• Best spectacle-corrected logMAR visual acuity, using best spectacle-corrected enrollment visual acuity as a co-variate [ Time Frame: 3 months from enrollment ] [ Designated as safety issue: No ]
  

• Infiltrate/scar size, correcting for infiltrate/scar size at enrollment [ Time Frame: 3 months from enrollment ] [ Designated as safety issue: No ]
  
• Best hard contact lens corrected visual acuity, correcting for best spectacle corrected visual acuity at enrollment [ Time Frame: 3 months from enrollment ] [ Designated as safety issue: No ]
  
• Time to resolution of epithelial defect [ Time Frame: At the time of re-epithelialization ] [ Designated as safety issue: No ]
  
• Ocular perforations [ Time Frame: At the time of perforation ] [ Designated as safety issue: No ]
  
• Best spectacle-corrected logMAR visual acuity, using best spectacle-corrected enrollment visual acuity as a co-variate [ Time Frame: 12 months from enrollment ] [ Designated as safety issue: No ]
  
• Best spectacle corrected visual acuity by subgroup analysis of causative organisms [ Time Frame: 3 months after enrollment ] [ Designated as safety issue: No ]
  
• Treatment response by subgroup analysis of the subtype of P.aeruginosa (invasive or cytotoxic) [ Time Frame: 3 months from enrollment ] [ Designated as safety issue: No ]
  
• The correlation between the best-corrected visual acuity and minimum inhibitory concentration to moxifloxacin [ Time Frame: 3 months after enrollment ] [ Designated as safety issue: No ]
  

Antimicrobial treatment of a bacterial corneal ulcer is generally effective in eradicating infection. However, "successful" treatment is not always associated with a good visual outcome. The scarring that accompanies the resolution of infection leaves many eyes blind. Some corneal specialists advocate the use of topical corticosteroids along with antibiotics in an effort to reduce immune-mediated tissue damage and scarring. Others fear using steroids to reduce the cornea's immune response will prolong or even exacerbate infection. Ophthalmologists have been divided on this issue for more than 30 years, and both approaches are acceptable according to the American Academy of Ophthalmology's Preferred Practice Patterns. Evidence from animal and human reports is mixed. A single randomized trial saw a non-significant benefit to steroids but was drastically underpowered (20 patients per study arm).

The study is a randomized, double-masked, placebo-controlled trial to determine whether adding topical steroids improves the outcomes of bacterial corneal ulcers. Five hundred bacterial corneal ulcers presenting to the Aravind Eye Hospitals, the UCSF Proctor Foundation, and the Dartmouth- Hitchcock Medical Center are being randomized to receive antibiotic plus steroid or antibiotic plus placebo. They are being followed closely until re- epithelialization and then rechecked at three weeks, three months and 12 months post enrollment. The primary outcome is best spectacle-corrected logMAR visual acuity three months after enrollment, using best spectacle-corrected enrollment visual acuity as a co-variate.

The pilot study was conducted from January, 2005 to August, 2005 at Aravind Eye Hospital to assess the feasibility and safety and to estimate the sample size of a larger main trial. 42 patients with culture-proven bacterial keratitis were enrolled. They were treated and followed up as in the main trial, up to 3 months from enrollment.