Steroids in the Management of Infectious Keratitis.
Steroids in the Management of Infectious Keratitis.
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类固醇治疗感染性角膜炎。
DOI：
10.1097/ico.0000000000003340
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发表时间：
2023
期刊：
影响因子：
2.8
通讯作者：
Keenan,JeremyD
中科院分区：
文献类型：
--
作者：
Keenan,JeremyD
目的：总结外用皮质类固醇治疗感染性角膜炎的证据基础。方法:复习要点。结果：感染性角膜炎是一种痛苦的疾病，即使抗菌治疗成功，通常也会导致明显的角膜基质瘢痕。皮质类固醇可以减轻炎症和随后的疤痕形成，同时减轻与角膜溃疡相关的急性眼痛。然而，皮质类固醇也会降低宿主的免疫反应，这可能会阻碍清除感染的能力。皮质类固醇的安全性和有效性在很大程度上取决于用于治疗潜在感染的抗菌素的有效性。随机试验发现，皮质类固醇与适当的抗病毒治疗一起使用对疱疹性角膜炎是安全有效的，与广谱局部抗生素一起使用对细菌性角膜炎是安全的。糖皮质激素对细菌性角膜炎的疗效尚未得到最终证实，尽管较晚期的细菌性角膜溃疡可能使用糖皮质激素效果更好。没有随机试验评估类固醇治疗真菌性角膜炎或棘阿米巴角膜炎的安全性和有效性。动物研究表明，皮质类固醇可能对真菌性角膜炎有害，观察性人体研究发现，在抗阿米巴药物之前使用类固醇对真菌性角膜炎和棘阿米巴角膜炎有害。结论：如果抗菌药物能够有效清除或抑制感染，如细菌性角膜炎和疱疹性角膜炎，局部使用皮质类固醇作为抗菌药物治疗的辅助治疗可能是有益的。随机试验将有助于进一步描述皮质类固醇在感染性角膜炎中的作用。
Purpose:To summarize the evidence base on the use of topical corticosteroids for infectious keratitis.Methods:Narrative review.Results:Infectious keratitis is a painful condition that often results in visually significant corneal stromal scarring, even when antimicrobial therapy is successful. Corticosteroids may reduce inflammation and subsequent scar formation and while relieving the acute ocular pain associated with a corneal ulcer. However, corticosteroids also reduce the host immune response, which could hinder the ability to clear infection. The safety and effectiveness of corticosteroids depends to a large part on the efficacy of the antimicrobials being used to treat the underlying infection. Randomized trials have found that corticosteroids are safe and effective for herpetic keratitis when used with appropriate antiviral therapy, and are safe for bacterial keratitis when used with broad spectrum topical antibiotics. The effectiveness of corticosteroids for bacterial keratitis has not been shown conclusively, although more advanced bacterial corneal ulcers may do better with corticosteroids. No randomized trials have assessed the safety and effectiveness of steroids for fungal or acanthamoeba keratitis. Animal studies suggest corticosteroids may be harmful in fungal keratitis, and observational human studies have found that steroids are harmful for fungal and acanthamoeba keratitis when started prior to anti-amoebics.Conclusions:Topical corticosteroids, when used as an adjunct to antimicrobial therapy, may be beneficial if the antimicrobial being used can effectively clear or suppress the infection, such as in bacterial and herpetic keratitis. Randomized trials would be helpful to further delineate the role of corticosteroids for infectious keratitis.