Topical steroid use linked to poorer outcomes in bacterial keratitis patients

Prior exposure to topical steroids before a diagnosis of bacterial keratitis is associated with more severe initial clinical presentation and poorer treatment outcomes, according to a study.

Patients with a history of topical steroid use, especially strong and long-term usage, are at a higher risk of requiring surgical intervention for bacterial keratitis.

The retrospective analysis included 194 patients with culture-proven bacterial keratitis, with 34 having prior topical steroid use (PS group) and 160 without prior topical steroid use (NPS group).

Microbiological analysis showed that Pseudomonas spp. was the most common isolate in the PS group, while Staphylococcus spp. dominated the NPS group. However, there was no significant difference in the distribution of bacterial strains between the two groups.

Patients in the PS group were more likely to have a history of previous ocular surface disease (41.2% vs 23.8%). In addition, a higher percentage of patients in the PS group had an initial best-corrected visual of <0.1 (70.6% vs 49.4%), larger epithelial defects (≥5 mm2) (64.7% vs 41.2%), longer epithelial healing times (>14 days) (55.9% vs 37.3%), and required surgical intervention (23.5% vs 8.8%).

The study also identified that prior topical steroid use, especially strong and long-term usage, were significant risk factors for surgical intervention.

Reference
Cho CH, Choi NH, Lee SB. Clinical comparative analysis of culture-proven bacterial keratitis according to prior topical steroid use: a retrospective study in a tertiary referral center of South Korea. Sci Rep. 2023;13(1):14477. doi: 10.1038/s41598-023-41588-2. PMID: 37660202.