Corticosteroids Do Not Outperform Placebo in Bacterial Keratitis Treatment

Recent clinical research indicates that adjunctive use of corticosteroids does not provide additional benefits over placebo in the treatment of bacterial keratitis. A study published in JAMA Ophthalmology on July 24, 2025, examined whether adding corticosteroids, specifically difluprednate, alongside standard antibiotic therapy and corneal cross-linking (CXL), improves outcomes for patients with bacterial corneal ulcers. The trial involved 280 participants who were assigned to one of three treatment groups: standard therapy with antibiotics and placebo, early corticosteroid therapy with antibiotics, or combined corticosteroid and CXL therapy.

The results showed no significant improvement in six-month visual acuity with the addition of topical corticosteroids. Furthermore, neither corticosteroids alone nor combined with CXL demonstrated a reduction in scar size; in fact, the group receiving CXL experienced increased scarring. Although there was a trend towards a lower risk of perforation or the need for surgical intervention in the early-steroid and CXL groups after adjusting for infiltrate depth, these differences were not statistically significant. Additionally, patients undergoing CXL reported more pain and larger scars, suggesting that these adjunctive therapies may not be more effective than standard antibiotic treatment alone.

This study suggests that the routine use of corticosteroids as an adjunct in bacterial keratitis may not improve patient outcomes and could potentially cause more discomfort and scarring. The findings highlight the need for continued research into more effective treatment options for bacterial corneal ulcers.

Source: https://medicalxpress.com/news/2025-07-corticosteroids-superior-placebo-treatment-bacterial.html