Urgent attention for prevention services is required to address the overall high HIV prevalence among MSM in the city, with special focus on subgroups as older, married MSM, and those recruited from bathhouses and saunas.
Although P. aeruginosa corneal ulcers have a more severe presentation, they appear to respond better to treatment than other bacterial ulcers. The authors did not find a significant benefit with corticosteroid treatment, but they also did not find any increase in adverse events. (ClinicalTrials.gov number, NCT00324168.).
Purpose To analyse predictors of clinical outcome in fungal keratitis. Methods Data was collected during a prospective, randomized, controlled, doublemasked clinical trial of treatment for fungal keratitis. Clinical features at presentation and demographics were collected at the enrolment visit for all patients. Pre-specified clinical outcomes included 3-month visual acuity and infiltrate/scar size, time to re-epithelialization, and corneal perforation. A separate multivariable model with each outcome as the dependent variable included all predictor variables.
Purpose
To compare the clinical course of Nocardia spp keratitis with keratitis due to other bacterial organisms, and to assess the effect of corticosteroids as adjunctive therapy using data collected from the Steroids for Corneal Ulcers Trial (SCUT).
Design
Sub-group analysis of a randomized controlled trial
Methods
Setting
Multicenter randomized controlled trial
Study Population
500 patients with bacterial keratitis, randomized 1:1 to topical corticosteroid or placebo who had received at least 48 hours of topical moxifloxacin
Intervention/Observation Procedure
Topical prednisolone phosphate 1% or placebo; clinical course of Nocardia keratitis
Main outcome measures
Best spectacle-corrected visual acuity and infiltrate/scar size at 3 months from enrollment
Results
Of 500 patients enrolled in the trial, 55 (11%) had a Nocardia corneal ulcer. Patients with Nocardia ulcers had better presentation visual acuity compared to non-Nocardia ulcers (median Snellen 20/45 compared to 20/145, P<0.001), and comparable 3-month visual acuity (median 20/25 versus 20/40, P=0.25). Nocardia ulcers had approximately 2 lines less improvement in visual acuity compared to non-Nocardia ulcers (0.21 logMAR, 95% CI 0.09 to 0.33 logMAR, P=0.001). This difference may reflect the better starting visual acuity in patients with Nocardia ulcers. In Nocardia ulcers, corticosteroids were associated with an average 0.4 mm increase in 3-month infiltrate/scar size (95% CI 0.03 to 0.77mm, P=0.03).
Conclusion
Nocardia ulcers responded well to treatment. They showed less overall improvement in visual acuity than non-Nocardia ulcers, but had better presentation acuity. Corticosteroids may be associated with worse outcomes.
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