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Topical corticosteroids as adjunctive therapy for bacterial keratitis

  • Review
  • Intervention

Authors


Abstract

Background

Bacterial keratitis is a serious ocular infectious disease that can lead to severe visual disability. Risk factors for bacterial corneal infection include contact lens wear, ocular surface disease, corneal trauma and previous ocular or eyelid surgery. Topical antibiotics constitute the mainstay of treatment in cases of bacterial keratitis where as the use of topical corticosteroids remains controversial. Topical corticosteroids are usually used to control inflammation using the smallest amount of the drug. Their use requires optimal timing, concomitant antibiotics and careful follow up.

Objectives

The objective of the review was to assess the clinical effectiveness and adverse effects of corticosteroids as adjunctive therapy for bacterial keratitis.

Search methods

We searched CENTRAL, MEDLINE, EMBASE, and LILACS up to 15 January 2007. We also searched the Science Citation Index to identify additional studies that had cited the included trial, an online database of ongoing trials (www.clinicaltrials.gov), reference lists of included trials, earlier reviews and the American Academy of Ophthalmology guidelines. We also contacted experts to identify any unpublished and ongoing randomized trials.

Selection criteria

We included randomized controlled trials evaluating adjunctive therapy with topical corticosteroids in people with bacterial keratitis.

Data collection and analysis

Two review authors independently screened all the retrieved articles. Methodological quality of the one included trial was assessed using forms developed using pre-specified criteria by at least two review authors. We planned to extract data on outcomes using forms developed for the purpose. We planned to report risk ratios for dichotomous outcomes and mean differences for continuous outcomes.

Main results

A single trial was eligible for inclusion in the review. Participants in the trial were randomized using a random numbers table. Allocation concealment was not attempted. Masking of participants, and care-providers was also not attempted. Outcome assessment was conducted independently by two physicians. Neither was masked to the treatment allocation. The trial reported the healing rate of epithelial defects and improvement in visual acuity.

Authors' conclusions

There are no good quality randomized trials evaluating the effects of adjunct use of topical corticosteroids in bacterial keratitis. The only randomized trial we identified in the literature suffered from major methodological inadequacies.

摘要

背景

類固醇眼藥作為細菌性角膜炎的輔助治療

細菌性角膜炎是一種嚴重的眼睛感染疾病,會導致嚴重的視力不良。細菌性角膜感染的危險因子包括戴隱形眼鏡,眼表疾病,角膜外傷和以前的眼部,或眼皮手術。抗生素眼藥是治療細菌性角膜炎的主要方式,使用類固醇眼藥仍頗具爭議。類固醇眼藥通常用最小的劑量來控制發炎。類固醇眼藥的使用要抓對時機,合併抗生素使用並小心追蹤。

目標

綜合評論的目的是評估類固醇眼藥為細菌性角膜炎的輔助治療於臨床使用上的有效性和副作用。

搜尋策略

我們尋找至2007年1月15日 CENTRAL, MEDLINE, EMBASE,和 LILACS資料庫。我們也搜查了科學引文的索引去確認額外的研究,包含正在進行中的線上資料庫試驗(www.clinicaltrials.gov),參考文獻中所包括的試驗,早期的綜合評論和美國眼科學的指引。我們還與專家聯繫,查明任何未發表和進行中的隨機試驗。

選擇標準

我們納入隨機控制的試驗,評估患有細菌性角膜炎的人使用類固醇眼藥輔助治療的效果。

資料收集與分析

兩位評論的作者獨自篩選搜索文章。包括試驗本身等項目品質,至少被兩個評論作者使用預先設計好的準則來進行評估。我們計劃以目的來設計評質表格,以獲得精確的數據 。我們以危險率作為二分結果,以平均差作為連續結果。

主要結論

一個試驗符合資格被納入綜合評論中。試驗的參與者被使用隨機號碼表隨機分配。未進行分配遮蔽。參加者和照護者也未遮蔽處理 。結果評估是由兩位醫生獨立進行的。對於治療分配也無遮蔽。本試驗報告角膜上皮缺損癒合速率與視力改善的相關性。

作者結論

沒有良好品質的隨機試驗去評價細菌性角膜炎輔助使用類固醇眼藥的療效。唯一的隨機試驗,我們認為文獻具主要不適當的方法學。

翻譯人

本摘要由高雄榮民總醫院洪碧蓮翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

類固醇眼藥作為細菌性角膜炎的輔助治療。細菌性角膜炎或因細菌感染導致的角膜發炎對於視力有潛在的威脅。細菌性角膜炎一種危險的眼睛狀況可能造成視力殘疾,其危險因子包含接觸透鏡的磨損,眼表疾病,角膜外傷和以前的眼,或眼皮手術。抗生素眼藥是細菌性角膜炎的主要治療方式。類固醇眼藥的輔助治療的好處是被受爭議的。我們找出一篇品質有待商確的隨機試驗,來評估細菌性角膜炎類固醇輔助的療效。我們沒有足夠證據証明類固醇眼藥作為細菌性角膜炎輔助治療的效果。

Plain language summary

Topical corticosteroids as adjunctive therapy for bacterial keratitis

Bacterial keratitis or corneal inflammation due to bacterial infection, is a potentially sight threatening condition. Risk factors for bacterial keratitis, a serious ocular condition that can result in visual disability, include contact lens wear, ocular surface disease, corneal trauma and previous ocular or eyelid surgery. Topical antibiotics are the mainstay of treatment for bacterial keratitis. The usefulness of adjunct treatment with topical corticosteroids is controversial. We identified a single randomized trial of borderline methodological quality, evaluating adjunct corticosteroid therapy for bacterial keratitis. We do not have sufficient evidence to determine the effects of adjunct treatment with topical corticosteroids for bacterial keratitis.