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A. Kuo, F. Mah; Evaluation of Topical Tobramycin/Dexamethasone and Tobramycin/Loteprednol in the Management of Blepharo–keratoconjunctivitis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2673.
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Purpose: Inflammation of the total ocular surface – lids, conjunctiva, and cornea – can cause significant morbidity ranging from decreased vision to corneal perforation in patients suffering from chronic staphylococcal blepharitis. The purpose of this study was to compare control of inflammation in blepharo–keratoconjunctivitis with two different topical antibiotic–steroid combinations. Methods: This was a randomized, parallel–group, contralateral study in twelve patients with blepharo–keratoconjunctivitis. Patients received either tobramycin/loteprednol 0.5% (TBL) or tobramycin/dexamethasone 0.1% (TBD) twice daily in either eye according to the randomization schedule. At baseline, the ocular surface was graded on a scale of 3 (extensive) to 0 (minimum) for 4 signs: blepharitis, ocular discharge, conjunctivitis, and corneal punctuate epithelial keratopathy (PEK). At follow–up 4 days later, the ocular surface was regraded to evaluate treatment response. The mean change scores were then compared using the Duncan multiple comparisons test. Results: Mean scores are reported: Baseline, post–TBL, post–TBD, respectively. Multiple comparison rank scores are listed thereafter (">" indicates statistical significance). Mean total ocular surface scores (sum of all 4 components) were 9.0, 4.4, and 2.7. Baseline>TBL>TBD (p≤0.05). Blepharitis mean scores were 1.9, 0.8, and 0.3. Baseline>TBL>TBD (p≤0.05). Discharge mean scores were 1.6, 0.7, and 0.4. Baseline>TBL>TBD (p≤0.05). Conjunctivitis mean scores were 1.7, 1.1, and 0.8. Baseline>TBL>TBD (p≤0.05). Corneal PEK mean scores were 2.1, 0.5, and 0.4. Baseline>TBL=TBD (p>0.05). Conclusions: For these patients with blepharo–keratoconjunctivitis, the two antibiotic–steroid regimens provided a comparable decrease in corneal PEK. However, topical tobramycin/dexamethasone significantly decreased clinical signs of ocular inflammation (i.e., blepharitis, discharge, conjunctivitis) when compared with tobramycin/loteprednol. Similarly, tobramycin/dexamethasone demonstrated clinically and statistically significant improvements in the total ocular surface scores when compared to tobramycin/loteprednol.
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