Corticoesteroides tópicos como tratamiento adyuvante para la queratitis bacteriana
Appendices
Appendix 1. CENTRAL search strategy
#1 MeSH descriptor: [Keratitis] explode all trees
#2 MeSH descriptor: [Corneal Ulcer] explode all trees
#3 MeSH descriptor: [Eye Infections, Bacterial] explode all trees
#4 cornea* near/3 ulcer*
#5 keratitis near/3 bacteria*
#6 bacteri* near/3 infec* near/5 ocular
#7 bacteria* near/3 infec* near/5 eye*
#8 #1 or #2 or #3 or #4 or #5 or #6 or #7
#9 MeSH descriptor: [Adrenal Cortex Hormones] explode all trees
#10 corticosteroid* or steroid*
#11 MeSH descriptor: [Prednisolone] this term only
#12 MeSH descriptor: [Dexamethasone] this term only
#13 MeSH descriptor: [Fluorometholone] this term only
#14 (prednisolone or pred forte or dexamethasone or fluorometholone or rimexolone)
#15 #9 or #10 or #11 or #12 or #13 or #14
#16 #8 and #15
Appendix 2. MEDLINE (OvidSP) search strategy
1. randomized controlled trial.pt.
2. (randomized or randomised).ab,ti.
3. placebo.ab,ti.
4. dt.fs.
5. randomly.ab,ti.
6. trial.ab,ti.
7. groups.ab,ti.
8. or/1‐7
9. exp animals/
10. exp humans/
11. 9 not (9 and 10)
12. 8 not 11
13. exp keratitis/
14. exp eye infections bacterial/
15. (cornea$ adj3 ulcer$).tw.
16. (keratitis adj3 bacteria$).tw.
17. (bacteri$ adj3 (infec$ adj5 ocular)).tw.
18. (bacteri$ adj3 (infec$ adj5 eye$)).tw.
19. or/13‐18
20. exp Adrenal Cortex Hormones/
21. (corticosteroid$ or steroid$).tw.
22. exp prednisolone/
23. exp Dexamethasone/
24. Fluorometholone/
25. (prednisolone or pred forte or dexamethasone or fluorometholone or rimexolone).tw.
26. or/20‐25
27. 19 and 26
28. 12 and 27
The search filter for trials at the beginning of the MEDLINE strategy is from the published paper by Glanville (Glanville 2006).
Appendix 3. EMBASE (OvidSP) search strategy
1. exp randomized controlled trial/
2. exp randomization/
3. exp double blind procedure/
4. exp single blind procedure/
5. random$.tw.
6. or/1‐5
7. (animal or animal experiment).sh.
8. human.sh.
9. 7 and 8
10. 7 not 9
11. 6 not 10
12. exp clinical trial/
13. (clin$ adj3 trial$).tw.
14. ((singl$ or doubl$ or trebl$ or tripl$) adj3 (blind$ or mask$)).tw.
15. exp placebo/
16. placebo$.tw.
17. random$.tw.
18. exp experimental design/
19. exp crossover procedure/
20. exp control group/
21. exp latin square design/
22. or/12‐21
23. 22 not 10
24. 23 not 11
25. exp comparative study/
26. exp evaluation/
27. exp prospective study/
28. (control$ or prospectiv$ or volunteer$).tw.
29. or/25‐28
30. 29 not 10
31. 30 not (11 or 23)
32. 11 or 24 or 31
33. exp keratitis/
34. bacterial eye infection/
35. (cornea$ adj3 ulcer$).tw.
36. (keratitis adj3 bacteria$).tw.
37. (bacteri$ adj3 (infec$ adj5 ocular)).tw.
38. (bacteri$ adj3 (infec$ adj5 eye$)).tw.
39. or/33‐38
40. corticosteroid/
41. (corticosteroid$ or steroid$).tw.
42. prednisolone/
43. dexamethasone/
44. fluorometholone/
45. (prednisolone or pred forte or dexamethasone or fluorometholone or rimexolone).tw.
46. or/40‐45
47. 39 and 46
48. 32 and 47
Appendix 4. LILACS search strategy
bacterial keratitis and corticosteroid or steroid or prednisolone or pred forte or dexamethasone or fluorometholone or dexamethasone or fluorometholone or rimexolone
Appendix 5. metaRegister of Controlled Trials search strategy
bacterial keratitis AND (corticosteroid OR steroid OR prednisolone OR pred forte OR dexamethasone OR fluorometholone OR dexamethasone OR fluorometholone OR rimexolone)
Appendix 6. ClinicalTrials.gov search strategy
bacterial keratitis AND (corticosteroid OR steroid OR prednisolone OR pred forte OR dexamethasone OR fluorometholone OR dexamethasone OR fluorometholone OR rimexolone)
Appendix 7. ICTRP search strategy
bacterial keratitis = Condition AND corticosteroid OR steroid OR prednisolone OR pred forte OR dexamethasone OR fluorometholone OR dexamethasone OR fluorometholone OR rimexolone = Intervention
Results from searching for studies for inclusion in the review
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Steroid versus placebo for the treatment of corneal ulcers, Outcome 1 Time to re‐epithelialization.
| Outcomes | |||||
| Visual acuity | Effect measure | Mean change in logMAR visual acuity from baseline, measured by ETDRS chart | Mean BCVA from Snellen chart and then converted to a numerical equivalent number; linear regression model | Mean difference in logMAR BCVA between groups from multiple linear regression model, using a protocol adapted from AREDS using a tumbling "E" chart | Mean logMAR BCVA adapted from AREDS using a tumbling "E" chart; mean difference in logMAR BCVA between groups from multiple linear regression model |
| Time point(s) measured | 10 weeks | 2 months | 3 weeks, 3 months, 12 months | 3 weeks and 3 months | |
| Estimate | Steroid group: ‐0.31 (SD or 95% CI not reported) Control group: ‐0.18 (SD or 95% CI not reported) | 1) Mean BCVA: Steroid group: mean pretreatment vision: 6; mean post‐treatment vision: 9.7 Non‐steroid group: mean pretreatment vision: 6.4; mean post‐treatment vision: 9.2 2) Linear regression model: linear regression showed no difference between groups | 3 weeks: steroid group had 0.024 better logMAR BCVA (95% CI ‐0.092 to 0.044) 3 months: steroid group had 0.009 better logMAR BCVA (95% CI ‐0.085 to 0.068) 12 months: steroid group had 0.04 better logMAR BCVA (95% CI ‐0.12 to 0.05) | 1) Mean (SD) logMAR BCVA: 3 weeks: steroid group: 0.66 (0.68); placebo group: 0.75 (0.75) 3 months: steroid group: 0.71 (0.72); placebo group: 0.59 (0.75) 2) Multiple linear regression model: 3 weeks: steroid group had 0.19 lower (better) logMAR BCVA (95% CI ‐0.52 to 0.15) 3 months: steroid group had 0.09 lower (better) logMAR BCVA (95% CI ‐0.41 to 0.24) | |
| Interpretation | No statistically significant difference between groups was found | No statistically significant difference between groups was found | No statistically significant difference between groups was found | No statistically significant difference between groups was found | |
| Healing rate/ulcer size /time to re‐epithelialization | Effect measure | Mean change in ulcer area from baseline (mm2), measured by photographic measurement and by clinician estimate (slit lamp) | Mean size of ulcer (mm2) healed per day, measured at the slit lamp | Mean difference in diameter of ulcer area from linear regression models, measured by a Haag‐Streit 900 slit lamp biomicroscope; median time to re‐epithelialization (days) | Mean difference in diameter of ulcer area from linear regression models, measured by a Haag‐Streit 900 slit lamp biomicroscope |
| Time point(s) measured | 10 weeks | 21 days | 3 weeks, 3 months, 12 months | 3 weeks and 3 months | |
| Estimate | Photographic measurement: Steroid group: ‐4.388 mm2 Control group: ‐1.919 mm2 (SD or 95% CI not reported) Clinician estimate (slit lamp): Steroid group: ‐4.206 mm2 Control group: ‐0.789 mm2 (SD or 95% CI not reported) | Steroid group: 0.36 mm2 per day Control group: 0.30 mm2 per day | Ulcer size: 3 weeks: steroid group had 0.05 mm smaller diameter of scar area (95% CI ‐0.09 to 0.15) 3 months: steroid group had 0.06 mm smaller diameter of scar area (95% CI ‐0.07 to 0.17) 12 months: steroid group had 0.03 mm smaller diameter of scar area (95% CI ‐0.12 to 0.18) Time to re‐epithelialization: Steroid group: 7.5 days (95% CI 5.5 to 8.5 days) Placebo group: 7 days (95% CI 5.5 to 8.5 days) | Ulcer size: 3 weeks: steroid group had 0.57 mm smaller diameter of scar area (95% CI 1.5 to 0.37) 3 months: steroid group had 0.33 mm smaller diameter of scar area (95% CI 1.4 to 0.75) Time to re‐epithelialization: steroid group: 8.6 days (SD 4.7) placebo group: 6.3 days (SD 3.1) | |
| Interpretation | No statistically significant difference between groups from photographic measurement; statistically significant difference between groups from clinician estimate | No statistically significant difference between groups was found | No statistically significant difference between groups was found | No statistically significant difference between groups was found | |
| AREDS: Age Related Eye Disease Study | |||||
| Adverse event | ||||||||||||
| Steroid | Control | RR (95% CI) | Steroid | Control | RR (95% CI) | Steroid | Placebo | RR (95% CI) | Steroid | Placebo | RR (95% CI) | |
| Recurrence of the ulcer | 1/14 | 0/12 | 2.60 (0.12 to 58.48) | 1/21 | 2/19 | 0.45 (0.04 to 4.60) | / | / | / | / | / | / |
| Second ulcer | 0/14 | 1/12 | 0.29 (0.01 to 6.50) | / | / | / | / | / | / | / | / | / |
| Corneal thinning | / | / | / | 1/21 | 1/19 | 0.90 (0.06 to 13.48) | 0/250 | 2/250 | 0.20 (0.01 to 4.14) | / | / | / |
| Corneal perforation | / | / | / | 1/21 | 1/19 | 0.90 (0.06 to 13.48) | 7/250 | 8/250 | 0.88 (0.32 to 2.38) | 0/20 | 2/22 | 0.20 (0.01 to 3.94) |
| Uncontrolled infection | / | / | / | 0/21 | 2/19 | 0.18 (0.01 to 3.56) | / | / | / | / | / | / |
| Persistent epithelial defect | / | / | / | 4/21 | 3/19 | 1.21 (0.31 to 4.71) | 44/250 | 27/250 | 1.63 (1.04 to 2.54) | / | / | / |
| Epithelial breakdown | / | / | / | 1/21 | 1/19 | 0.90 (0.06 to 13.48) | / | / | / | / | / | / |
| Death | / | / | / | / | / | / | 7/250 | 5/250 | 1.40 (0.45 to 4.35) | / | / | / |
| Systemic infection | / | / | / | / | / | / | 1/250 | 0/250 | 3.00 (0.12 to 73.29) | / | / | / |
| Increase in hypopyon | / | / | / | / | / | / | 4/250 | 4/250 | 1.00 (0.25 to 3.95) | / | / | / |
| IOP elevation | / | / | / | / | / | / | 2/250 | 10/250 | 0.20 (0.04 to 0.90) | 0/20 | 1/22 | 0.37 (0.02 to 8.48) |
| Worsening infiltrate | / | / | / | / | / | / | 9/250 | 4/250 | 2.25 (0.70 to 7.21) | 0/20 | 1/22 | 0.37 (0.02 to 8.48) |
| Other | / | / | / | / | / | / | 9/250 | 13/250 | 0.69 (0.30 to 1.59) | / | / | / |
| CI: confidence interval | ||||||||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Time to re‐epithelialization Show forest plot | 2 | Hazard Ratio (Fixed, 95% CI) | Totals not selected | |
