JAMA Ophthalmol

Steroids, corneal cross-linking fail to improve outcomes in bacterial keratitis

July 31, 2025

Among patients with bacterial corneal ulcers, adjunctive topical corticosteroids and corneal cross-linking (CXL) didn't improve visual outcomes or scar size compared with standard antibiotic therapy alone.

Study details: The SCUT II randomized trial (NCT04097730) enrolled 280 patients with smear- or culture-positive bacterial corneal ulcers and moderate vision loss at five centers in India and the U.S. Participants were randomized to either:

• topical moxifloxacin, 0.5%, plus topical placebo plus sham CXL (standard therapy arm)
• topical moxifloxacin, 0.5%, plus difluprednate, 0.05%, plus sham CXL (early-steroid arm)
• topical moxifloxacin, 0.5%, plus difluprednate, 0.05%, plus CXL with riboflavin (CXL arm)

Outcomes were assessed at 6 months, including best spectacle-corrected visual acuity (BSCVA), infiltrate/scar size, microbiological cure, and pain scores.

Results: There was no significant difference in 6-month BSCVA between adjunctive steroids and placebo (−0.04; P=0.58), or between CXL plus steroids and steroids alone (0.04; P=0.62). Scar size wasn't improved with steroids (P=0.65), and was significantly larger with CXL plus steroids compared with steroids alone (P=0.02). After controlling for infiltrate depth, the risk for perforation was numerically lower in the early-steroid arm and the need for therapeutic penetrating keratoplasty was numerically lower in the CXL arm, but neither difference was statistically significant.

Source:

Prajna NV, et al. (2025, July 24). JAMA Ophthalmol. Steroids and Cross-Linking for Ulcer Treatment: The SCUT II Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40705354/