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    Role of steroids in bacterial keratitis further defined

    NEI-sponsored study provides some reassuring data on the controversial topic

    Dr. Jeng

    Baltimore—The Steroids for Corneal Ulcers Trial (SCUT) is an important study that provides high-level scientific evidence to guide care of patients with bacterial corneal ulcers, said Bennie H. Jeng, MD, MS.

    Based on the results of SCUT, ophthalmologists can feel more comfortable using topical corticosteroids as an adjunct to antibiotics to treat a bacterial corneal ulcer in many circumstances, assuming there is no impending or present perforation, he noted.

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    In addition, the study data suggest that starting the steroid earlier after diagnosis, within 2 or 3 days, may be better than delaying its initiation.

    “SCUT is not without its limitations,” said Dr. Jeng, professor and chairman, Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore. “However, it was a rigorously designed well-powered study. While it did not show any obvious benefit of steroid use as an adjunct to a topical antibiotic regarding the primary endpoint, it also found no serious safety concerns.”

    “Therefore, keeping in mind that clinical judgment is always needed because every corneal ulcer is different, SCUT is a valuable study because it allays some long-standing fears about the use of steroids in eyes with bacterial keratitis,” he said.

    Although theoretically, steroid treatment could improve visual outcomes by controlling inflammation that could lead to tissue destruction and scarring, there has long been concern surrounding steroid use due to the potential for delayed epithelial healing and worsening of the infection, particularly when Pseudomonas aeruginosa is the pathogen.

    However, as stated in the American Academy of Ophthalmology’s Preferred Practice Pattern Guidelines on bacterial keratitis version available prior to SCUT, “there is insufficient evidence to make an official recommendation.”

    Cheryl Guttman Krader
    Cheryl Guttman Krader is a contributor to Dermatology Times, Ophthalmology Times, and Urology Times.

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