Comparative Analysis Of The Clinical Aspects And Treatment Outcomes In Bacterial Keratitis According To Prior Topical Steroid Use

To compare the clinical aspects and treatment outcomes between prior topical steroid users and non-users (PS and NPS, respectively) before the diagnosis of bacterial keratitis.

Retrospective, consecutive study. All of study case were taken by Department of Ophthalmology, Yeungnam University College of Medicine, South Korea.

We retrospectively analyzed 194 patients (PS, 34; NPS, 160) with culture-positive bacterial keratitis between January 2007 and December 2016. The microbiological profiles, epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between the PS and NPS groups. Risk factors for surgical intervention were evaluated using the two-proportion Z-test. Based on the duration of prior steroid use, the PS group was subdivided into long-term (n=17, 14 days or more) and short-term (n=17, less than 14 days) use groups.

Pseudomonas (9/40, 26.5%) and Staphylococcus (42/187, 26.3%) were the most common isolates in the PS and NPS groups, respectively. Significant differences were observed between the PS and NPS groups in terms of previous ocular surface disease (48.7% vs. 18.1%, p<0.001), initial best-corrected visual acuity < 0.1 (70.6% vs. 49.4%, p=0.024), epithelial defect size ≥ 5 mm2 (64.7% vs. 41.2%, p=0.013), epithelial healing time > 14 days (55.9% vs. 37.3%, p=0.045), and surgical intervention (23.5% vs. 8.8%, p=0.031). Prior topical steroid use (Z=2.46) and long-term use group (Z=2.45) were significant risk factors for surgical intervention, whereas short-term use was not (Z=0.86).

Topical steroid use before bacterial keratitis diagnosis was associated with a history of ocular surface disease, poor initial clinical features, delayed epithelial healing, and more surgical interventions. The results of this study highlight the importance of caution in the use of topical steroids in clinical practice.