Safety And Efficacy Of Topical Corticosteroid In Bacterial Keratitis: A Systematic Review

The use of topical corticosteroids in bacterial keratitis remains a topic of debate due to concerns about their potential benefits and risks. This review summarizes current evidence, evaluating their effectiveness and safety outcomes. 

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was followed in conducting this review.

We searched PUBMED; Science Direct, COCHRANE and Google Scholar with no restrictions on language or year of publication with “topical corticosteroid”, “bacterial keratitis”, “best-corrected visual acuity” and “adverse event” as the keywords. We included randomized-controlled trials, retrospective studies and case series. The results from the electronic databases were imported into a reference management program (Rayyan), where duplicate articles were manually removed. Following this, the titles and abstracts of all studies were independently reviewed by four authors. Subsequently, the full texts of the remaining potentially relevant studies were assessed to determine whether they met the inclusion criteria outlined below.

We reviewed five studies comparing bacterial keratitis treatment with and without corticosteroids (3-day to 12-month follow-ups). Overall, the effects of corticosteroids in bacterial keratitis were mixed, offering benefits in some cases while posing risks in others. High-dose corticosteroids improved vision without increasing infection risk. In Pseudomonas aeruginosa keratitis, corticosteroids delayed healing and led to worse outcomes. Non-Nocardia ulcers showed slight vision improvement with corticosteroid use, whereas Nocardia ulcers developed lager scars. Despite these variations, no significant differences were observed between corticosteroid and non-corticosteroid groups in transplant rates, vision loss, recurrence, or final outcomes.

Using topical corticosteroid for bacterial keratitis may slightly slow down healing but doesn’t impact visual acuity (VA), patient outcomes, or cause more adverse effects. High doses of corticosteroids may improve vision in certain cases. Their effects might depend on the type of bacteria. In summary, corticosteroid treatment for bacterial keratitis seems safe with no major impact on long-term vision.