Topical Treatment of Acute Adenoviral Keratoconjunctivitis With 0.2% Cidofovir and 1% Cyclosporine

Abstract

To evaluate the efficacy of 0.2% cidofovir eyedrops and 1% cyclosporine eyedrops administered 4 times daily (qid) to treat acute adenoviral keratoconjunctivitis.Methods: A randomized, controlled, double-masked study was conducted on 39 patients with acute adenoviral keratoconjunctivitis of recent onset. Patients were divided into 4 treatment groups: (1) cidofovir qid, (2) cyclosporine qid, (3) cidofovir+cyclosporine qid, and (4) sodium chloride qid (control). The diagnosis was confirmed using adenoviral polymerase chain reaction from conjunctival swabs. Duration of treatment was 21 days.Main Outcome Measures: Severity of conjunctival hyperemia, conjunctival chemosis, superficial punctate keratitis during treatment, and presence and severity of corneal subepithelial infiltrates were evaluated using a clinical score. Duration until subjective improvement of symptoms was recorded.Results: Subjective improvement of local symptoms was accelerated in the cyclosporine group. All other clinically relevant variables showed no statistically significant difference among the 4 treatment groups. Particularly, we did not find a difference in the frequency of corneal subepithelial infiltrates at the end of treatment.Conclusions: Use of cidofovir, cyclosporine, or both did not accelerate the improvement of clinical symptoms of acute adenoviral keratoconjunctivitis compared with the natural course of the infection as demonstrated by this pilot study. This might be because of the wide spectrum of the clinical course of the infection, low sensitivity to cidofovir, too low of a concentration of cidofovir, or early cessation of viral replication in the course of the infection. The effect of a higher concentration of topical cidofovir with and without cyclosporine requires investigation in a larger group of patients.

Human adenovirus: Viral pathogen with increasing importance

“…EKC is highly contagious, has a tendency to occur in epidemics, and has been reported worldwide such as epidemic outbreaks in hospitals, swimming pools, military bases, schools, and other community settings; in Asia, this disease is endemic [41][42][43][44][45]. In 1955, Jawetz et al [25] were the fi rst to attribute the etiology of EKC to the infection of ocular surface tissue caused by HAdV.…”

Clinical Potential of the Acyclic Nucleoside Phosphonates Cidofovir, Adefovir, and Tenofovir in Treatment of DNA Virus and Retrovirus Infections

“…There is an anecdotal report of the potential effectiveness of 0.2% cidofovir eye drops in a patient with adenoviral conjunctivitis (91), but a larger study failed to show a statistically significant effect of topical 0.2% cidofovir on the course of the acute phase of adenoviral conjunctivitis (98). Eye drops of 1% cidofovir did prove effective in the prevention of severe corneal opacities and, concomitantly, caused inflammation of the eyelids and conjunctiva (99).…”

Comparison of clinical outcome with different treatment regimens in acute adenoviral keratoconjunctivitis

“…One study found accelerated subjective improvement of local symptoms with 1% cyclosporine eyedrops (4 times a day for 21 days), as Treatment in acute adenoviral keratoconjunctivitis L Asena et al compared with 0.2% cidofovir or a combination of 0.2% cidofovir+1% cyclosporine. 20 In our study, we observed that patients receiving topical corticosteroids experienced the symptoms for a shorter period of time when compared with the palliative treatment group. The mean time until the resolution of the subjective symptoms was significantly higher in patients receiving only artificial tears and palliative treatment (13.3 ± 4.2 days), when compared with patients receiving topical 2% Cyclosporine A (11.2 ± 4.9 days) and topical 1% prednisolone acetate (9.5 ± 4.9 days).…”

“…Although there are reports that show the efficacy of topical CsA (1 and 2%) in decreasing the incidence of corneal opacities and in the therapy of active subepithelial infiltrates during the chronic phase, [11][12][13]19,20 there are no studies reported to compare the safety and efficacy of topical Cyclosporine A with topical corticosteroids and palliative treatment in acute adenoviral keratoconjunctivitis. Therefore, we aimed to compare the clinical outcome with different treatment regimens including topical corticosteroids, Cyclosporin A and exclusively palliative therapy, in a large group of patients who admitted to two tertiary eye care centers.…”