类固醇和治疗的交叉链接:SCUT II随机临床试验
N Venkatesh Prajna1, Prajna Lalitha1, Sumithra Chandru1
1Aravind Eye Care System, Madurai, India.
辅助局部皮质类固醇和角膜交叉链接 (CXL) 并没有改善细菌角膜炎的视力敏度. 皮质类固醇的CXL增加了痕大小,这表明这些治疗方法并不优于单独使用抗生素.
科学领域:
- 眼科医生 眼科 眼科
- 传染性疾病 传染性疾病
- 角膜外科手术 角膜外科手术
背景情况:
- 细菌性角膜炎可以导致显著的视力丧失.
- 目前正在探索诸如局部皮质类固醇和角膜交叉链接 (CXL) 等辅助疗法,以改善治疗结果.
- 将这些治疗与标准抗生素治疗相结合的疗效需要严格的评估.
研究的目的:
- 为了评估添加局部二二二烯酸盐和/或利博紫外线A角膜交叉链接 (CXL) 标准局部抗生素治疗细菌角膜炎的好处.
- 为了比较视力敏度和角膜痕结果在治疗后六个月.
主要方法:
- 一项由美国国立卫生研究院 (NIH) 资助的假控制试验随机选择了280名涂抹/培养阳性细菌角膜炎的参与者.
- 参与者接受了局部莫西素加上安慰剂,二二烯酸盐或二二烯酸盐加CXL.
- 主要结局是六个月最佳眼镜校正视敏度 (BSCVA).
主要成果:
- 在辅助局部类固醇和安慰剂之间没有观察到六个月BSCVA的显著差异 (P=.58).
- 与局部类固醇配合的辅助CXL与单独使用类固醇相比,视力敏度没有改善 (P=.62).
- 与皮质类固醇结合的CXL显著增加了痕大小 (P=0.02),而局部皮质类固醇单独并没有改善痕大小 (P=.65).
结论:
- 除了局部抗生素外,辅助局部皮质类固醇和CXL也没有表现出优于细菌角膜炎的标准抗生素治疗的优势.
- 与皮质类固醇相结合的角膜交叉链接可能导致角膜痕增加.
- 这些发现表明,目前的辅助疗法可能无法提供超越细菌角膜炎常规抗生素治疗的显著益处.
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