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Role of steroids in the treatment of bacterial keratitis
Authors Palioura S, Henry C, Amescua G, Alfonso E
Received 20 October 2015
Accepted for publication 1 December 2015
Published 27 January 2016 Volume 2016:10 Pages 179—186
DOI https://doi.org/10.2147/OPTH.S80411
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Scott Fraser
Sotiria Palioura, Christopher R Henry, Guillermo Amescua, Eduardo C Alfonso
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
Abstract: Bacterial keratitis can lead to severe visual impairment from corneal ulceration, subsequent scarring, and possible perforation. The mainstay of treatment is topical antibiotics, whereas the use of adjunctive topical corticosteroid drops remains a matter of debate. Herein, we review the rationale for and against the use of topical corticosteroids and we assess their effectiveness and safety in the published randomized controlled trials that have evaluated their role as adjunctive therapy for bacterial corneal ulcers. In the largest study to date, the Steroids for Corneal Ulcers Trial, topical corticosteroid drops were neither helpful nor harmful for the 500 participants as a whole. However, subgroup analyses suggested that topical corticosteroids may be beneficial upon early administration (within 2–3 days after starting antibiotics) for more central corneal ulcers with poorer vision at presentation, for invasive Pseudomonas strains, and for non-Nocardia ulcers. These results are discussed within the limitations of the study.
Keywords: topical corticosteroids, corneal ulcer, eye infection, antibiotic, endophthalmitis, perforation
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