Jennifer R. Rose-Nussbaumer
SAN FRANCISCO — Steroids and corneal cross-linking could be useful in treating bacterial keratitis, according to a speaker here.
Topical fortified antibiotics are often used by corneal surgeons in the United States, but there have been no wide-ranging studies regarding what broad-spectrum antibiotic is best in patients with bacterial keratitis, Jennifer R. Rose-Nussbaumer, MD, said at Cornea Subspecialty Day at the American Academy of Ophthalmology annual meeting.
“It’s likely that inflammation is playing an important role in the scarring and irregular astigmatism that leads to visual instability in these patients,” she said. “The ideal therapy would address both infection and inflammation in these cases.”
A study in patients with corneal ulcers found corticosteroids did not affect visual acuity, scar size or corneal perforation; however, a subgroup analysis found those with large central ulcers had better results, as well as those who had early steroid treatment.
A study of corneal cross-linking, which has an antimicrobial and anti-inflammatory role, in 16 patients with bacterial keratitis showed all patients responded to therapy, and only two of those patients needed topical antibiotics, Rose-Nussbaumer said.
With this information, the pilot Cross-Linking Assisted Infection Reduction study was undertaken, in which smear-positive bacterial ulcers were treated with moxifloxacin alone vs. moxifloxacin plus cross-linking.
Those in the cross-linking group were 50% less likely to be culture positive 1 day after treatment; however, the results were not statistically significant. In addition, visual acuity was one line less for patients treated in the cross-linking group.
Overall, the hypothesis should be tested in a larger randomized trial.
“Steroids do appear to be safe, and there does seem to be some role [for them] in bacterial keratitis,” Rose-Nussbaumer said. “Cross-linking may reduce culture positivity and adverse events, but it might also negatively impact visual acuity.” – by Rebecca L. Forand
Rose-Nussbaumer J. Beating back bacterial keratitis. Presented at: American Academy of Ophthalmology annual meeting; Oct. 11-15, 2019; San Francisco.
Disclosure : Rose-Nussbaumer reports no relevant financial disclosures.