Fluorometholone Study

In this prospective, randomized, parallel-group clinical cohort study, the investigators seek to determine whether adjunctive topical fluorometholone (FML) improves best-corrected visual acuity (BCVA) at 3 months in patients with bacterial corneal ulcers compared with standard topical antibiotic therapy alone. The primary objective is to compare the mean 3-month BCVA (logMAR) between the intervention arm (standard topical antibiotic therapy + FML 0.1%) and a control arm (standard topical antibiotic therapy alone).

Inclusion criteria

• Adults aged ≥ 18 years.
• Clinical diagnosis of a bacterial corneal ulcer based on slit-lamp examination.
• Ulcer severity classified as:

• Mild: Diameter ≤ 3 mm AND stromal depth ≤ 1/3 thickness.
• Moderate: Diameter >3-6 mm and/or stromal depth > 1/3-2/3.
• Severe: Diameter >6 mm and/or stromal depth >2/3.
• Completed microbiologic work-up including ≥ 1 of:

• Corneal culture, or
• PCR testing.
• Received ≥ 48-96 hours of empiric topical antibiotic therapy prior to randomization (fluoroquinolone monotherapy or fortified cefazolin/tobramycin based on standard of care).
• Able and willing to provide informed consent and comply with study visits.

Exclusion criteria

• Clinical or laboratory evidence of:

• Herpes simplex keratitis.
• Acanthamoeba keratitis.
• Fungal keratitis (positive smear, culture or PCR).
• Corneal perforation or imminent perforation at presentation.
• Current use of:

• Topical corticosteroids in the study eye, or
• Systemic corticosteroids during this ulcer episode.
• History of steroid-responsive glaucoma or uncontrolled intraocular pressure (IOP).