Early addition of topical corticosteroids in the treatment of bacterial keratitis

JAMA Ophthalmol. 2014 Jun;132(6):737-41. doi: 10.1001/jamaophthalmol.2014.292.


Importance: Scarring from bacterial keratitis remains a leading cause of visual loss.

Objective: To determine whether topical corticosteroids are beneficial as an adjunctive therapy for bacterial keratitis if given early in the course of infection.

Design, setting, and participants: The Steroids for Corneal Ulcers Trial (SCUT) was a randomized, double-masked, placebo-controlled trial that overall found no effect of adding topical corticosteroids to topical moxifloxacin hydrochloride in bacterial keratitis. Here, we assess the timing of administration of corticosteroids in a subgroup analysis of the SCUT. We define earlier administration of corticosteroids (vs placebo) as addition after 2 to 3 days of topical antibiotics and later as addition after 4 or more days of topical antibiotics.

Main outcomes and measures: We assess the effect of topical corticosteroids (vs placebo) on 3-month best spectacle-corrected visual acuity in patients who received corticosteroids or placebo earlier vs later. Further analyses were performed for subgroups of patients with non-Nocardia keratitis and those with no topical antibiotic use before enrollment.

Results: Patients treated with topical corticosteroids as adjunctive therapy within 2 to 3 days of antibiotic therapy had approximately 1-line better visual acuity at 3 months than did those given placebo (-0.11 logMAR; 95% CI, -0.20 to -0.02 logMAR; P = .01). In patients who had 4 or more days of antibiotic therapy before corticosteroid treatment, the effect was not significant; patients given corticosteroids had 1-line worse visual acuity at 3 months compared with those in the placebo group (0.10 logMAR; 95% CI, -0.02 to 0.23 logMAR; P = .14). Patients with non-Nocardia keratitis and those having no topical antibiotic use before the SCUT enrollment showed significant improvement in best spectacle-corrected visual acuity at 3 months if corticosteroids were administered earlier rather than later.

Conclusions and relevance: There may be a benefit with adjunctive topical corticosteroids if application occurs earlier in the course of bacterial corneal ulcers.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Adult
  • Aza Compounds / administration & dosage*
  • Confidence Intervals
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / drug therapy*
  • Female
  • Fluoroquinolones
  • Follow-Up Studies
  • Humans
  • Keratitis / drug therapy*
  • Keratitis / microbiology
  • Linear Models
  • Male
  • Middle Aged
  • Moxifloxacin
  • Multivariate Analysis
  • Prednisolone / administration & dosage*
  • Quinolines / administration & dosage*
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome


  • Aza Compounds
  • Fluoroquinolones
  • Quinolines
  • Prednisolone
  • Moxifloxacin