The Steroids for Corneal Ulcers Trial

Levofloxacin and Tobramycin for Severe Bacterial Keratouveitis

“…The SCUT (the Steroids for Corneal Ulcers Trial) study found no significant difference in 3-month visual acuity and no major safety concerns between patients receiving topical steroid or placebo as adjunctive therapy in the treatment of bacterial corneal ulcers, 47 but a significant effect of corticosteroids was observed in subgroups with the worst visual acuity and central ulcer location at baseline compared with the placebo. These subgroups analyses suggest that patients with severe ulcers may benefit from the use of steroids as adjunctive therapy.…”

Early Addition of Topical Corticosteroids in the Treatment of Bacterial Keratitis

“…6,7 A potential limitation to the SCUT may have been that corticosteroids or placebo were not administered early enough to show a difference across all degrees of ulcer severity. 1,10 Approximately one-third of SCUT patients received topical antibiotics for longer than 4 days before corticosteroid or placebo administration.…”

“…6,7 Of the 500 patients included in SCUT, 8 were excluded from the analysis because of missing data specifying the duration of antibiotic treatment before receiving the corticosteroid or placebo. On presentation, screened patients with corneal ulcers were immediately treated with moxifloxacin hydrochloride every hour while awake for the first 48 hours, then every 2 hours until enrolled in the study.…”

“…1–5 A recent randomized clinical trial comparing corticosteroids with placebo as an adjunctive therapy found no difference in best spectacle-corrected visual acuity (BSCVA) at 3 months when all patients were analyzed. 6,7 The same trial found benefit with corticosteroid use in the subgroups with more severe ulcers (defined by enrollment visual acuity and the ulcer’s size, depth, or location) and in BSCVA at 12 months among patients with ulcers caused by non- Nocardia species. 8,9 Some argue that the Steroids for Corneal Ulcers Trial (SCUT) started corticosteroid application too late in the course of the ulcer and that an overall difference would have been seen if corticosteroids had been started earlier.…”

Visual Recovery in Treated Bacterial Keratitis

“…The methods of the trial have been described previously. 1 Patients with culture-proven bacterial keratitis who had been treated with ≥48 hours of topical moxifloxacin were randomized to topical prednisolone phosphate or topical placebo. Certified refractionists assessed logarithm of the minimum angle of resolution (logMAR) best spectacle corrected visual acuity (BSCVA) with a Tumbling “E” chart at enrollment, 3 weeks (study window: 2.5–5 weeks), 3 months (window: 2.5–5 months), and 12 months (window: 10–14 months).…”