The use of topical corticosteroids in a randomized controlled trial was found to be neither beneficial nor harmful in the overall patient population in the study. However, it helped patients who had more serious forms of bacterial corneal ulcers, according to UCSF researchers.
In a paper published this month in the Archives of Ophthalmology, one of the JAMA/Archives journals, researchers found significant vision improvement—one and a half to two lines of improvement on an eye chart—by using steroid therapy on patients with severe ulcers.
"We consider this finding very significant; it's a clinically meaningful difference," said the paper's co-author Nisha Acharya, MD, MS, associate professor and director of the Uveitis Service in the UCSF Department of Ophthalmology. Although secondary to the study's original purpose, Acharya said the results in severe cases were identified early on, so "we didn't start doing all of these analyses after the fact. It was of interest. So I think there is something there."
The use of topical corticosteroids is somewhat controversial within the ophthalmology community, with no specific evidence pointing one way or the other. Concerns include corneal perforation and worsening vision.
"It's important to note that in the worst ulcer group, not only do we not find a safety problem, we actually found that steroids resulted in a benefit in vision," Acharya said. "So I think that is really reassuring because those were the people with whom we were most scared to use steroids."
UCSF researchers collaborated with colleagues at the Aravind Eye Care System, in Madurai, India. They studied 500 participants from the United States and India between September 2006 and February 2010 in the Steroids for Corneal Ulcers Trial (SCUT). Half of the patients received corticosteroid treatment and the other half received placebos.
Complications from contact lens use are the most common culprit in corneal ulcers in the United States, while agriculture-related injuries are the most common in India. Researchers checked participants three months after the start of the trial, testing for visual acuity and corneal perforations. Patients showed no significant improvement in their vision for participants in the corticosteroid treatment group versus those in the control group.
The study also reinforced the use of steroids in treatment of the ulcers because it found that they were not harmful.
"There was no increase in cornea perforations in our patient population," Acharya said. "I'm reassured to know that it's not associated with harm."
Building on their findings, Acharya and her colleagues intend to continue their work, studying patients with even more severe corneal ulcers.
"It makes us feel like we're moving towards an evidence-based paradigm of care for corneal ulcers rather than a trial and error sort of approach," Acharya said. "We have a good collaboration and now that we've had some success with this, we hope to be able to continue with it to answer other questions related to this field."
The lead author of the paper is Muthiah Srinivasan, MD, of Aravind Eye Hospital; co-authors are Jeena Mascarenhas, MD, Revathi Rajaraman, MD, Meenakshi Ravindran, MD, Prajna Lalitha, MD, of Aravind Eye Hospital; David Glidden, PhD, of UCSF Department of Epidemiology and Biostatistics; Thomas Lietman, MD, Kathryn Ray, MA, Kevin Hong, BA, Catherine Oldenburg, MPH, and Salena Lee, OD of The Francis I. Proctor Foundation for Research in Ophthalmology at UCSF; Michael Zegans, MD, of Dartmouth Medical School; and Stephen McLeod, MD, of UCSF Department of Ophthalmology.
The study was supported by funds from the National Institutes of Health (NIH).
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.
Follow UCSF on Twitter @ucsf /@ucsfscience
Leland Kim | EurekAlert!
Innovative genetic tests for children with developmental disorders and epilepsy
11.07.2018 | Christian-Albrechts-Universität zu Kiel
Oxygen loss in the coastal Baltic Sea is “unprecedentedly severe”
05.07.2018 | European Geosciences Union
For the first time ever, scientists have determined the cosmic origin of highest-energy neutrinos. A research group led by IceCube scientist Elisa Resconi, spokesperson of the Collaborative Research Center SFB1258 at the Technical University of Munich (TUM), provides an important piece of evidence that the particles detected by the IceCube neutrino telescope at the South Pole originate from a galaxy four billion light-years away from Earth.
To rule out other origins with certainty, the team led by neutrino physicist Elisa Resconi from the Technical University of Munich and multi-wavelength...
For the first time a team of researchers have discovered two different phases of magnetic skyrmions in a single material. Physicists of the Technical Universities of Munich and Dresden and the University of Cologne can now better study and understand the properties of these magnetic structures, which are important for both basic research and applications.
Whirlpools are an everyday experience in a bath tub: When the water is drained a circular vortex is formed. Typically, such whirls are rather stable. Similar...
Physicists working with Roland Wester at the University of Innsbruck have investigated if and how chemical reactions can be influenced by targeted vibrational excitation of the reactants. They were able to demonstrate that excitation with a laser beam does not affect the efficiency of a chemical exchange reaction and that the excited molecular group acts only as a spectator in the reaction.
A frequently used reaction in organic chemistry is nucleophilic substitution. It plays, for example, an important role in in the synthesis of new chemical...
Optical spectroscopy allows investigating the energy structure and dynamic properties of complex quantum systems. Researchers from the University of Würzburg present two new approaches of coherent two-dimensional spectroscopy.
"Put an excitation into the system and observe how it evolves." According to physicist Professor Tobias Brixner, this is the credo of optical spectroscopy....
Ultra-short, high-intensity X-ray flashes open the door to the foundations of chemical reactions. Free-electron lasers generate these kinds of pulses, but there is a catch: the pulses vary in duration and energy. An international research team has now presented a solution: Using a ring of 16 detectors and a circularly polarized laser beam, they can determine both factors with attosecond accuracy.
Free-electron lasers (FELs) generate extremely short and intense X-ray flashes. Researchers can use these flashes to resolve structures with diameters on the...
13.07.2018 | Event News
12.07.2018 | Event News
03.07.2018 | Event News
17.07.2018 | Information Technology
17.07.2018 | Materials Sciences
17.07.2018 | Power and Electrical Engineering