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Arch Ophthalmol. 2012 Feb;130(2):143-50. doi: 10.1001/archophthalmol.2011.315. Epub 2011 Oct 10.

Corticosteroids for bacterial keratitis: the Steroids for Corneal Ulcers Trial (SCUT).

Author information

1
Departments of Cornea and External Diseases, Aravind Eye Care System, Madurai, India.

Abstract

OBJECTIVE:

To determine whether there is a benefit in clinical outcomes with the use of topical corticosteroids as adjunctive therapy in the treatment of bacterial corneal ulcers.

METHODS:

Randomized, placebo-controlled, double-masked, multicenter clinical trial comparing prednisolone sodium phosphate, 1.0%, to placebo as adjunctive therapy for the treatment of bacterial corneal ulcers. Eligible patients had a culture-positive bacterial corneal ulcer and received topical moxifloxacin for at least 48 hours before randomization.

MAIN OUTCOME MEASURES:

The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 3 months from enrollment. Secondary outcomes included infiltrate/scar size, reepithelialization, and corneal perforation.

RESULTS:

Between September 1, 2006, and February 22, 2010, 1769 patients were screened for the trial and 500 patients were enrolled. No significant difference was observed in the 3-month BSCVA (-0.009 logarithm of the minimum angle of resolution [logMAR]; 95% CI, -0.085 to 0.068; P = .82), infiltrate/scar size (P = .40), time to reepithelialization (P = .44), or corneal perforation (P > .99). A significant effect of corticosteroids was observed in subgroups of baseline BSCVA (P = .03) and ulcer location (P = .04). At 3 months, patients with vision of counting fingers or worse at baseline had 0.17 logMAR better visual acuity with corticosteroids (95% CI, -0.31 to -0.02; P = .03) compared with placebo, and patients with ulcers that were completely central at baseline had 0.20 logMAR better visual acuity with corticosteroids (-0.37 to -0.04; P = .02).

CONCLUSIONS:

We found no overall difference in 3-month BSCVA and no safety concerns with adjunctive corticosteroid therapy for bacterial corneal ulcers.

APPLICATION TO CLINICAL PRACTICE:

Adjunctive topical corticosteroid use does not improve 3-month vision in patients with bacterial corneal ulcers.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00324168.

PMID:
21987582
PMCID:
PMC3830549
DOI:
10.1001/archophthalmol.2011.315
[Indexed for MEDLINE]
Free PMC Article

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