Document Detail


Nocardia keratitis: clinical course and effect of corticosteroids.
MedLine Citation:
PMID:  22959881     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To compare the clinical course of Nocardia species keratitis with keratitis resulting from other bacterial organisms and to assess the effect of corticosteroids as adjunctive therapy using data collected from the Steroids for Corneal Ulcers Trial.
DESIGN: Subgroup analysis of a randomized controlled trial.
METHODS: setting: Multicenter randomized controlled trial. study population: Five hundred patients with bacterial keratitis randomized 1:1 to topical corticosteroid or placebo who had received at least 48 hours of topical moxifloxacin. intervention/observation procedure: Topical prednisolone phosphate 1% or placebo and clinical course of Nocardia keratitis. main outcome measures: Best spectacle-corrected visual acuity and infiltrate or scar size at 3 months from enrollment.
RESULTS: Of 500 patients enrolled in the trial, 55 (11%) had a Nocardia corneal ulcer. Patients with Nocardia ulcers had better presentation visual acuity compared with non-Nocardia ulcers (median Snellen visual acuity, 20/45, compared with 20/145; P < .001) and comparable 3-month visual acuity (median, 20/25, vs 20/40; P = .25). Nocardia ulcers had approximately 2 lines less of improvement in visual acuity compared with non-Nocardia ulcers (0.21 logarithm of the minimal angle of resolution; 95% confidence interval, 0.09 to 0.33 logarithm of the minimal angle of resolution; P = .001). This difference may reflect the better starting visual acuity in patients with Nocardia ulcers. In Nocardia ulcers, corticosteroids were associated with an average 0.4-mm increase in 3-month infiltrate or scar size (95% confidence interval, 0.03 to 0.77 mm; P = .03).
CONCLUSIONS: Nocardia ulcers responded well to treatment. They showed less overall improvement in visual acuity than non-Nocardia ulcers, but had better presentation acuity. Corticosteroids may be associated with worse outcomes.
Authors:
Prajna Lalitha; Muthiah Srinivasan; Revathi Rajaraman; Meenakshi Ravindran; Jeena Mascarenhas; Jeganathan Lakshmi Priya; Aileen Sy; Catherine E Oldenburg; Kathryn J Ray; Michael E Zegans; Stephen D McLeod; Thomas M Lietman; Nisha R Acharya
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-09-05
Journal Detail:
Title:  American journal of ophthalmology     Volume:  154     ISSN:  1879-1891     ISO Abbreviation:  Am. J. Ophthalmol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-15     Completed Date:  2013-01-30     Revised Date:  2013-12-05    
Medline Journal Info:
Nlm Unique ID:  0370500     Medline TA:  Am J Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  934-939.e1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00324168
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MeSH Terms
Descriptor/Qualifier:
Administration, Topical
Adult
Anti-Infective Agents / administration & dosage,  therapeutic use*
Aza Compounds / administration & dosage,  therapeutic use
Corneal Ulcer / diagnosis,  drug therapy*,  microbiology
Double-Blind Method
Eye Infections, Bacterial / diagnosis,  drug therapy*,  microbiology
Female
Glucocorticoids / administration & dosage,  therapeutic use*
Humans
Male
Middle Aged
Nocardia / genetics,  isolation & purification*
Nocardia Infections / diagnosis,  drug therapy*,  microbiology
Polymerase Chain Reaction
Prednisolone / administration & dosage,  analogs & derivatives,  therapeutic use
Quinolines / administration & dosage,  therapeutic use
Treatment Outcome
Visual Acuity / physiology
Grant Support
ID/Acronym/Agency:
EY02162/EY/NEI NIH HHS; K23 EY017897/EY/NEI NIH HHS; K23EY017897/EY/NEI NIH HHS; U10 EY015114/EY/NEI NIH HHS; U10 EY015114/EY/NEI NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Infective Agents; 0/Aza Compounds; 0/Glucocorticoids; 0/Quinolines; 752SY38R6C/prednisolone phosphate; 9PHQ9Y1OLM/Prednisolone; U188XYD42P/moxifloxacin
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