Nocardia Keratitis: Clinical Course and Effect of Corticosteroids

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.)