Topical Corticosteroids for Infectious Keratitis Before Culture-Proven Diagnosis
Received 13 December 2020
Accepted for publication 27 January 2021
Published 16 February 2021 Volume 2021:15 Pages 609—616
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Koji Hirano,1 Hidenori Tanaka,2 Kumiko Kato,3 Kaoru Araki-Sasaki4
1Department of Ophthalmology, Fujita Health University Bantane Hospital, Nagoya, Aichi, 454-8509, Japan; 2Department of Ophthalmology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan; 3Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan; 4Department of Ophthalmology, Kansai Medical University, Hirakata, Osaka, 573-1010, Japan
Correspondence: Koji Hirano
Department of Ophthalmology, Fujita Health University Bantane Hospital, 6-10, Otoubashi 3-cho-me, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
Purpose: In clinical practice we sometimes encounter patients with severe corneal ulcers who have been treated with topical corticosteroids. This study reviewed the clinical features and visual outcomes of these patients and investigated the background of the prescription of topical corticosteroids.
Patients and Methods: The medical records of patients who visited the Cornea Service at Fujita Health University Bantane Hospital and were treated for infectious keratitis from April 2016 to March 2020 were retrospectively reviewed. Patients treated with topical corticosteroids before a culture-proven diagnosis were studied in terms of demographics, best-corrected visual acuity at arrival and at last visit, the clinical course after visit, ocular history, and combination therapy by the previous ophthalmologist.
Results: Out of the 200 eyes of 197 patients with infectious keratitis, 14 eyes of 14 patients were treated with topical corticosteroids before a culture-proven diagnosis. All 14 patients were referred, as they had severe keratitis that could not be cured with topical antibiotics and corticosteroids. Based on the culture results, we diagnosed Acanthamoeba keratitis (AK) in six patients, fungal keratitis (FK) in two patients, bacterial keratitis (including a suspected case) in two patients, and unknown cause in four patients. Two patients with AK, FK, and unknown keratitis had unfortunate clinical courses and poor visual outcomes. From the information in the referral letters, at least six of the 14 patients were treated with either acyclovir ocular ointment or valaciclovir tablets, along with topical corticosteroids.
Conclusion: Application of topical corticosteroids for keratitis that does not respond to empirical antibiotic therapy is harmful since AK or FK is likely involved in these topical antibiotic-resistant cases. Microbiological evidence, as well as a differential diagnosis of herpetic stromal keratitis, is needed when prescribing topical corticosteroid for the treatment of suspected infectious keratitis.
Keywords: culture-proven diagnosis, empiric antibiotic therapy, herpetic keratitis, infectious keratitis, topical corticosteroids
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