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Adjunctive topical corticosteroids and corneal cross-linking (CXL) did not improve visual acuity in bacterial keratitis. CXL with corticosteroids increased scar size, suggesting these treatments are not superior to antibiotics alone.

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Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Corneal Surgery

Background:

  • Bacterial keratitis can lead to significant vision loss.
  • Adjunctive therapies like topical corticosteroids and corneal cross-linking (CXL) are explored to improve treatment outcomes.
  • The efficacy of combining these treatments with standard antibiotic therapy requires rigorous evaluation.

Purpose of the Study:

  • To evaluate the benefit of adding topical difluprednate and/or riboflavin-ultraviolet A corneal cross-linking (CXL) to standard topical antibiotic treatment for bacterial keratitis.
  • To compare visual acuity and corneal scarring outcomes at six months post-treatment.

Main Methods:

  • A National Institutes of Health (NIH)-funded, sham-controlled trial randomized 280 participants with smear/culture-positive bacterial keratitis.
  • Participants received topical moxifloxacin plus either placebo, difluprednate, or difluprednate plus CXL.
  • The primary outcome was best spectacle-corrected visual acuity (BSCVA) at six months.

Main Results:

  • No significant difference in six-month BSCVA was observed between adjunctive topical steroids and placebo (P=.58).
  • Adjunctive CXL with topical steroids showed no improvement in visual acuity compared to steroids alone (P=.62).
  • CXL combined with corticosteroids significantly increased scar size (P=.02), and topical corticosteroids alone did not improve scar size (P=.65).

Conclusions:

  • Adjunctive topical corticosteroids and CXL, in addition to topical antibiotics, did not demonstrate superiority over standard antibiotic treatment for bacterial keratitis.
  • Corneal cross-linking combined with corticosteroids may lead to increased corneal scarring.
  • These findings suggest that current adjunctive therapies may not offer significant benefits beyond conventional antibiotic treatment for bacterial keratitis.