Dexamethasone/Povidone Eye Drops versus Artificial Tears for Treatment of Presumed Viral Conjunctivitis: A Randomized Clinical Trial

Pinto, Roberto Damian Pacheco; Lira, Rodrigo Pessoa Cavalcanti; Abe, Ricardo Y.; Zacchia, Rafael Santos; Felix, João Paulo Fernandes; Pereira, André Venâncio Fernandes; Arieta, Carlos Eduardo Leite; Castro, Rosane Silvestre de; Bonon, Sandra Helena Alves

doi:10.3109/02713683.2014.964419

Cited by 46 publications

(30 citation statements)

References 40 publications

(49 reference statements)

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“…18 A study that used the adenovirus type 5/New Zealand rabbit ocular model showed that corticosteroids alone can increase viral replication and the duration of viral shedding. 19 However, results from the present study and others [14][15][16] suggest that PVP-I/dexamethasone does not increase or prolong viral shedding, with adenoviral eradication observed from day 3 through day 12 in our study. In addition, rapid adenoviral eradication and clinical resolution with PVP-I/dexamethasone should ensure that the…”

Section: The Results Of This Study Indicate That Ancontrasting

confidence: 75%

“…The results from our study are consistent with results from studies of different PVP-I/dexamethasone formulations. [13][14][15][16] A phase 2 pilot study (NCT01461954) conducted in Brazil has also investigated the safety and efficacy of PVP-I 0.6%/dexamethasone 0.1% compared with vehicle for the treatment of clinically suspected acute viral conjunctivitis, and showed trends toward efficacy; however, too few patients with confirmed adenoviral conjunctivitis were enrolled to deliver meaningful results.…”

Section: The Results Of This Study Indicate That Anmentioning

confidence: 99%

“…14 In a randomized controlled trial of 122 patients with a clinical diagnosis of presumed viral conjunctivitis, ocular administration of PVP-I 0.4%/dexamethasone 0.1% QID significantly reduced the duration of conjunctivitis compared with patients receiving artificial tears. 15 More recently, in a randomized controlled trial of 74 patients with adenoviral keratoconjunctivitis, patients treated with PVP-I 1.0%/dexamethasone 0.1% experienced significantly faster improvement of clinical signs than control groups, with near-complete recovery in 5-7 days and almost-complete viral eradication (92% reduction) by the fifth day of treatment. 16 In this multicenter phase 2 randomized controlled study, we evaluated the efficacy and safety of an ophthalmic suspension of PVP-I 0.6% and dexamethasone 0.1% for the treatment of acute adenoviral conjunctivitis in adults.…”

mentioning

confidence: 99%

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Randomized, Controlled, Phase 2 Trial of Povidone-Iodine/Dexamethasone Ophthalmic Suspension for Treatment of Adenoviral Conjunctivitis

Pepose

Ahuja²,

Liu³

et al. 2019

American Journal of Ophthalmology

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Section: The Results Of This Study Indicate That Ancontrasting

confidence: 75%

Section: The Results Of This Study Indicate That Anmentioning

confidence: 99%

mentioning

confidence: 99%

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Randomized, Controlled, Phase 2 Trial of Povidone-Iodine/Dexamethasone Ophthalmic Suspension for Treatment of Adenoviral Conjunctivitis

Pepose

Ahuja²,

Liu³

et al. 2019

American Journal of Ophthalmology

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“…23 Since 8 days pi, the time point pi of maximal observed loss of innervation, coincides with a highly inflammatory milieu in the infected cornea, 12,14 we hypothesized the mechanism triggering regression of corneal nerves is immune system mediated. To test this hypothesis, we evaluated the effects of DEX, a clinically prescribed, anti-inflammatory reagent, 25,26 on the corneal nerve network after HSV-1 infection. C57BL6 mice were ocularly infected or scarified and left uninfected as controls.…”

Section: Dex Prevents Corneal Nerve Regression and Sensation Loss Aftmentioning

confidence: 99%

IL-6 Contributes to Corneal Nerve Degeneration after Herpes Simplex Virus Type I Infection

Chucair-Elliott

Jinkins

Carr

et al. 2016

The American Journal of Pathology

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Herpes simplex virus type 1 (HSV-1) is a leading cause of neurotrophic keratitis characterized by decreased corneal sensation because of damage to the corneal sensory fibers. We and others have reported regression of corneal nerves during acute HSV-1 infection. To determine whether denervation is caused directly by the virus or indirectly by the elicited immune response, mice were infected with HSV-1 and topically treated with dexamethasone (DEX) or control eye drops. Corneal sensitivity was measured using a Cochet-Bonnet esthesiometer and nerve network structure via immunohistochemistry. Corneas were assessed for viral content by plaque assay, leukocyte influx by flow cytometry, and content of chemokines and inflammatory cytokines by suspension array. DEX significantly preserved corneal nerve structure and sensitivity on infection. DEX reduced myeloid and T-cell populations in the cornea and did not affect viral contents at 4 and 8 days post infection. The elevated protein contents of chemokines and inflammatory cytokines on infection were greatly suppressed by DEX. Subconjunctival delivery of neutralizing antibody against IL-6 to infected mice resulted in partial preservation of corneal nerve structure and sensitivity. Our study supports a role for the immune response, but not local virus replication in the development of HSV-1einduced neurotrophic keratitis. IL-6 is one of the factors produced by the elicited inflammatory response to HSV-1 infection contributing to nerve regression.

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“…Reported side effects were limited to increased stinging upon instillation when compared to treatment with palliative artificial tears. 94…”

Section: Combination Dexamethasone/pvi Treatmentmentioning

confidence: 99%

<p>Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions</p>

Labib¹,

Minhas²,

Chigbu³

2020

OPTH

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Human adenovirus (HAdV) is the most common cause of infectious conjunctivitis, accounting for up to 75% of all conjunctivitis cases and affecting people of all ages and demographics. In addition to ocular complications, it can cause systemic infections in the form of gastroenteritis, respiratory disease, and dissemination in immunocompromised individuals. HAdV causes lytic infection of the mucoepithelial cells of the conjunctiva and cornea, as well as latent infection of lymphoid and adenoid cells. Epidemic keratoconjunctivitis (EKC) is the most severe ocular manifestation of HAdV infection, in which the presence of subepithelial infiltrates (SEIs) in the cornea is a hallmark feature of corneal involvement. SEIs have the tendency to recur and may lead to long-term visual disability. HAdV persistence and dissemination are linked to sporadic outbreaks of adenoviral keratoconjunctivitis. There is no FDA-approved antiviral for treating adenoviral keratoconjunctivitis, and as such, solutions should be proffered to handle the challenges associated with viral persistence and dissemination. Several treatment modalities have been investigated, both systemically and locally, to not only mitigate symptoms but reduce the course of the infection and prevent the risk of long-term complications. These options include systemic and topical antivirals, in-office povidone-iodine irrigation (PVI), immunoglobulin-based therapy, antiinflammatory therapy, and immunotherapy. More recently, combination PVI/dexamethasone ophthalmic formulations have shown favorable outcomes and were well tolerated in clinical trials for the treatment of EKC. Possible, future treatment considerations include sialic acid analogs, cold atmospheric plasma, N-chlorotaurine, and benzalkonium chloride. Continued investigation and evaluation of treatment are warranted to reduce the economic burden and potential long-term visual debilitation in affected patients. This review will focus on how persistence and dissemination of HAdV pose a significant challenge to the management of adenoviral keratoconjunctivitis. Furthermore, current and future trends in prophylactic and therapeutic modalities for adenoviral keratoconjunctivitis will be discussed.

show abstract

Dexamethasone/Povidone Eye Drops versus Artificial Tears for Treatment of Presumed Viral Conjunctivitis: A Randomized Clinical Trial

Abstract: The use of topical dexamethasone 0.1%/povidone-iodine 0.4% eye drops four times daily appears to reduce the duration of conjunctivitis, although it causes more stinging than artificial tears.

Cited by 46 publications

References 40 publications

Randomized, Controlled, Phase 2 Trial of Povidone-Iodine/Dexamethasone Ophthalmic Suspension for Treatment of Adenoviral Conjunctivitis

Randomized, Controlled, Phase 2 Trial of Povidone-Iodine/Dexamethasone Ophthalmic Suspension for Treatment of Adenoviral Conjunctivitis

IL-6 Contributes to Corneal Nerve Degeneration after Herpes Simplex Virus Type I Infection

<p>Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions</p>

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