In an effort to describe the usage patterns of steroids in treating bacterial keratitis and analyze the effect of steroids on visual outcomes, a team of Australian researchers evaluated 328 patients, 164 of who were treated with steroids. 

The team found that high-dose steroid treatment is significantly associated with better visual outcomes in patients with culture-positive bacterial keratitis.

The single-center retrospective study included patients with culture-positive bacterial keratitis who were treated between 1999 and 2015 at Princess Alexandra Hospital in Brisbane, Australia. Patients with culture-positive bacterial keratitis were identified through the Queensland Pathology Database, and clinical information was gathered through a subsequent medical record review.

High-dose steroid treatment was classified as six or more drops of a steroid daily, initiated within seven days of corneal scraping. The outcome of a patient's episode of keratitis was classified as good if their final visual acuity was 6/12 or better, poor if it was 6/60 or worse or required a corneal transplant or average for all other cases. Microbiological and clinical variables' association with outcomes was evaluated in univariate analyses. Variables significant at P<0.1 levels were examined with steroid treatment levels of high, regular, low or no dose.

The researchers found that factors significantly associated with outcomes were high-dose steroid treatment, visual acuity on presentation, age group, cause of keratitis, infiltrate size and location. They note that the odds ratio of better outcomes with high-dose steroids was 5.49.

Green M, Hughes I, Hogden J, et al. High-dose steroid treatment of bacterial keratitis. Cornea. October 24, 2018. [Epub ahead of print].