This randomized, placebo-controlled, double-masked study examined whether using topical corticosteroids as adjunctive therapy for bacterial corneal ulcers improves clinical outcomes. The authors report in the February issue of the Archives of Ophthalmology that there was no overall difference in BSCVA after three months among patients treated with topical moxifloxacin who received either prednisolone sodium phosphate 1.0% or placebo as adjunctive therapy. However, there were no safety concerns, and subgroup analyses suggest a role for topical corticosteroids in treating more severe ulcers.
This study, the Steroids for Corneal Ulcers Trial (SCUT), included 500 patients with a culture-positive bacterial corneal ulcer who received topical moxifloxacin for at least 48 hours before randomization. The authors believe that this is the first large randomized controlled trial to provide evidence regarding the safety and efficacy of corticosteroids for treating bacterial corneal ulcers.
They found no significant difference at three months in infiltrate/scar size (P = 0.40), time to re-epithelialization (P = 0.44) or corneal perforation (P > 0.99) between the treatment groups.
However, they did find a significant effect of corticosteroids in subgroups of baseline BSCVA (P = 0.03) and ulcer location (P = 0.04). At three months, patients with vision of counting fingers or worse at baseline had 0.17 logMAR better visual acuity with corticosteroids compared with placebo, and patients with ulcers that were completely central at baseline had 0.20 logMAR better visual acuity with corticosteroids.
These results suggest that patients with severe ulcers, who have the most to gain in terms of visual acuity, may benefit from the use of corticosteroids as adjunctive therapy. However, the study also demonstrates no obvious benefit to using corticosteroids in the overall study population.
In terms of the safety of adjunctive topical corticosteroids for bacterial corneal ulcers, the authors found no increased risk of corneal perforation. There was also no difference in the number of penetrating keratoplasties performed between the study arms, and the treatment was not associated with an increase in IOP.