For the remedy of bacterial keratitis, adjunctive corticosteroids will not be superior to placebo and adjunctive corneal cross-linking (CXL) is related to elevated scar measurement, based on a research revealed on-line July 24 in JAMA Ophthalmology.
N. Venkatesh Prajna, D.O., from the Aravind Eye Care System in Madurai, India, and colleagues examined the good thing about adjunctive topical difluprednate and CXL with riboflavin along with topical antibiotics in a placebo-controlled trial involving members with smear- and/or culture-positive bacterial corneal ulcers with Snellen visible acuity of 20/40 or worse.
2 hundred eighty members have been enrolled and randomly assigned to topical moxifloxacin + topical placebo + sham CXL (standard-therapy arm) versus topical moxifloxacin + difluprednate + sham CXL (early-steroid arm) versus topical moxifloxacin + difluprednate + CXL (CXL arm).
The researchers noticed no vital distinction in six-month visible acuity with adjunctive topical steroids versus placebo or with adjunctive CXL and topical steroids versus topical steroids alone. After controlling for baseline infiltrate and/or scar measurement, adjunctive topical corticosteroids didn’t enhance scar measurement at six months, whereas CXL plus corticosteroids elevated scar measurement in contrast with steroids alone. After controlling for infiltrate depth, the chance for perforation or the necessity for therapeutic penetrating keratoplasty was decrease, however not considerably so, within the early-steroid arm and within the CXL arm.
“Adjunctive topical corticosteroids were not superior to placebo, and adjunctive CXL had increased scar size with more pain, suggesting that these alternative therapies, on average, may not be superior to topical moxifloxacin monotherapy for treatment of bacterial keratitis,” the authors write.
Extra data:
N. Venkatesh Prajna et al, Steroids and Cross-Linking for Ulcer Therapy, JAMA Ophthalmology (2025). DOI: 10.1001/jamaophthalmol.2025.2188
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Corticosteroids not superior to placebo for add-on remedy of bacterial keratitis (2025, July 28)
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