Results of the SCUT trial show that adjunctive topical corticosteroid therapy in eyes with bacterial corneal ulcers is safe, might be particularly useful in eyes with severe ulcers or Pseudomonas infection, is more beneficial when started earlier than later, and should be avoided when Nocardia is the causative pathogen.
“Although the difference between groups was not statistically significant, the benefit favoring corticosteroid treatment was actually greatest in eyes with Pseudomonas infection than with any other pathogen,” he said. “Prior to SCUT, we would not have used a corticosteroid in an eye with a central Pseudomonas ulcer. It was encouraging to see, therefore, that eyes with Pseudomonas did not do worse when treated with a corticosteroid.”
Among eyes with a Nocardia corneal ulcer, however, BSCVA at 3 months was significantly worse in the corticosteroid group. The difference compared with controls was about 1 line, and an analysis of BSCVA outcomes at 1 year showed a significant difference favoring corticosteroid treatment when eyes with Nocardia were excluded.
“The message here is do not use corticosteroids to treat a corneal ulcer caused by Nocardia. In fact, the data suggests that perhaps Nocardia ulcers should have been excluded from SCUT,” he said. Other secondary outcome analyses compared BSCVA outcomes of the corticosteroid and placebo treatment groups in eyes with baseline BSCVA <20/400 or central ulcers.
For these subgroups with the “worst” ulcers, mean BSCVA at 3 months was significantly better in the corticosteroid group compared with controls.
Another secondary outcome analysis examined whether the timing of corticosteroid initiation affected functional outcomes. Its results showed a 1.1-line greater improvement in BSCVA among eyes that received corticosteroid treatment within 2 to 3 days versus in those where there was a longer delay, and the benefit of earlier treatment was statistically significant.
“This finding was somewhat surprising because it was previously thought that it was better to try to eliminate the bacteria before adding the corticosteroid,” he said.
Thomas M. Lietman, MD
E: [email protected]
This article was adapted from Dr. Lietman’s presentation during Cornea Subspecialty Day at the 2017 meeting of the American Academy of Ophthalmology. Dr. Lietman has no relevant financial interests to disclose.