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F. Orucov, A. Solomon, D. Landau, E. Strassman, J. Frucht–Pery; Effect of Adjunctive Steroid Treatment on the Outcome of Bacterial Keratitis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1904.
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To evaluate the outcome of bacterial keratitis treated with or without adjunctive topical steroids in additional to the traditional antibiotics use.
We retrospectively reviewed the records of patients who were hospitalized with bacterial keratitis in the department of Ophthalmology at Hadassah Hospital in Jerusallem between the years 1999–2004. We did not include patients with incomplete records. 65 files were reviewed and 41 files with complete data were included in the study. Age, sex , ulcer size and localization, microbiological etiology, epithelization time and the final best corrected visual acuity were evaluated. Patients were divided into two groups. Group 1: of 21 patients with bacterial keratitis who received standard therapy of fortified cephazolin 50 mg/ml and gentamicin 1.4% drops. Group 2: of 20 patients who received same topical antibiotics and adjunctive drops of dexamethasone phosphate 0.1% were added after identification of the bacteria or improved symptomatology when the cultures were negative. Two tailed T–Test and Chi–Square Test were used for statistical analysis.
There were no differences between age, sex, ulcer size and localization and visual acuity at the first examination (p = 0.306 to 0.588). Contact–lens wear was the most common predisposing factor in both groups (33.3% and 20%). Corneal cultures were positive in 57.1% in group 1 and in 45% in group 2 .The most common isolated organisms were P. aeruginosa (33.3% in Group 1 and 44.4% in Group 2) and species of Staphylococcus (33.3% in Group 1 and 11.1% in Group 2). Treatment with topical steroids began between days 2–12 ( mean 6.0±3.1 day) and they were applied for 4 to 180 days (mean 50.4±42.5 day). Most of cases received steroid QID. Steroid gradually tapered and stopped. Complete epithelization was achieved after 3 to 30 days ( mean 9.4±7.1 days) in Group 1 and 3 to 38 days (mean 14.5±10.9 days) in Group 2 (p=0.119). Final visual acuities were 0.49±0.38 (between hand motion and 1.0) in Group 1 and 0.34±0.34 (between light perception and 0.90) in Group 2. The number of gained Snellen lines were 2.6±3.1 in Group 1 and 1.7±.2.4 in Group 2 (p=0.370) .
The use of adjunctive steroids did not significantly improved the outcome of microbial keratitis.
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