Indecision about corticosteroids for bacterial keratitis: an evidence-based update

Area of Science:

• Ophthalmology
• Infectious Diseases
• Pharmacology

Background:

• Bacterial keratitis is a significant cause of vision loss, affecting approximately 1 in 10,000 Americans annually.
• Predisposing factors, patient health, microbial agents, and treatment choices influence the course and outcome of bacterial keratitis.
• While antibacterial treatments are often curative, they do not always prevent sight-limiting corneal complications, leading to consideration of anti-inflammatory therapies.

Purpose of the Study:

• To systematically evaluate the impact of topical corticosteroids on the development and progression of bacterial keratitis.
• To quantify the risks and benefits associated with corticosteroid use in the context of bacterial keratitis management.

Main Methods:

• A systematic literature review was conducted, analyzing publications from 1950 to 2000.
• Included study designs encompassed animal experiments, case reports, case-comparison studies, cohort studies, and clinical trials.
• Electronic and manual search strategies were employed to identify relevant publications.

Main Results:

• Pre-diagnosis topical corticosteroid use significantly increased the risk of ulcerative keratitis in eyes with pre-existing corneal disease (OR, 2.63).
• Corticosteroid use after bacterial keratitis onset heightened the likelihood of antibiotic treatment failure or infectious complications (OR, 3.75).
• The effect of concurrent topical corticosteroid and antibiotic therapy post-keratitis onset was inconclusive, with clinical studies showing no significant outcome improvement (OR, 0.62).

Conclusions:

• Topical corticosteroids appear to elevate the risk of infectious complications in bacterial keratitis.
• The role of corticosteroids as an adjunct to antibacterial therapy remains uncertain.
• Further prospective studies are essential to guide evidence-based management of bacterial keratitis.