Nocardia Keratitis: Clinical Course and Effect of Corticosteroids
Nocardia Keratitis: Clinical Course and Effect of Corticosteroids
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DOI：
10.1016/j.ajo.2012.06.001
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发表时间：
2012-12-01
影响因子：
4.2
通讯作者：
Acharya, Nisha R.
中科院分区：
文献类型：
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作者：
Lalitha, Prajna;Srinivasan, Muthiah;Acharya, Nisha R.
中心点 目的：比较诺卡氏菌属角膜炎与其他细菌引起的角膜炎的临床病程，并使用从类固醇治疗角膜溃疡试验中收集的数据评估皮质类固醇作为辅助治疗的效果。中心点设计：随机对照试验的亚组分析。中心点方法：背景：多中心随机对照试验。研究人群：500 名细菌性角膜炎患者按照 1:1 的比例随机接受局部皮质类固醇或安慰剂治疗，这些患者接受了至少 48 小时的局部莫西沙星治疗。干预/观察程序：局部使用 1% 磷酸泼尼松龙或安慰剂以及诺卡氏菌角膜炎的临床病程。主要观察指标：入组后 3 个月时的最佳眼镜矫正视力以及浸润或疤痕大小。中心点结果：在参加试验的 500 名患者中，55 名 (11%) 患有诺卡氏菌角膜溃疡。与非诺卡菌溃疡患者相比，诺卡菌溃疡患者的视力表现更好（中位 Snellen 视力为 20/45，与 20/145 相比；P < .001），并且 3 个月视力相当（中位视力为 20/25，与 20/40 相比；P = .25）。与非诺卡氏菌溃疡相比，诺卡氏菌性溃疡的视力改善大约少 2 行（最小分辨角的对数为 0.21；95% 置信区间，最小分辨角的对数为 0.09 至 0.33；P = 0.001）。这种差异可能反映出诺卡氏菌溃疡患者的初始视力较好。在诺卡氏菌溃疡中，皮质类固醇与 3 个月浸润或疤痕大小平均增加 0.4 毫米相关（95% 置信区间，0.03 至 0.77 毫米；P = 0.03）。中心点结论：诺卡氏菌溃疡对治疗反应良好。与非诺卡氏菌溃疡相比，他们的视力总体改善较少，但表现敏锐度更好。皮质类固醇可能与更糟糕的结果有关。 （美国眼科杂志 2012 年；154：934-939。(C) 2012 年，Elsevier Inc. 保留所有权利。）
center dot 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.center dot DESIGN: Subgroup analysis of a randomized controlled trial.center dot 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.center dot 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).center dot 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. (Am J Ophthalmol 2012;154: 934-939. (C) 2012 by Elsevier Inc. All rights reserved.)