Pseudomonas aeruginosa keratitis: outcomes and response to corticosteroid treatment

• Published in: Investigative ophthalmology & visual science Vol. 53; no. 1; pp. 267 - 272
• Main Authors: Sy, Aileen, Srinivasan, Muthiah, Mascarenhas, Jeena, Lalitha, Prajna, Rajaraman, Revathi, Ravindran, Meenakshi, Oldenburg, Catherine E, Ray, Kathryn J, Glidden, David, Zegans, Michael E, McLeod, Stephen D, Lietman, Thomas M, Acharya, Nisha R
• Format: Journal Article
• Language: English
• Published: United States Association for Research in Vision and Ophthalmology, Inc 25.01.2012
• Subjects: Adult; Anti-Infective Agents - adverse effects; Anti-Infective Agents - therapeutic use; Aza Compounds - adverse effects; Aza Compounds - therapeutic use; Corneal Ulcer - drug therapy; Corneal Ulcer - microbiology; Corneal Ulcer - physiopathology; Double-Blind Method; Eye Infections, Bacterial - drug therapy; Eye Infections, Bacterial - microbiology; Eye Infections, Bacterial - physiopathology; Female; Fluoroquinolones; Follow-Up Studies; Glucocorticoids - adverse effects; Glucocorticoids - therapeutic use; Humans; Male; Middle Aged; Moxifloxacin; Prednisolone - adverse effects; Prednisolone - analogs & derivatives; Prednisolone - therapeutic use; Pseudomonas aeruginosa - isolation & purification; Pseudomonas Infections - drug therapy; Pseudomonas Infections - microbiology; Pseudomonas Infections - physiopathology; Quinolines - adverse effects; Quinolines - therapeutic use; Treatment Outcome; Visual Acuity - physiology
• ISSN: 1552-5783; 0146-0404; 1552-5783
• DOI: 10.1167/iovs.11-7840

To compare the clinical course and effect of adjunctive corticosteroid therapy in Pseudomonas aeruginosa with those of all other strains of bacterial keratitis. Subanalyses were performed on data collected in the Steroids for Corneal Ulcers Trial (SCUT), a large randomized controlled trial in which patients were treated with moxifloxacin and were randomly assigned to 1 of 2 adjunctive treatment arms: corticosteroid or placebo (4 times a day with subsequent reduction). Multivariate analysis was used to determine the effect of predictors, organism, and treatment on outcomes, 3-month best-spectacle-corrected visual acuity (BSCVA), and infiltrate/scar size. The incidence of adverse events over a 3-month follow-up period was compared using Fisher's exact test. SCUT enrolled 500 patients. One hundred ten patients had P. aeruginosa ulcers; 99 of 110 (90%) enrolled patients returned for follow-up at 3 months. Patients with P. aeruginosa ulcers had significantly worse visual acuities than patients with other bacterial ulcers (P = 0.001) but showed significantly more improvement in 3-month BSCVA than those with other bacterial ulcers, adjusting for baseline characteristics (-0.14 logMAR; 95% confidence interval, -0.23 to -0.04; P = 0.004). There was no significant difference in adverse events between P. aeruginosa and other bacterial ulcers. There were no significant differences in BSCVA (P = 0.69), infiltrate/scar size (P = 0.17), and incidence of adverse events between patients with P. aeruginosa ulcers treated with adjunctive corticosteroids and patients given placebo. Although P. aeruginosa corneal ulcers have a more severe presentation, they appear to respond better to treatment than other bacterial ulcers. The authors did not find a significant benefit with corticosteroid treatment, but they also did not find any increase in adverse events. (ClinicalTrials.gov number, NCT00324168.).