Ocular Microbiology and Immunology Group
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2025 OMIG Abstract

Vision-Related Quality of Life Outcomes in Patients Treated for Microbial Keratitis in the SCUT II Trial

Alejandro Arboleda¹, NV Prajna², N Radhakrishnan², Prajna Lalitha², Revathi Rajaraman²,
Anitha Venugopal², Sarah Abdelrahman³, Benjamin F Arnold³, Guillermo Amescua⁴, Thomas M Lietman³, Jennifer Rose-Nussbaumer<sup>5

1</sup>Department of Ophthalmology, Baylor College of Medicine, Houston, Texas; ²Aravind Eye Care System, Madurai, India; ³Dept of Ophthalmology and Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California; ⁴Byers Eye Institute, Dept of Ophthalmology, Stanford University, Palo Alto, California; ⁵Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida

Purpose: This study evaluated vision-related quality of life and pain in patients with microbial keratitis treated with topical antibiotics, with or without adjunctive steroid and corneal crosslinking (CXL), in the Steroids and Crosslinking for Ulcer Treatment (SCUT II) Trial.

Methods: Participants with smear/culture-positive bacterial keratitis were randomized to one of three treatment groups: (1) moxifloxacin 0.5% + placebo + sham CXL; (2) moxifloxacin 0.5% + difluprednate 0.05% + sham CXL; or (3) moxifloxacin 0.5% + difluprednate 0.05% + CXL. All participants completed the Indian Visual Function Questionnaire (IND-VFQ) at baseline and six months after enrollment. Average IND-VFQ scores and Rasch-derived subscale scores for vision-specific mobility, activity limitation, psychosocial impact, and visual symptoms were analyzed. Pain scores were recorded at baseline and at three-day follow-up. Linear regressions were used to compare IND-VFQ and pain scores between the groups.

Results: IND-VFQ and pain scores improved for all subjects six months after initiating treatment compared to baseline (p < 0.001). Linear regressions comparing the addition of difluprednate to treatment with moxifloxacin showed no significant difference in average IND-VFQ scores (p = 0.98), vision-specific mobility (p = 0.82), activity limitation (p = 0.76), psychosocial impact (p = 0.71), visual function (p = 0.71), or pain scores (p = 0.16). Adding CXL to treatment with moxifloxacin and difluprednate also resulted in similar average IND-VFQ (p = 0.45), vision-specific mobility (p = 0.27), activity limitation (p = 0.29), psychosocial impact (p = 0.97), and visual function (p = 0.61) compared to sham CXL. However, patients treated with CXL reported higher pain scores at the 3 day follow up visit than those who did not receive CXL (p = 0.01).

Conclusions: In SCUT II, vision-related quality of life and pain improved for all subjects. Adjunctive difluprednate 0.5% did not negatively impact vision-related quality of life. Adjunct CXL did not significantly affect quality of life measures but was associated with increased short-term pain. These findings, along with the SCUT II primary endpoint results, suggest that steroids are generally safe in bacterial keratitis, whereas routine use of CXL for microbial keratitis is not recommended.