An ongoing study will determine which treatment option for keratitis has the best outcomes. Photo: Joseph W. Sowka, OD.
An ongoing study will determine which treatment option for keratitis has the best outcomes. Photo: Joseph W. Sowka, OD. Click image to enlarge.

Although antibiotics can successfully achieve a microbiological cure in infectious keratitis, outcomes are often suboptimal due to corneal scarring. Treatment of corneal ulcers should address both the infection and the inflammation. Adjunctive topical steroids may improve outcomes by reducing inflammation, and corneal crosslinking (CXL) may simultaneously reduce both inflammatory cells and bacterial pathogens.

An ongoing study set to last until September 2023 is looking into the differences in six-month visual acuity between standard medical therapy with antibiotics vs. antibiotics with adjunctive early topical steroid therapy vs. antibiotic treatment plus CXL and early topical steroids.

This international, randomized, sham- and placebo-controlled, three-arm clinical trial includes patients with smear-positive bacterial ulcers in a 1:1:1 fashion to one of three treatment arms: (1) topical 0.5% moxifloxacin plus topical placebo plus sham CXL, (2) topical 0.5% moxifloxacin plus difluprednate 0.05% plus sham CXL or (3): topical 0.5% moxifloxacin plus difluprednate 0.05% plus CXL.

The team anticipates that combined adjunctive topical steroids and CXL will improve best-spectacle corrected visual acuity and also reduce complications such as corneal perforation and the need for therapeutic penetrating keratoplasty.

“The results of this study are expected to provide evidence of the efficacy of CXL and early steroids as adjunctive treatments in bacterial keratitis,” the study authors wrote. “We anticipate that these therapies will improve outcomes such as visual acuity, while reducing the rate of complications such as perforation or the need for therapeutic penetrating keratoplasty.”

Radhakrishnan N, Prajna VN, Prajna LS, et al. Double-masked, shame and placebo-controlled trial of corneal cross-linking and topical difluprednate in the treatment of bacterial keratitis: Steroids and Cross-linking for Ulcer Treatment Trial (SCUT II) study protocol. BMJ Open Ophthalmol. October 28, 2021. [Epub ahead of print].