Medicine, University of Missouri, Columbia, Missouri, USA.
J Ocul Pharmacol Ther. 2021 Oct;37(8):452-463. doi: 10.1089/jop.2021.0040. Epub 2021 Aug 26.
Microbial keratitis is devastating corneal morbidity with a variable spectrum of clinical manifestations depending on the infective etiology. Irrespective of the varied presentation delayed treatment can lead to severe visual impairment resulting from corneal ulceration, possible perforation, and subsequent scarring. Corticosteroids with a potent anti-inflammatory activity reduce host inflammation, thus minimizing resultant scarring while improving ocular symptoms. These potential effects of corticosteroids have been applied widely to treat various corneal diseases ranging from vernal keratoconjunctivitis to dry eye disease. However, antimicrobial therapy remains the mainstay of treatment in microbial keratitis, whereas the use of adjunctive topical corticosteroid therapy remains a matter of debate. Understandably, the use of topical corticosteroids is a double-edged sword with pros and cons in the treatment of microbial keratitis. Herein we review the rationale for and against the use and safety of topical corticosteroids in the treatment of infective keratitis. Important considerations, including type, dose, efficacy, the timing of initiation of corticosteroids, use of concomitant antimicrobial agents, and duration of corticosteroid therapy while prescribing corticosteroids for microbial keratitis, have been discussed. This review intends to provide new insights into the therapeutic utility of steroids as adjunctive treatment of corneal ulcer.
微生物性角膜炎是一种破坏性的角膜疾病，其临床表现因感染病因而异。无论表现形式如何，如果治疗不及时，都可能导致严重的视力损害，包括角膜溃疡、穿孔和随后的瘢痕形成。具有强大抗炎作用的皮质类固醇可减轻宿主炎症，从而最大限度地减少瘢痕形成，同时改善眼部症状。这些皮质类固醇的潜在作用已广泛应用于治疗各种角膜疾病，从春季角结膜炎到干眼症。然而，在微生物性角膜炎的治疗中，抗菌治疗仍然是主要方法，而局部皮质类固醇治疗的辅助应用仍然存在争议。可以理解的是，局部皮质类固醇的使用在治疗微生物性角膜炎时是一把双刃剑，既有优点也有缺点。本文综述了在治疗感染性角膜炎时使用和不使用局部皮质类固醇的理由和安全性。在为微生物性角膜炎开皮质类固醇处方时，还讨论了重要的考虑因素，包括皮质类固醇的类型、剂量、疗效、皮质类固醇开始使用的时间、与抗菌药物的联合使用以及皮质类固醇治疗的持续时间。本文旨在为类固醇作为角膜溃疡辅助治疗的治疗效果提供新的见解。
