Kathryn J Ray1, Muthiah Srinivasan2, Jeena Mascarenhas2, Revathi Rajaraman3, Meenakshi Ravindran4, David V Glidden5, Catherine E Oldenburg6, Catherine Q Sun6, Michael E Zegans7, Stephen D McLeod8, Nisha R Acharya8, Thomas M Lietman9. 1. F. I. Proctor Foundation, University of California, San Francisco2Department of Epidemiology and Biostatistics, University of California, San Francisco. 2. Aravind Eye Care System, Madurai, India. 3. Aravind Eye Care System, Coimbatore, India. 4. Aravind Eye Care System, Tirunelveli, India. 5. Department of Epidemiology and Biostatistics, University of California, San Francisco. 6. F. I. Proctor Foundation, University of California, San Francisco. 7. Department of Surgery (Ophthalmology), Dartmouth Medical School, Lebanon, New Hampshire7Department of Microbiology and Immunology, Dartmouth Medical School, Lebanon, New Hampshire. 8. F. I. Proctor Foundation, University of California, San Francisco8Department of Ophthalmology, University of California, San Francisco. 9. F. I. Proctor Foundation, University of California, San Francisco2Department of Epidemiology and Biostatistics, University of California, San Francisco8Department of Ophthalmology, University of California, San Francisco.
Abstract
IMPORTANCE: Scarring from bacterial keratitis remains a leading cause of visual loss. OBJECTIVE: 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. MAIN OUTCOMES AND MEASURES: 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: There may be a benefit with adjunctive topical corticosteroids if application occurs earlier in the course of bacterial corneal ulcers.
RCT Entities:
IMPORTANCE: Scarring from bacterial keratitis remains a leading cause of visual loss. OBJECTIVE: 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. MAIN OUTCOMES AND MEASURES: 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. RESULTS: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. CONCLUSIONS AND RELEVANCE: There may be a benefit with adjunctive topical corticosteroids if application occurs earlier in the course of bacterial corneal ulcers.
Authors: Muthiah Srinivasan; Jeena Mascarenhas; Revathi Rajaraman; Meenakshi Ravindran; Prajna Lalitha; David V Glidden; Kathryn J Ray; Kevin C Hong; Catherine E Oldenburg; Salena M Lee; Michael E Zegans; Stephen D McLeod; Thomas M Lietman; Nisha R Acharya Journal: Arch Ophthalmol Date: 2011-10-10
Authors: Muthiah Srinivasan; Jeena Mascarenhas; Revathi Rajaraman; Meenakshi Ravindran; Prajna Lalitha; Kieran S O'Brien; David V Glidden; Kathryn J Ray; Catherine E Oldenburg; Michael E Zegans; John P Whitcher; Stephen D McLeod; Travis C Porco; Thomas M Lietman; Nisha R Acharya Journal: Am J Ophthalmol Date: 2013-10-01 Impact factor: 5.258
Authors: Prajna Lalitha; Muthiah Srinivasan; Revathi Rajaraman; Meenakshi Ravindran; Jeena Mascarenhas; Jeganathan Lakshmi Priya; Aileen Sy; Catherine E Oldenburg; Kathryn J Ray; Michael E Zegans; Stephen D McLeod; Thomas M Lietman; Nisha R Acharya Journal: Am J Ophthalmol Date: 2012-09-05 Impact factor: 5.258
Authors: Sumayya Ahmad; Michelle Lopez; Marwan Attala; Anat Galor; Natalie A Stanciu; Darlene Miller; Leejee Suh; Thomas Albini; Victor L Perez; Carol L Karp; Janet L Davis; Eduardo Alfonso; Richard K Forster; Guillermo Amescua Journal: Ocul Immunol Inflamm Date: 2017-10-17 Impact factor: 3.070
Authors: Nina Ni; Muthiah Srinivasan; Stephen D McLeod; Nisha R Acharya; Thomas M Lietman; Jennifer Rose-Nussbaumer Journal: Curr Opin Ophthalmol Date: 2016-07 Impact factor: 3.761