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20-10-2011 | General practice | Article

Steroids ineffective at improving vision after bacterial corneal ulceration

Abstract

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MedWire News: Topical corticosteroids fail to improve visual acuity in patients with bacterial corneal ulcers, according to a study published in the Archives of Ophthalmology.

The study authors describe the use of corticosteroids in treating bacterial corneal ulcers as long debated. "The American Academy of Ophthalmology suggests that, although there may be a role for corticosteroids in the treatment of bacterial corneal ulcers, there is insufficient evidence to make an official recommendation," they write.

Muthiah Srinivasan, of Aravind Eye Care System in Madurai, India, and colleagues designed the Steroids for Corneal Ulcers Trial to resolve the contention. They enrolled 500 patients with bacterial corneal ulcers, 97% from India and the rest from the USA. They randomly assigned corticosteroid treatment to half of the patients, with the remainder as a placebo group.

There was no significant difference in baseline visual acuity between the patients from the two countries, and the authors note that 44% of the patients were agricultural workers.

At the 3-month follow-up, patients with vision of counting fingers or worse at baseline had 0.17 logMAR better acuity if they were receiving the corticosteroid treatment than if they were in the placebo group, and this difference was significant.

Srinivasen and team found no safety concerns for use of corticosteroids. There was no significant difference in the number of corneal perforations between the two groups.

Although a higher proportion of epithelial defects were observed in the corticosteroid group than the placebo, this difference did not persist after baseline epithelial defect size was considered. This does not support the concerns of some ophthalmologists that corticosteroids may delay healing of the epithelial defect, the researchers say.

Significantly fewer corticosteroid group patients developed intraocular pressure greater than 25 mmHg compared with the controls, but intraocular pressure greater than 35mmHg was not found in either group.

The researchers write that their study design and sample size meant that their analysis was high powered but further research is needed. "We plan to continue to conduct subgroup analyses to further explore a potential benefit of corticosteroid treatment, including in subgroups by organism, antibiotic susceptibility, and other clinical or demographic factors," they say.

No association between corticosteroids and vision after bacterial corneal ulcers were found but Srinivasen et al conclude: "Pre-specified subgroup analyses suggest that there may be a role for topical corticosteroids in ulcers that are more severe at baseline. However, a larger study examining only severe corneal ulcers is needed to confirm this supposition."

By Chloe McIvor

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