Corticosteroids for Bacterial Keratitis The Steroids for Corneal Ulcers Trial (SCUT)

Departments of Cornea and External Diseases, Aravind Eye Care System, Madurai, India.
Archives of ophthalmology (Impact Factor: 4.4). 02/2012; 130(2):143-50. DOI: 10.1001/archophthalmol.2011.315
Source: PubMed


To determine whether there is a benefit in clinical outcomes with the use of topical corticosteroids as adjunctive therapy in the treatment of bacterial corneal ulcers.
Randomized, placebo-controlled, double-masked, multicenter clinical trial comparing prednisolone sodium phosphate, 1.0%, to placebo as adjunctive therapy for the treatment of bacterial corneal ulcers. Eligible patients had a culture-positive bacterial corneal ulcer and received topical moxifloxacin for at least 48 hours before randomization.
The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 3 months from enrollment. Secondary outcomes included infiltrate/scar size, reepithelialization, and corneal perforation.
Between September 1, 2006, and February 22, 2010, 1769 patients were screened for the trial and 500 patients were enrolled. No significant difference was observed in the 3-month BSCVA (-0.009 logarithm of the minimum angle of resolution [logMAR]; 95% CI, -0.085 to 0.068; P = .82), infiltrate/scar size (P = .40), time to reepithelialization (P = .44), or corneal perforation (P > .99). A significant effect of corticosteroids was observed in subgroups of baseline BSCVA (P = .03) and ulcer location (P = .04). At 3 months, patients with vision of counting fingers or worse at baseline had 0.17 logMAR better visual acuity with corticosteroids (95% CI, -0.31 to -0.02; P = .03) compared with placebo, and patients with ulcers that were completely central at baseline had 0.20 logMAR better visual acuity with corticosteroids (-0.37 to -0.04; P = .02).
We found no overall difference in 3-month BSCVA and no safety concerns with adjunctive corticosteroid therapy for bacterial corneal ulcers.
Adjunctive topical corticosteroid use does not improve 3-month vision in patients with bacterial corneal ulcers. Identifier: NCT00324168.

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Available from: Jeena Mascarenhas, Mar 22, 2014
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    • "The Steroids for Corneal Ulcers Trial (SCUT), was a randomized controlled trial investigating the effects of adjunctive corticosteroid therapy to fluoroquinolone (moxifloxacin) treatment on the outcomes of bacterial keratitis [25,26]. Analysis of moxifloxacin resistance of bacterial keratitis isolates (including P, aeruginosa) from the SCUT study showed that increased resistance to this fluoroquinolone in vitro (i.e. "
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    • "Though corneal scarring is the third leading cause of blindness worldwide and affects over one million Americans every year [1], no effective therapy is yet available to treat corneal scarring. Steroids have been used, but their effectiveness remains controversial and they have significant side effects [2], [3]. Mitomycin C is commonly used in clinic to treat laser surgery-induced corneal scarring [4]–[6]. "
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