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Soleimani M, Haydar AA, Cheraqpour K, Zeidabadinejad H, Esfandiari A, Eshaghhosseiny N, Shahmohammadi A, Banz S, Djalilian AR. In praise of povidone-iodine application in ophthalmology. Surv Ophthalmol 2023:S0039-6257(23)00143-1. [PMID: 37944600 DOI: 10.1016/j.survophthal.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/26/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
Polyvinyl pyrrolidone or povidone-iodine (PVP-I) is a water-soluble complex formed by the combination of iodine and a water-soluble polymer, polyvinyl pyrrolidone. This complex exerts bactericidal, fungicidal, and virucidal action by gradually releasing free iodine at the site of application to react with pathogens. In ophthalmology, PVP-I is used as a disinfectant and antiseptic agent for preoperative preparation of the skin and mucous membranes and for treating contaminated wounds. PVP-I has been shown to reduce effectively the risk of endophthalmitis in various ocular procedures, including cataract surgery and intravitreal injections; however, it has also been used in the treatment of conjunctivitis, keratitis, and endophthalmitis, with promising results especially in low-resource situations. PVP-I has been associated with complications such as postoperative eye pain, persistent corneal epithelial defects, ocular inflammation, and an attendant risk of keratitis. In cases of poor PVP-I tolerance, applying PVP-I at lower concentrations or using alternative antiseptics such as chlorhexidine should be considered. We provide an update on the efficacy of PVP-I in the prophylaxis and treatment of conjunctivitis, keratitis, and endophthalmitis and a comprehensive analysis of the current literature regarding the use of PVP-I in the management of these ocular conditions. Also, PVP-I-related adverse effects and toxicities and its alternatives are discussed. The goal is to present a thorough evaluation of the available evidence and to offer practical recommendations for clinicians regarding the therapeutic usage of PVP-I in ophthalmology.
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Affiliation(s)
- Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Ali A Haydar
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Haniyeh Zeidabadinejad
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amirreza Esfandiari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | - Soraya Banz
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; University of Edinburgh, UK.
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
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Chen YS, Hsu CH, Chang HC. Efficacy of povidone-iodine-containing therapies for treatment of adenoviral conjunctivitis: A systematic review and network meta-analysis. Acta Ophthalmol 2023; 101:826-827. [PMID: 37130094 DOI: 10.1111/aos.15689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/20/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Yu-Sheng Chen
- Department of Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Hsin Hsu
- Department of Ophthalmology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hua-Ching Chang
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Abstract
PURPOSE To summarize the evidence base on the use of topical corticosteroids for infectious keratitis. METHODS Narrative review. RESULTS Infectious keratitis is a painful condition that often results in visually significant corneal stromal scarring, even when antimicrobial therapy is successful. Corticosteroids may reduce inflammation and subsequent scar formation and while relieving the acute ocular pain associated with a corneal ulcer. However, corticosteroids also reduce the host immune response, which could hinder the ability to clear infection. The safety and effectiveness of corticosteroids depends to a large part on the efficacy of the antimicrobials being used to treat the underlying infection. Randomized trials have found that corticosteroids are safe and effective for herpetic keratitis when used with appropriate antiviral therapy, and are safe for bacterial keratitis when used with broad spectrum topical antibiotics. The effectiveness of corticosteroids for bacterial keratitis has not been shown conclusively, although more advanced bacterial corneal ulcers may do better with corticosteroids. No randomized trials have assessed the safety and effectiveness of steroids for fungal or acanthamoeba keratitis. Animal studies suggest corticosteroids may be harmful in fungal keratitis, and observational human studies have found that steroids are harmful for fungal and acanthamoeba keratitis when started prior to anti-amoebics. CONCLUSIONS Topical corticosteroids, when used as an adjunct to antimicrobial therapy, may be beneficial if the antimicrobial being used can effectively clear or suppress the infection, such as in bacterial and herpetic keratitis. Randomized trials would be helpful to further delineate the role of corticosteroids for infectious keratitis.
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Affiliation(s)
- Jeremy D Keenan
- Francis I Proctor Foundation, University of California, San Francisco, CA; and
- Department of Ophthalmology, University of California, San Francisco, CA
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4
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Kowanz DH, Rokohl AC, Heindl LM. [Viral Conjunctivitis: Findings, Therapy, and Prophylaxis]. Klin Monbl Augenheilkd 2023; 240:1317-1331. [PMID: 37586401 DOI: 10.1055/a-2129-1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Viral conjunctivitis is one of the most common acute eye diseases. The fall and winter months are known to be the main season for viral infections which is also reflected in the ophthalmological outpatient clinics. Viral conjunctivitis is often accompanied by symptoms of the upper and lower respiratory tract, fever, chills, arthralgia or skin lesions. The spectrum of pathogens comprises DNA viruses such as Adeno-, Herpes simplex and Molluscum contagiosum as well as RNA viruses. Symptoms caused by pandemic pathogens such as SARS-CoV-2 and mpox viruses can also cause ocular manifestation. Viral conjunctivitis is often self-limiting leaving no residual symptoms, however an ophthalmologist should be consulted if there are inflammatory symptoms of the anterior eye accompanied by visual disturbance. It is particularly important to recognize the affection of corneal or even intraocular structures early to initiate an adequate and effective therapy. Affection of the cornea, vitreus or retina can result in temporary or permanent impairment of the field of vision and visual acuity. The diagnosis is usually made without further tests on the basis of the typical clinical presentation. Rapid tests or PCR diagnostics are also available for confirmation. In most patients the treatment is symptomatically with artificial tears and antibiotic eye drops in cases accompanied by secondary bacterial infections, not prophylactically. If the cornea or other ocular structures are affected by certain viruses, local as well as systemic virostatic therapy is initiated. The most important prophylactic measure is meticulous and consistent hygiene.
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González Martín-Moro J, Zarallo-Gallardo J, Guzmán-Almagro E, Antón Rodríguez C. A systematic review and meta-analysis on the efficacy of topical povidone iodine in adenoviral conjunctivitis. Cont Lens Anterior Eye 2023; 46:101873. [PMID: 37380515 DOI: 10.1016/j.clae.2023.101873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To evaluate if topical povidone iodine (alone (PI) or combined with dexamethasone (PI-DXM)) is superior to placebo for treating adenoviral conjunctivitis (AC). METHODS A systematic review was performed according to Preferred Reporting Items for the Systematic Review and Meta-Analyses (PRISMA) Statement. An electronic search was made on PubMed, Embase and Cochrane Library. Randomized control studies that compared PI or PI-DXM with placebo were included. At least three researchers were involved in all phases. Primary outcomes were AC duration and the number of clinical resolutions during the first week. Secondary outcomes were conjunctival redness and serous discharge one week after starting treatment and the rate of AC complications. RESULTS Only five studies met the inclusion criteria. PI-DXM reduced the duration of the disease by 2.4 days (IC95% 4.09-0.71), however this result was based only in one study. PI and PI-DXM did not modify the probability of clinical resolution during the first week; relative risk (RR) = 1.77 (IC95% 0.63-4.96) and 1.70 (IC95% 0.67-4.36). The impact of PI on the probability of pseudomembranes could not be estimated. PI-DXM did not influence the risk of developing subepithelial infiltrates RR = 0.73 (IC95% 0.02-33.38). CONCLUSIONS At this time there is great uncertainty about the usefulness of PI on the course of adenoviral conjunctivitis. PI-DXM may have a small effect on AC duration. To make future reviews possible, it is important to standardize the way in which these results are reported. Futures studies should include etiological confirmation, unit of study (eyes vs patients) and report on those aspects that are more relevant for patient quality of life (duration of the disease, development of complications: pseudomembranes and subepithelial infiltrates).
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Affiliation(s)
- Julio González Martín-Moro
- Department of Ophthalmology, University Hospital of Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain; Faculty of Medicine, Universidad Francisco de Vitoria, Carretera Pozuelo, km 1800, 28223 Majadahonda, Madrid, Spain.
| | - Jesús Zarallo-Gallardo
- Department of Ophthalmology, University Hospital of Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain; Faculty of Medicine, Universidad Francisco de Vitoria, Carretera Pozuelo, km 1800, 28223 Majadahonda, Madrid, Spain
| | - Elena Guzmán-Almagro
- Department of Ophthalmology, University Hospital of Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain
| | - Cristina Antón Rodríguez
- Faculty of Medicine, Universidad Francisco de Vitoria, Carretera Pozuelo, km 1800, 28223 Majadahonda, Madrid, Spain
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Cho K, Kuo IC. Treatment trials for viral conjunctivitis: what we have learned and how we can improve. CORNEA OPEN 2023; 2:e0006. [PMID: 37378070 PMCID: PMC10299741 DOI: 10.1097/coa.0000000000000006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Affiliation(s)
- Kyongjin Cho
- Department of Ophthalmology, The Dankook University College of Medicine, Cheonan, Korea
| | - Irene C Kuo
- Department of Ophthalmology, Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland
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Gilmour KM, Ramaesh K. Case for conservative management of adenoviral pseudomembranous conjunctivitis. BMJ Case Rep 2023; 16:e253014. [PMID: 36810328 PMCID: PMC9945021 DOI: 10.1136/bcr-2022-253014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
The clinical course of adenoviral pseudomembranous conjunctivitis is mostly self-limiting and requires only supportive management measures; however, a minority of patients may develop severe inflammation in response to the virus, which can present as subepithelial infiltrates and pseudomembranes. In its most severe form, symblepharon can result from the inflammatory response resulting in longer-term clinical sequelae. The optimal management of adenoviral pseudomembranous conjunctivitis is poorly defined and while debridement is commonly recommended, there is limited evidence base to support this practice. In this paper, we present two cases of PCR-proven adenoviral pseudomembranous conjunctivitis managed conservatively with topical lubricants and corticosteroids rather than debridement to good effect.
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Affiliation(s)
| | - Kanna Ramaesh
- Ophthalmology, Tennent Institute of Ophthalmology, Glasgow, UK
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Liu P, Li G, Han M, Cheng X, Cui Y, Yang Q, Zhang C. Efficacy and Safety of Ophthalmic Preparations of Glucocorticoids in Patients with Epidemic Keratoconjunctivitis: A Systematic Review and Meta-analysis. Ther Innov Regul Sci 2022; 57:476-483. [PMID: 36414914 DOI: 10.1007/s43441-022-00479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Epidemic keratoconjunctivitis (EKC) is a highly contagious infectious ocular disease that has been widespread worldwide. Ophthalmic preparations of glucocorticoids (OPGs) are the supportive therapies for EKC; however, they are still controversial. METHODS We performed a systematic review and meta-analysis to evaluate the efficacy and safety of OPGs in patients with EKC. Electronic searches were conducted in PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, China National Knowledge Internet (CNKI), and Wanfang Database from inception to 25 Aug 2022. We included and analyzed randomized controlled trials (RCTs) and cohort studies that compared OPGs to other positive drugs or placebo in patients with EKC. RESULTS Six studies (five RCTs and one retrospective cohort) involving 286 patients were included in the analysis. Compared with artificial tears, OPGs could relieve ocular symptoms faster in the acute phase of epidemic keratoconjunctivitis (AEKC). There was no significant difference in the incidence of corneal subepithelial infiltrates (SEIs) in AEKC when OPGs were used for 7 days, but there was a substantial difference for 21 and 28 days. In the chronic phase of epidemic keratoconjunctivitis (CEKC), there was no significant difference in the rate of complete elimination of SEIs at 6 months of OPGs treatment compared with immunosuppressants [RR = 1.07,95%CI (0.71,1.61), p = 0.75], as well as in the recurrence rate of SEIs after 6 months [RR = 2.05,95%CI (0.82,5.12), P = 0.13]. OPGs significantly increased intraocular pressure (IOP) at 6 months compared with immunosuppressants [MD = - 1.13,95%CI (- 1.97, - 0.30), P = 0.007]. There was no significant difference in cessation of therapy due to drug intolerance between OPGs and immunosuppressants [RR = 0.69,95%CI (0.16,2.94), p = 0.62]. CONCLUSIONS OPGs might relieve ocular symptoms and reduce the incidence of SEIs in AEKC, whereas not recommended the therapy in CEKC. More high-quality clinical evidence is required to confirm our findings.
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Affiliation(s)
- Pengpeng Liu
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Guangyao Li
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Mei Han
- Evidence-Based Medicine Center, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Cheng
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | | | | | - Chao Zhang
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.
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Liu SH, Hawkins BS, Ren M, Ng SM, Leslie L, Han G, Kuo IC. Topical Pharmacologic Interventions Versus Active Control, Placebo, or No Treatment for Epidemic Keratoconjunctivitis: Findings From a Cochrane Systematic Review. Am J Ophthalmol 2022; 240:265-275. [PMID: 35331686 PMCID: PMC9808666 DOI: 10.1016/j.ajo.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To summarize key findings from a Cochrane systematic review of the effectiveness and safety of topical pharmacologic interventions compared with active control or placebo for epidemic keratoconjunctivitis (EKC). DESIGN Systematic review. METHODS We included randomized controlled trials that compared antiseptic agents, virustatic agents, or immune-modulating topical therapies with placebo or an active control. We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis. RESULTS Ten randomized controlled trials with 892 participants with acute or chronic EKC were included. Eight trials compared interventions with artificial tears or saline (n = 4) or with steroids (n = 4); two 3-arm trials contributed data to both comparisons. Estimates suggested that compared with tears, after povidone-iodine (PVP-I) alone (2 studies, 409 participants) more participants with acute EKC had resolution of symptoms (risk ratio [RR] 1.15 [95% confidence interval {CI} 1.07-1.24]) and signs (RR 3.19 [95% CI 2.29-4.45]) within 10 days. In 2 trials comparing treatments with steroid alone or steroid with levofloxacin, fewer eyes treated with PVP-I or polyvinyl alcohol iodine (PVA-I) plus steroid developed subepithelial infiltrates within 21 days (RR 0.08 [95% CI 0.01-0.55]; 69 eyes). No treatment was shown to improve resolution of infiltrates. CONCLUSIONS Low- to very low-level certainty of evidence suggested that PVP-I or PVA-I with steroid may confer some benefit in acute EKC, but imprecision from small sample sizes, the potential risk of bias from inadequate reporting or trial design, and variability in participant selection, outcome measurement, and reporting limit the amount and quality of evidence.
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Affiliation(s)
- Su-Hsun Liu
- From the Department of Ophthalmology (S-H.L., S.M.N., L.L.), School of Medicine, University of Colorado, Aurora, Colorado
| | - Barbara S Hawkins
- Wilmer Eye Institute (B.S.H., M.R., I.C.K.), Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore
| | - Mark Ren
- Wilmer Eye Institute (B.S.H., M.R., I.C.K.), Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore
| | - Sueko M Ng
- From the Department of Ophthalmology (S-H.L., S.M.N., L.L.), School of Medicine, University of Colorado, Aurora, Colorado
| | - Louis Leslie
- From the Department of Ophthalmology (S-H.L., S.M.N., L.L.), School of Medicine, University of Colorado, Aurora, Colorado
| | - Genie Han
- Department of Epidemiology (G.H.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Irene C Kuo
- Wilmer Eye Institute (B.S.H., M.R., I.C.K.), Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore.
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Isik P, Harbiyeli II, Ozturk G, Erdem E, Yagmur M, Yarkin F. The relationship between clinical findings and viral load in Adenoviral Keratoconjunctivitis. Jpn J Infect Dis 2022; 75:592-596. [PMID: 35908877 DOI: 10.7883/yoken.jjid.2022.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study aimed to evaluate the relationship between clinical findings and viral load in adenoviral keratoconjunctivitis (Ad-Kc). In this cross-sectional study, 30 eyes of 30 patients with Ad-Kc were enrolled. The real-time polymerase chain reaction was performed to detect and quantify adenovirus in all samples. The patient groups were divided into three subgroups according to baseline viral loads (<107, 107-108, >108 HAdV copies/ml). The follow-up duration, HAdV DNA copy number, treatment regimen, and detailed clinical findings including uncorrected visual acuity, eyelid edema, conjunctival hyperemia, chemosis, follicular reaction, corneal involvement, conjunctival pseudomembrane, and subepithelial infiltrates (SEIs) were recorded. The study showed that a high initial viral load was associated with the development of SEIs and pseudomembrane formation (p<0.05). Clinical findings and ocular complications of Ad-Kc were found similar in treatment groups at the final visit (p>0.05). Our results showed that a high initial viral load in Ad-Kc may be predictive of inflammatory sequelae. Determination of the initial viral load in Ad-Kc may be helpful to better understand the clinical course of the disease and prevent complications.
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Affiliation(s)
- Puren Isik
- Ophthalmology Department, Faculty of Medicine, Balcali Hospital, Cukurova University, Turkey
| | - Ibrahim Inan Harbiyeli
- Ophthalmology Department, Faculty of Medicine, Balcali Hospital, Cukurova University, Turkey
| | - Gokhan Ozturk
- Virology Department, Faculty of Medicine, Cukurova University, Turkey
| | - Elif Erdem
- Ophthalmology Department, Faculty of Medicine, Balcali Hospital, Cukurova University, Turkey
| | - Meltem Yagmur
- Ophthalmology Department, Faculty of Medicine, Balcali Hospital, Cukurova University, Turkey
| | - Fugen Yarkin
- Virology Department, Faculty of Medicine, Cukurova University, Turkey
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11
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Liu SH, Hawkins BS, Ng SM, Ren M, Leslie L, Han G, Kuo IC. Topical pharmacologic interventions versus placebo for epidemic keratoconjunctivitis. Cochrane Database Syst Rev 2022; 3:CD013520. [PMID: 35238405 PMCID: PMC8892837 DOI: 10.1002/14651858.cd013520.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Viruses cause about 80% of all cases of acute conjunctivitis. Human adenoviruses are believed to account for 65% to 90% of cases of viral conjunctivitis, or 20% to 75% of all causes of infectious keratoconjunctivitis worldwide. Epidemic keratoconjunctivitis (EKC) is a highly contagious subset of adenoviral conjunctivitis that has been associated with large outbreaks at military installations and at medical facilities. It is accompanied by severe conjunctival inflammation, watery discharge, and light sensitivity, and can lead to chronic complications such as corneal and conjunctival scarring with discomfort and poor quality of vision. Due to a lack of consensus on the efficacy of any pharmacotherapy to alter the clinical course of EKC, no standard of care exists, therefore many clinicians offer only supportive care. OBJECTIVES To assess the efficacy and safety of topical pharmacological therapies versus placebo, an active control, or no treatment for adults with EKC. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 4); Ovid MEDLINE; Ovid Embase; Latin American and Caribbean Health Sciences database (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), with no restrictions on language or year of publication. The date of the last search was 27 April 2021. SELECTION CRITERIA We included randomized controlled trials in which antiseptic agents, virustatic agents, or topical immune-modulating therapy was compared with placebo, an active control, or no treatment. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. MAIN RESULTS We identified 10 studies conducted in Asia, Europe, the Middle East, and North Africa with a total of 892 participants who were treated for 7 days to 6 months and followed for 7 days up to 1.5 years. Study characteristics and risk of bias In most studies participants were predominantly men (range: 44% to 90%), with an age range from 9 to 82 years. Three studies reported information on trial registration, but we found no published study protocol. The majority of trials had small sample sizes, ranging from 18 to 90 participants enrolled per study; the only exception was a trial that enrolled 350 participants. We judged most studies to be at high or unclear risk of bias across risk of bias domains. Findings We included 10 studies of 892 EKC participants and estimated combined intervention effects in analyses stratified by steroid-containing control treatment or artificial tears. Six trials contributed to the comparisons of topical interventions (povidone-iodine [PVP-I], trifluridine, ganciclovir, dexamethasone plus neomycin) with artificial tears (or saline). Very low certainty evidence from two trials comparing trifluridine or ganciclovir with artificial tears showed inconsistent effects on shortening the mean duration of cardinal symptoms or signs of EKC. Low certainty evidence based on two studies (409 participants) indicated that participants treated with PVP-I alone more often experienced resolution of symptoms (risk ratio (RR) 1.15, 95% confidence interval (CI) 1.07 to 1.24) and signs (RR 3.19, 95% CI 2.29 to 4.45) during the first week of treatment compared with those treated with artificial tears. Very low certainty evidence from two studies (77 participants) suggested that PVP-I or ganciclovir prevented the development of subepithelial infiltrates (SEI) when compared with artificial tears within 30 days of treatment (RR 0.24, 95% CI 0.10 to 0.56). Four studies compared topical interventions (tacrolimus, cyclosporin A [CsA], trifluridine, PVP-I + dexamethasone) with topical steroids, and one trial compared fluorometholone (FML) plus polyvinyl alcohol iodine (PVA-I) with FML plus levofloxacin. Evidence from one trial showed that more eyes receiving PVP-I 1.0% plus dexamethasone 0.1% had symptoms resolved by day seven compared with those receiving dexamethasone alone (RR 9.00, 95% CI 1.23 to 66.05; 52 eyes). In two trials, fewer eyes treated with PVP-I or PVA-I plus steroid developed SEI within 15 days of treatment compared with steroid alone or steroid plus levofloxacin (RR 0.08, 95% CI 0.01 to 0.55; 69 eyes). One study found that CsA was no more effective than steroid for resolving SEI within four weeks of treatment (RR 0.84, 95% CI 0.67 to 1.06; N = 88). The evidence from trials comparing topical interventions with steroids was overall of very low level certainty. Adverse effects Antiviral or antimicrobial agents plus steroid did not differ from artificial tears in terms of ocular discomfort upon instillation (RR 9.23, 95% CI 0.61 to 140.67; N = 19). CsA and tacrolimus eye drops were associated with more cases of severe ocular discomfort, and sometimes intolerance, when compared with steroids (RR 4.64, 95% CI 1.15 to 18.71; 2 studies; N = 141). Compared with steroids, tacrolimus did not increase the risk of elevated intraocular pressure (RR 0.07, 95% CI 0 to 1.13; 1 study; N = 80), while trifluridine conferred no additional risk compared to tear substitute (RR 5.50, 95% CI 0.31 to 96.49; 1 study; N = 97). Overall, bacterial superinfection was rare (one in 23 CsA users) and not associated with use of the intervention steroid (RR 3.63, 95% CI 0.15 to 84.98; N = 51). The evidence for all estimates was of low or very low certainty. AUTHORS' CONCLUSIONS The evidence for the seven specified outcomes was of low or very low certainty due to imprecision and high risk of bias. The evidence that antiviral agents shorten the duration of symptoms or signs when compared with artificial tears was inconclusive. Low certainty evidence suggests that PVP-I alone resolves signs and symptoms by seven days relative to artificial tears. PVP-I or PVA-I, alone or with steroid, is associated with lower risks of SEI development than artificial tears or steroid (very low certainty evidence). The currently available evidence is insufficient to determine whether any of the evaluated interventions confers an advantage over steroids or artificial tears with respect to virus eradication or its spread to initially uninvolved fellow eyes. Future updates of this review should provide evidence of high-level certainty from trials with larger sample sizes, enrollment of participants with similar durations of signs and symptoms, and validated methods to assess short- and long-term outcomes.
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Affiliation(s)
- Su-Hsun Liu
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Barbara S Hawkins
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sueko M Ng
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark Ren
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Orthopedics, Columbia University Irving Medical Center, New York, New York, USA
| | - Louis Leslie
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Genie Han
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Irene C Kuo
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Efficacy and tolerability of polyvinylpyrrolidone-iodine 0.6% treatment in adenoviral keratoconjunctivitis: a Prospective Randomized Controlled Study. Eye (Lond) 2022; 36:160-166. [PMID: 33654316 PMCID: PMC8727611 DOI: 10.1038/s41433-020-01344-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To analyze the effect of the employment of polyvinylpyrrolidone-iodine (PVP-I) 0.6% eye drop on the clinical course of patients affected by Adenoviral Keratoconjunctivitis (AKC). METHODS Consecutive patients with clinical signs of AKC and positive results of AdenoPlus test were enrolled from four Italian Centres. Patients were randomized to receive: PVP-I 0.6% eye drops four times/daily for 20 days (Group A) or hyaluronate-based tear substitutes four times/daily for 20 days (Group B). Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) Optovue iVue pachymetry map; corneal haze; conjunctival injection and chemosis; subepithelial corneal infiltrates (SEIs); corneal and conjunctival staining and corneal densitometry were recorded at diagnosis and at every follow-up visit. The primary outcome was the resolution time of AKC. RESULTS Overall, 59 AKC patients (34 for Group A and 25 for Group B) completed the study. Patients of Group A showed a significantly shorter resolution time and lower incidence of SEIs compared to patients of Group B. In particular, SEIs were present at the last visit in 3/34 (8.82%) patients of the Group A vs 11/25 (44%) of the Group B (p = 0.005). Patients of Group A showed a significantly lower incidence of corneal haze compared to patients of Group B (0/34 vs 3/25; p = 0.038). No side effects were reported for both groups. CONCLUSIONS Although further clinical evaluations are needed, according to our data the use of PVP-I 0.6% eye drop in the setting of AKC reduces the risk of SEIs as well as the resolution time of the disease.
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Current Opinion on the Therapeutic Capacity of Taurine-Containing Halogen Derivatives in Infectious and Inflammatory Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1370:83-98. [DOI: 10.1007/978-3-030-93337-1_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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14
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Than T, Morettin CE, Harthan JS, Hartwick AT, Huecker JB, Johnson SD, Migneco MK, Shorter E, Whiteside M, Olson CK, Alferez CS, van Zyl T, Rodic-Polic B, Storch GA, Gordon MO. Efficacy of a Single Administration of 5% Povidone-Iodine in the Treatment of Adenoviral Conjunctivitis. Am J Ophthalmol 2021; 231:28-38. [PMID: 34102153 DOI: 10.1016/j.ajo.2021.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of a single, in-office administration of 5% povidone-iodine (PVP-I) compared to artificial tears (AT) for adenoviral conjunctivitis (Ad-Cs). DESIGN Double-masked pilot randomized trial. METHODS Patients presenting with presumed adenoviral conjunctivitis were screened at 9 U.S. clinics. INCLUSION CRITERIA ≥18 years of age, symptoms ≤4 days, and a positive AdenoPlus test. EXCLUSION CRITERIA thyroid disease, iodine allergy, recent ocular surgery, and ocular findings inconsistent with early-stage Ad-Cs. Randomization was to a single administration of 5% PVP-I or AT in 1 eye and examinations on days 1-2, 4, 7, 14, and 21 with conjunctival swabs taken at each visit for quantitative polymerase chain reaction. Primary outcome was percent reduction from peak viral load. Secondary outcomes were improvement in clinical signs and symptoms. RESULTS Of 56 patients randomized, 28 had detectable viral titers at baseline. Day 4 posttreatment, viral titers in the 5% PVP-I and AT groups were 2.5% ± 2.7% and 14.4% ± 10.5% of peak, respectively (P = .020). Severity of participant-reported tearing, lid swelling, and redness as well as clinician-graded mucoid discharge, bulbar redness, and bulbar edema were lower in the 5% PVP-I group than AT group on day 4 (P < .05). After day 4, viral titers and severity of signs and symptoms decreased markedly in both groups and no differences between groups were detected. CONCLUSIONS Pilot data suggest a single, in-office administration of 5% PVP-I could reduce viral load and hasten improvement of clinical signs and symptoms in patients with Ad-Cs.
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Sarma P, Bhattacharyya A, Prakash A, Kaur H, Prajapat M, Borah M, Kumar S, Bansal S, Sharma S, Kaur G, Kumar H, Sharma DJ, Das KK, Avti P, Medhi B. Yogic Neti-Kriya Using Povidone Iodine: Can it have a Preventive Role Against SARS-CoV-2 Infection Gateway? Indian J Otolaryngol Head Neck Surg 2021; 74:3186-3192. [PMID: 34692450 PMCID: PMC8520578 DOI: 10.1007/s12070-021-02885-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/18/2021] [Indexed: 12/29/2022] Open
Abstract
During this COVID-19 pandemic, except steroid, none of the therapeutic measures have showed any evidence of efficacy. Traditionally jala-neti using lukewarm salted water remains a yogic way of maintaining upper airway hygiene. Saline irrigation decreases the concentration of inflammatory mediators (e.g. histamine, leukotriene etc.) in nasal secretions, reduces the severity and frequency of sinusitis, reduce need of antibiotic therapy and restores competency of nasal mucosa. Jala-neti is an integral part of six cleansing techniques of yogic kriyas practised in India since thousands of years. Jala-neti can clean the upper airways, prevents colonization of infectious agents, removes foreign bodies, prevents stasis of mucous and subsequently enhances the drainage of paranasal sinuses and maintain health. Regular practice of Jala neti improves nasal symptoms and overall health status of patients with sinusitis. Jala-neti sample can even be used for COVID-19 diagnosis. Povidone iodine (PVP-I) has been utilized as a time tested antimicrobial agent with broad spectrum coverage against wide range of bacteria and viruses. Anti-SARS-CoV-2 action of PVP-I was seen at a concentration as low as 0.45%. PVP-I is generally well tolerated upto 5%, however nasal ciliotoxicity is reported at this concentration, however, this toxicity is not reported with lower concentrations(1.25% and 0.5%). So, theoretically, by using neti-kriya with povidone iodine (0.5–1%) as irrigation solution can combine and enhance the protection against COVID-19 and this can be an important armor in the fight against COVID-19. However, this hypothesis needs to be validated in real life clinical trial scenario before implementing.
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Affiliation(s)
- Phulen Sarma
- Department of Pharmacology, PGIMER, Chandigarh, Pin 160012 India
| | - Anusuya Bhattacharyya
- Department of Ophthalmology, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Ajay Prakash
- Department of Pharmacology, PGIMER, Chandigarh, Pin 160012 India
| | - Hardeep Kaur
- Department of Pharmacology, PGIMER, Chandigarh, Pin 160012 India
| | - Manisha Prajapat
- Department of Pharmacology, PGIMER, Chandigarh, Pin 160012 India
| | - Mukundam Borah
- Department of Pharmacology, Gauhati Medical College and Hospital, Guwahati, Assam India
| | - Subodh Kumar
- Department of Pharmacology, PGIMER, Chandigarh, Pin 160012 India
| | - Seema Bansal
- Department of Pharmacology, PGIMER, Chandigarh, Pin 160012 India
| | - Saurabh Sharma
- Department of Pharmacology, PGIMER, Chandigarh, Pin 160012 India
| | - Gurjeet Kaur
- Department of Pharmacology, PGIMER, Chandigarh, Pin 160012 India
| | - Harish Kumar
- Department of Pharmacology, PGIMER, Chandigarh, Pin 160012 India
| | - Dibya Jyoti Sharma
- Department of Internal Medicine, Silchar Medical College and Hospital, Silchar, Assam India
| | - Karuna Kumar Das
- Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh, Assam India
| | - Pramod Avti
- Department of Biophysics, PGIMER, Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, PGIMER, Chandigarh, Pin 160012 India
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Fukuda M, Nakamura J, Ito S, Kawazoe K, Miyanaga Y, Teshigawara T, Okuda K, Mizuki N, Shimada M. Vaccination inhibits the human adenoviral transduction in a mouse keratoconjunctivitis model. Vaccine 2021; 39:3498-3508. [PMID: 34016474 DOI: 10.1016/j.vaccine.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
Adenovirus infections are a major cause of epidemic keratoconjunctivitis (EKC), which can lead to corneal subepithelial infiltrates and multifocal corneal opacity. In the current study, we investigated the use of an E1/E3-deleted adenovirus serotype 5 (Ad5) vector as a vaccine administered intramuscularly (IM) or intranasally (IN) against subsequent challenges with a luciferase-expressing Ad5 (Ad5-Luci) vector via eyedrop. We evaluated the adaptive immune response to Ad5 vector vaccination and confirmed a robust polyfunctional CD8 T cell response in splenic cells. Neutralizing Ad5 antibodies were also measured in the sera of vaccinated mice as well as Ad5 antibody in the eye wash solutions. Upon challenge with Ad5-Luci vector 8 weeks post the primary immunization, transduction was significantly reduced by > 70% in the vaccinated mice, which was slightly better in IM- vs. that in IN-vaccinated animals. Resistance to subsequent challenge was observed 10 months post primary IM vaccination, with sustained reduction up to 60% in the Ad5-Luci vector transduction. Passive immunization of naive mice with antisera from IM to vaccinated mice subsequently challenged with the Ad5-Luci vector resulted in approximately 40% loss in transduction efficiency. Furthermore, the mice that received IM immunization with or without CD8 T cell depletion showed > 40% and 70% reductions, respectively, in Ad8 genomic copies after Ad8 topical challenge. We conclude that Ad-vector vaccination successfully induced an adaptive immune response that prevented subsequent Ad transduction in the cornea and conjunctiva-associated tissues in a mouse model of adenovirus keratoconjunctivitis, and that both cellular and humoral immunity play an important role in preventing Ad transduction.
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Affiliation(s)
- Michiko Fukuda
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Jutaro Nakamura
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Saori Ito
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | | | | | - Takeshi Teshigawara
- Department of Ophthalmology, Yokosuka Chuoh Eye Clinic, Yokosuka 238-0008, Japan
| | - Kenji Okuda
- Department of Molecular Biodefense Research, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Masaru Shimada
- Department of Molecular Biodefense Research, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan.
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Abstract
Adenoviral conjunctivitis is the most common cause of ocular viral infection in the world, but currently has no approved therapeutic treatments. The antiseptic povidone-iodine (PVP-I) has been used as an off-label treatment for the condition, but high-quality evidence for its use is limited. This paper aims to review the literature surrounding the use of PVP-I in the management of adenoviral conjunctivitis. Unfortunately, treatment regimens, inclusion criteria, outcome measures, and review periods vary widely between studies, making direct comparisons between outcomes difficult. The majority of studies investigate daily instillation of 0.4 to 2.0% PVP-I rather than one-time instillation of PVP-I as has been used anecdotally in practice. In addition, only one treatment arm investigates daily PVP-I alone, with no significant difference in the duration of disease or clinical outcome compared to placebo. All other treatment arms investigate PVP-I in combination with dexamethasone which generally improve outcomes. Tolerability of PVP-I is generally good for low concentrations <1.0%, but efficacy of treatment is generally reported to be concentration dependent. Future research should investigate the optimal concentration, dosing regimen and role of each agent in combination treatment and aim to use laboratory techniques to improve diagnosis and provide quantifiable outcomes.
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Affiliation(s)
- Rebecca Mt Dang
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Kathleen Watt
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Alex Hui
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Comparative study of topical regimen for adenoviral kearoconjunctivitis by 0.1% fluorometholone with and without polyvinyl alcohol iodine. Jpn J Ophthalmol 2020; 65:107-114. [PMID: 33241466 DOI: 10.1007/s10384-020-00788-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to compare the efficacy of the topical regimens of iodine/steroids vs. antibiotics/steroids in acute to subacute adenoviral keratoconjunctivitis. STUDY DESIGN A prospective open-label study. PATIENTS AND METHODS Nineteen patients diagnosed with unilateral or bilateral adenoviral conjunctivitis at less than 1 week from onset were enrolled in this study. Patients were divided randomly into two groups; group 1 was treated with 1.5% levofloxacin with 0.1% fluorometholone administered four times a day and group 2 was treated with a sixfold dilution of polyvinyl alcohol iodine (PAI) solution with 0.1% fluorometholone four times a day. Conjunctival samples from all affected eyes were obtained for real-time PCR. The total scores of acute signs (i.e., eyelid edema, conjunctival injecton, conjunctival discharge, follicules, pseudomembranes, subconjunctival hemorrhage) and symptoms, HAdV DNA copy number, and the presence of multiple subepithelial corneal infiltrates (MSI) were evaluated every 5 visits up to Day 30 after diagnosis. RESULTS Comparing the total scores of acute signs and symptoms and viral load, we observed no significant differences between the two groups. At day 15 after diagnosis the proportion of patients with MSI in group 2 (35.7%) was significantly lower than in group 1 (0%). CONCLUSIONS The impact of topical iodine/steroid therapy on acute signs and symptoms associated with adenoviral conjunctivitis is limited and not substantially different in the responses to antibiotics/steroids. However, this regimen results in a significant decrease in the incidence of MSI during the subacute phase of infection.
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Opazo MC, Coronado-Arrázola I, Vallejos OP, Moreno-Reyes R, Fardella C, Mosso L, Kalergis AM, Bueno SM, Riedel CA. The impact of the micronutrient iodine in health and diseases. Crit Rev Food Sci Nutr 2020; 62:1466-1479. [DOI: 10.1080/10408398.2020.1843398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ma. Cecilia Opazo
- Laboratorio de Endocrino-Inmunología, Facultad de Ciencias de la Vida, Departamento de Ciencias Biológicas, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Endocrine-Immunology Laboratory, Facultad de Ciencias de la Vida, Departamento de Ciencias Biológicas, Universidad Andres Bello, Santiago, Chile
| | - Irenice Coronado-Arrázola
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Omar P. Vallejos
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Moreno-Reyes
- Erasme Hospital, Department of Nuclear Medicine, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Carlos Fardella
- Millennium Institute on Immunology and Immunotherapy (IMII). Departmento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departmento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Translational Research in Endocrinology (CETREN-UC), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lorena Mosso
- Millennium Institute on Immunology and Immunotherapy (IMII). Departmento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departmento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departmento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susan M. Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia A. Riedel
- Laboratorio de Endocrino-Inmunología, Facultad de Ciencias de la Vida, Departamento de Ciencias Biológicas, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Endocrine-Immunology Laboratory, Facultad de Ciencias de la Vida, Departamento de Ciencias Biológicas, Universidad Andres Bello, Santiago, Chile
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Michelini FM, Bueno CA, Areco YB, Alché LE. A synthetic stigmastane displays antiadenoviral activity and reduces the inflammatory response to viral infection. Antiviral Res 2020; 183:104879. [PMID: 32918925 DOI: 10.1016/j.antiviral.2020.104879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/04/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
Although human adenovirus (ADV) infections are mild and self-limited in immunocompetent individuals, they can be severe and life-threatening in immunocompromised patients. Despite their significant clinical impact, there are not currently approved antiviral therapies for ADV infections. On the other hand, in some cases, the immune response induced by ADV infection can cause tissue damage. Even more, in the case of adenovirus vectors used in gene therapy, host immunity generally antagonize viral efficacy. Therefore, the need for searching an effective and safe therapy is increasing. In this work, we describe the antiadenoviral activity of the synthetic stigmastane (22S, 23S)-22,23-dihydroxystigmast-4-en-3-one (Compound 1) with already reported antiviral and antiinflammatory activities against other viruses of clinical importance. Compound 1 displayed no virucidal activity and did not affect ADV entry to the cells. The compound inhibited viral replication and it also reduced cytokine secretion in epithelial and inflammatory infected cells. Thus, Compound 1 would be a promissory drug potentially useful against adenoviral infections as well as an adjuvant of adenoviral vectors in gene therapy.
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Affiliation(s)
- Flavia M Michelini
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química Biológica (IQUIBICEN), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina.
| | - Carlos A Bueno
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química Biológica (IQUIBICEN), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina
| | - Yanina B Areco
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química Biológica (IQUIBICEN), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina
| | - Laura E Alché
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Química Biológica (IQUIBICEN), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina
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Azari AA, Arabi A. Conjunctivitis: A Systematic Review. J Ophthalmic Vis Res 2020; 15:372-395. [PMID: 32864068 PMCID: PMC7431717 DOI: 10.18502/jovr.v15i3.7456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/25/2020] [Indexed: 01/10/2023] Open
Abstract
Conjunctivitis is a commonly encountered condition in ophthalmology clinics throughout the world. In the management of suspected cases of conjunctivitis, alarming signs for more serious intraocular conditions, such as severe pain, decreased vision, and painful pupillary reaction, must be considered. Additionally, a thorough medical and ophthalmic history should be obtained and a thorough physical examination should be done in patients with atypical findings and chronic course. Concurrent physical exam findings with relevant history may reveal the presence of a systemic condition with involvement of the conjunctiva. Viral conjunctivitis remains to be the most common overall cause of conjunctivitis. Bacterial conjunctivitis is encountered less frequently and it is the second most common cause of infectious conjunctivitis. Allergic conjunctivitis is encountered in nearly half of the population and the findings include itching, mucoid discharge, chemosis, and eyelid edema. Long-term usage of eye drops with preservatives in a patient with conjunctival irritation and discharge points to the toxic conjunctivitis as the underlying etiology. Effective management of conjunctivitis includes timely diagnosis, appropriate differentiation of the various etiologies, and appropriate treatment.
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Affiliation(s)
- Amir A Azari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Pentacam corneal densitometry-guided treatment of adenoviral corneal subepithelial infiltrates: a comparative study between transepithelial phototherapeutic keratectomy and topical tacrolimus. Int Ophthalmol 2020; 41:67-77. [PMID: 32852646 DOI: 10.1007/s10792-020-01553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the changes in the measurement of corneal densitometry and total corneal higher-order aberrations (HOAs) between topical tacrolimus and transepithelial phototherapeutic keratectomy (Te-PTK) in the treatment of adenoviral corneal subepithelial infiltrates (SEIs). SUBJECT AND METHODS This is an interventional prospective randomized study, including 63 eyes of 35 patients with symptomatic adenoviral corneal SEIs for at least 6 months. All patients underwent previous topical steroid therapy associated with unsatisfactory response and/or complications. Patients were assigned into three groups: (1) Te-PTK group: Te-PTK with MMC 0.02% was performed by a Technolas; Teneo excimer laser; (2) tacrolimus group: tacrolimus 0.03% ointment was applied once daily for 2-6 months; the endpoint of treatment was based on the improvement in the corneal densitometry, BCVA, and OSDI; and (3) control group: no intervention was done. BCVA, corneal densitometry, and total corneal higher-order aberrations (HOAs) evaluation using Pentacam HR were done at the baseline, 1 week, and then 1, 3, 6, and 12 months of the study. RESULTS The study population was similar between all groups. The mean follow-up was 12.75 ± 0.9 months. Bilateral corneal SEI was recorded at 80%. At 12-month follow-ups, the mean BCVA improved in both the Te-PTK and tacrolimus groups without significant changes in the control group. The mean corneal densitometry of the anterior, central, and total cornea decreased significantly in the Te-PTK and tacrolimus groups. HO-RMS and total RMS decreased significantly in the Te-PTK and tacrolimus groups. BCVA, corneal densitometry (anterior, central, and total cornea), and corneal aberrations (total coma, total trefoil, HO-RMS, and total RMS) values were significantly better for the Te-PTK and tacrolimus groups than the control group. There were no statistically significant differences between Te-PTK and tacrolimus groups in terms of BCVA, corneal densitometry, corneal HOA, and the persistence of corneal SEIs. The persistence of corneal SEIs was significantly lower in Te-PTK and tacrolimus groups than the control group. CONCLUSION Te-PTK and topical tacrolimus are effective methods for the treatment of adenoviral corneal SEIs improving visual acuity, corneal densitometry, and corneal HOA. The densitometry program of the Pentacam may give an objective guide for the treatment of adenoviral corneal SEIs. TRIAL REGISTRATION ClinicalTrials.gov ID is NCT04267991.
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Edington M, Ramaesh K, Lockington D. Virucidal benefits of povidone-iodine use on the ocular surface: a review. BMJ Open Ophthalmol 2020; 5:e000509. [PMID: 32818151 PMCID: PMC7406023 DOI: 10.1136/bmjophth-2020-000509] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 12/23/2022] Open
Abstract
Povidone-iodine (PVI) preparations are well known for their microbicidal effect. In ophthalmology, PVI is commonly used to sterilise the ocular surface prior to surgical procedures. It is also used uncommonly as treatment for adenoviral conjunctivitis, yet the virucidal benefits of PVI have not been clearly documented in existing clinical management guidelines for ocular surface conditions. The COVID-19 pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has challenged traditional healthcare systems. The morbidity and mortality of this highly contagious disease have resulted in fatalities among healthcare workers, including ophthalmologists. The SARS-CoV-2 virus has been identified on conjunctival testing, a potential source of contagious infection which may be unrecognised in asymptomatic carriers. Concern has been raised that ocular procedures may be ‘aerosol-generating’ and the additional wearing of personal protective equipment has been recommended to protect operating theatre staff. This literature review demonstrates that PVI has a broad virucidal activity, including against coronaviruses. It is already used perioperatively as standard of ophthalmic care and has been shown clinically to be effective against adenoviruses on the ocular surface. The current surgical practice of application of 5%–10% PVI applied periocularly for 3 min seems to provide an adequate effective reduction in the patient’s ocular surface viral load. The virucidal benefits of routine PVI use should be included in ophthalmology guidelines regarding safe ocular surgery protocols.
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Affiliation(s)
| | - Kanna Ramaesh
- Tennent Institute of Ophthalmology, Glasgow, United Kingdom
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Cagini C, Mariniello M, Messina M, Muzi A, Balducci C, Moretti A, Levorato L, Mencacci A. The role of ozonized oil and a combination of tobramycin/dexamethasone eye drops in the treatment of viral conjunctivitis: a randomized clinical trial. Int Ophthalmol 2020; 40:3209-3215. [PMID: 32696102 PMCID: PMC7669761 DOI: 10.1007/s10792-020-01503-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023]
Abstract
Purpose To determine whether topical tobramycin 0.3%/dexamethasone 0.1% plus ozonized oil eye drops reduces clinical signs and infectious viral titers of presumed viral conjunctivitis more than tobramycin/dexamethasone eye drops alone. Methods Prospective, single-blind, randomized, parallel-groups trial. Eighty patients with a clinical diagnosis of presumed viral conjunctivitis were randomizedly divided into two treatment groups: a study group and a control group, 40 for each group. Patients in the study group received topical tobramycin 0.3%/dexamethasone 0.1% eye drops, plus ozonized oil eye drops, both four times daily; patients in the control group received only topical tobramycin 0.3%/dexamethasone eye drops four times daily. The treatment was for seven days in both groups. Swabs were taken from the conjunctival fornix for adenovirus PCR analysis on the day of recruitment and at seven days follow-up. Clinical signs were also recorded on the day of recruitment and at follow-up examination: the main outcomes were conjunctival injection and conjunctival chemosis, graded on a 4-point clinical scale, presence or absence of superficial punctate keratitis and subepithelial corneal infiltrates. Results No statistically significant difference was reached in adenoviral infection negativization between the two groups, although the study group showed a higher number of PCR negative results at seven days follow-up. PCR real time detected adenoviral infection in 17 of 24 patients on the day of recruitment and it was positive in 4 patients on the seventh day (viral positivity reduction of 76%). In the control group PCR was positive for adenovirus in 18 of 24 patients on the day of recruitment and in 7 patients at seven days follow-up (reduction of 61%). There was statistically significant difference on conjunctival clinical signs between the study and control groups. Significant difference was also found on superficial punctate keratitis resolution between the study and the control group. In the former superficial punctate keratitis was detected in 14 eyes on the first day and in 5 eyes after seven days while in the latter superficial punctate keratitis was found in 124 eyes on the first day and in 6 eyes on the seventh day. No difference was found in subepithelial corneal infiltrates appearance between the two groups. Conclusions The use of ozonized-oil containing eye drops in combination with topical tobramycin 0.3%/dexamethasone 0.1% eye drops four times daily seems to reduce the signs of conjunctivitis, and the duration of viral infection, although it does not affect the subepithelial corneal infiltrates appearance.
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Affiliation(s)
- C Cagini
- Division of Ophthalmology, Department of Surgical and Biomedical Sciences, University of Perugia, Ospedale S. Maria della Misericordia, S. Andrea Delle Fratte, 06156, Perugia, Italy.
| | - M Mariniello
- Division of Ophthalmology, Department of Surgical and Biomedical Sciences, University of Perugia, Ospedale S. Maria della Misericordia, S. Andrea Delle Fratte, 06156, Perugia, Italy
| | - M Messina
- Division of Ophthalmology, Department of Surgical and Biomedical Sciences, University of Perugia, Ospedale S. Maria della Misericordia, S. Andrea Delle Fratte, 06156, Perugia, Italy
| | - A Muzi
- Division of Ophthalmology, Department of Surgical and Biomedical Sciences, University of Perugia, Ospedale S. Maria della Misericordia, S. Andrea Delle Fratte, 06156, Perugia, Italy
| | - C Balducci
- Division of Ophthalmology, Department of Surgical and Biomedical Sciences, University of Perugia, Ospedale S. Maria della Misericordia, S. Andrea Delle Fratte, 06156, Perugia, Italy
| | - A Moretti
- Microbiology Unit, Department of Medicine, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - L Levorato
- Microbiology Unit, Department of Medicine, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - A Mencacci
- Microbiology Unit, Department of Medicine, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
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Ta CN, Raizman MB, Gross RD, Joshi S, Mallick S, Wang Y, Segal B. A Prospective, Randomized Trial of Povidone-Iodine 0.6% and Dexamethasone 0.1% Ophthalmic Suspension for Acute Bacterial Conjunctivitis. Am J Ophthalmol 2020; 215:56-65. [PMID: 32222367 DOI: 10.1016/j.ajo.2020.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of a topical ophthalmic suspension combination of povidone-iodine 0.6% (PVP-I) and dexamethasone 0.1% (DEX) for infectious and inflammatory components of bacterial conjunctivitis. DESIGN Randomized, double-masked, multicenter, phase 3 clinical trial. METHODS Subjects of all ages (those <3 months had to be full-term) with a diagnosis of bacterial conjunctivitis were randomized 3:1:3 to either PVP-I/DEX, PVP-I alone, or placebo. The primary endpoint was clinical resolution in the study eye, and the key secondary efficacy endpoint was bacterial eradication, both at the day 5 visit. Adverse events (AEs) were documented at all visits. RESULTS Overall, 753 subjects were randomized (intent-to-treat [ITT] population; PVP-I/DEX [n = 324]; PVP-I [n = 108]; placebo [n = 321]); mean and standard deviation (SD) age was 44.3 (22.9) years, and most were female (61.2%) and white (78.1%). In all treatment groups, mean treatment compliance was >98%. The modified ITT population for the efficacy analysis comprised 526 subjects. In the study eye at the day 5 visit, clinical resolution was achieved by 50.5% (111/220) subjects in the PVP-I/DEX group vs 42.8% (95/222) in the placebo group (P = .127), and bacterial eradication was achieved by 43.3% (94/217) and 46.8% (102/218), respectively (P = .500). Treatment-emergent AEs were experienced by 32.8% (106/323), 39.8% (43/108), and 19.0% (61/321) of subjects in the safety population treated with PVP-I/DEX, PVP-I, and placebo, respectively (most mild in severity). CONCLUSION In this study, PVP-I/DEX did not demonstrate additional benefit in clinical efficacy compared with placebo in subjects with bacterial conjunctivitis.
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Arici C, Mergen B. Late-term topical tacrolimus for subepithelial infiltrates resistant to topical steroids and ciclosporin secondary to adenoviral keratoconjunctivitis. Br J Ophthalmol 2020; 105:614-618. [PMID: 32563992 DOI: 10.1136/bjophthalmol-2020-316196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/11/2020] [Accepted: 06/01/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE Investigation of the efficacy and safety of 12 months of topical tacrolimus 0.03% ointment treatment against the subepithelial infiltrates (SEIs) due to adenoviral keratoconjunctivitis (AKC) resisting at least 2 years was aimed. METHODS This case series included consecutive patients with SEIs secondary to AKC who were resistant to topical steroid and ciclosporin-A (CSA) treatment and treated with topical 0.03% tacrolimus (Protopic; Fujisawa Healthcare, Teva, Deerfield, Illinois, USA) for 12 months, at least 2 years after AKC. For the evaluation of treatment efficacy, best-corrected visual acuity (BCVA), Fantes score, corneal subepithelial infiltrate score (CSIS), Oxford score, Schirmer and tear breakup time results were evaluated. Intraocular pressure and complaints of the patients were followed for evaluating the safety profile of the treatment. The patients were followed after the baseline visit at the 1st, 3rd, 6th and 12th month. RESULTS 15 eyes of 11 patients with SEIs and 16 eyes of 16 healthy controls were included in this study. 1 patient (9.1%) could not tolerate the treatment. Significant improvements in BCVA, CSIS, Fantes score and Schirmer results were observed in the study group starting from the 3rd-month visit, and the improvements persisted until the end of 12 months of treatment. CONCLUSION Topical 0.03% tacrolimus might show efficacy against the SEIs persisting at least 2 years despite corticosteroid and/or CSA treatment without any prominent side effect. While at least a period of 3 months was necessary for a significant improvement in the BCVA, SEIs and Schirmer results, a period of 6 months was necessary for a decrease in Oxford score.
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Affiliation(s)
- Ceyhun Arici
- Department of Ophthalmology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Burak Mergen
- Department of Ophthalmology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Adenovirus load correlates with respiratory disease severity among hospitalized pediatric patients. Int J Infect Dis 2020; 97:145-150. [PMID: 32531431 DOI: 10.1016/j.ijid.2020.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Human adenoviruses (HAdVs) are common pathogens that can cause respiratory, gastrointestinal and other infections. We investigated the correlation between adenovirus viral load in clinical respiratory samples and the respiratory disease severity in pediatric patients. METHODS Medical records of patients hospitalized in the Sheba Medical Center (SMC) with confirmed adenovirus infection were retrospectively analyzed. The possible correlation between disease severity score and Real time PCR 'cycle threshold' (Ct), a proxy of viral load, was assessed in patients aged 9 years and under. In addition, Ct values of hospitalized versus community-care patient samples, positive for various respiratory viruses including adenovirus, were compared. RESULTS Adenovirus load in respiratory samples, as measured by Ct values, was found to be negatively correlated with respiratory disease severity in hospitalized pediatric patients aged under 9 years. Moreover, hospitalized patients presented with significantly higher Ct levels for various respiratory viruses as compared to community-care patients. CONCLUSION In this study we found a correlation between Ct values obtained from adenovirus q-PCR analysis of respiratory clinical samples and disease severity in patients aged 9 years and under. Such finding may serve as a predictor of respiratory disease course in pediatric patients and will be beneficial for the differential diagnosis and treatment of pediatric patients.
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Sarma P, Kaur H, Medhi B, Bhattacharyya A. Possible prophylactic or preventive role of topical povidone iodine during accidental ocular exposure to 2019-nCoV. Graefes Arch Clin Exp Ophthalmol 2020; 258:2563-2565. [PMID: 32436084 PMCID: PMC7239348 DOI: 10.1007/s00417-020-04752-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Phulen Sarma
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Hardeep Kaur
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Anusuya Bhattacharyya
- Department of Ophthalmology, Government Medical College and Hospital, Sector 32, Chandigarh, India.
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Labib BA, Minhas BK, Chigbu DI. Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions. Clin Ophthalmol 2020; 14:837-852. [PMID: 32256043 PMCID: PMC7094151 DOI: 10.2147/opth.s207976] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/25/2020] [Indexed: 02/06/2023] Open
Abstract
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, anti-inflammatory 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.
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Affiliation(s)
- Bisant A Labib
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USA
| | - Bhawanjot K Minhas
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USA
| | - DeGaulle I Chigbu
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USA
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Kuo IC, Ren M, Leviste KD, Hawkins BS, Lindsley KB. Topical pharmacologic interventions versus placebo for epidemic keratoconjunctivitis. Cochrane Database Syst Rev 2020. [DOI: 10.1002/14651858.cd013520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Irene C Kuo
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine; Department of Ophthalmology; 4924 Campbell Blvd #100 Baltimore Maryland USA 21236
| | - Mark Ren
- The Johns Hopkins University School of Medicine; Wilmer Eye Institute; Baltimore Maryland USA
| | - Katherine D Leviste
- University of Miami Miller School of Medicine; Department of Ophthalmology, Bascom Palmer Eye Institute; 1638 NW 10th Avenue #822 Miami Florida USA 33136
| | - Barbara S Hawkins
- The Johns Hopkins University School of Medicine; Wilmer Eye Institute; Baltimore Maryland USA
| | - Kristina B Lindsley
- IBM Watson Health; Life Sciences, Oncology, & Genomics; Baltimore Maryland USA
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Mystery eye: Human adenovirus and the enigma of epidemic keratoconjunctivitis. Prog Retin Eye Res 2019; 76:100826. [PMID: 31891773 DOI: 10.1016/j.preteyeres.2019.100826] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/20/2022]
Abstract
Known to occur in widespread outbreaks, epidemic keratoconjunctivitis (EKC) is a severe ocular surface infection with a strong historical association with human adenovirus (HAdV). While the conjunctival manifestations can vary from mild follicular conjunctivitis to hyper-acute, exudative conjunctivitis with formation of conjunctival membranes, EKC is distinct as the only form of adenovirus conjunctivitis in which the cornea is also involved, likely due to the specific corneal epithelial tropism of its causative viral agents. The initial development of a punctate or geographic epithelial keratitis may herald the later formation of stromal keratitis, and manifest as subepithelial infiltrates which often persist or recur for months to years after the acute infection has resolved. The chronic keratitis in EKC is associated with foreign body sensation, photophobia, glare, and reduced vision. However, over a century since the first clinical descriptions of EKC, and over 60 years since the first causative agent, human adenovirus type 8, was identified, our understanding of this disorder remains limited. This is underscored by a current lack of effective diagnostic tools and treatments. In part, stasis in our knowledge base has been encouraged by the continued acceptance, and indeed propagation of, inaccurate paradigms pertaining to disease etiology and pathogenesis, particularly with regard to mechanisms of innate and adaptive immunity within the cornea. Owing to its often persistent and medically refractory visual sequelae, reconsideration of key aspects of EKC disease biology is warranted to identify new treatment targets to curb its worldwide socioeconomic burden.
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Kulkarni C, Ballal K. A treatment protocol for minimizing duration and complications of adenoviral epidemic keratoconjunctivitis. Taiwan J Ophthalmol 2019; 10:269-277. [PMID: 33437600 PMCID: PMC7787099 DOI: 10.4103/tjo.tjo_66_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/08/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE: The purpose of the study was to assess the treatment protocol of topical 2.5% Povidone-Iodine (PovI) and 0.1% fluorometholone (FluM) for Adenoviral Epidemic keratoconjunctivitis (EKC) in reducing the duration and severity of the disease as compared to conventional treatment. This was a retrospective case–control study. MATERIALS AND METHODS: Cases were defined as patients with EKC receiving the treatment protocol and conjunctival swab taken for polymerase chain reaction. Controls were defined as similar patients receiving conventional treatment protocol. Forty-one cases and 35 controls were identified for analysis. Cases were treated with a protocol using 2.5% povidone-iodine eye drops and 0.1% FluM eye drops. Controls received conventional treatment until resolution of signs and symptoms. Both the groups were followed up for 1 month. Data collected were analyzed for effect of the two treatment protocols on the duration of EKC, rate of recovery, and incidence of complications. RESULTS: The treatment protocol was significantly better than conventional treatment protocol in achieving cure (P = 0.002) with large effect size. The proportion of cases achieving cure was significantly higher with treatment protocol (64% vs. 11% at 5 days, P < 0.001) by 5 days. There was a significant reduction of the subepithelial infiltrates (SEI) incidence group (10% vs. 57%, P < 0.001). There were no SEI at 1 month in the treatment group (0% vs. 31%). CONCLUSION: Treatment protocol used in our study can significantly reduce the severity and duration of EKC. It can prevent chronic keratitis in majority of cases. Since povidone-iodine is nonspecific and virucidal for adenovirus, this therapy can be used for other types of adenoviral conjunctivitis.
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Affiliation(s)
- Chidanand Kulkarni
- Department of Ophthalmology and KMC, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kirthinath Ballal
- Department of Community Medicine, KMC, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Shorter E, Whiteside M, Harthan J, Margolis MS, Hartwick AT, Johnson S, Migneco M, Morettin C, Olson CK, Huecker J, Than T, Gordon MO. Safety and tolerability of a one-time, in-office administration of 5% povidone-iodine in the treatment of adenoviral conjunctivitis: The Reducing Adenoviral Patient Infected Days (RAPID) study. Ocul Surf 2019; 17:828-832. [PMID: 31401340 PMCID: PMC6874762 DOI: 10.1016/j.jtos.2019.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/02/2019] [Accepted: 08/07/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To report safety and tolerability of a one-time administration of ophthalmic 5% povidone-iodine (5% PVP-I) in a double-masked randomized trial for the treatment of adenoviral conjunctivitis (Ad-Cs). METHODS Of 212 participants screened, 56 eligible participants with red eye symptoms ≤4 days and a positive adenoviral rapid immunoassay were randomized to a one-time administration of ophthalmic 5% PVP-I or preservative free artificial tears (AT). Safety was assessed by corneal fluorescein staining (baseline, immediate post-administration and Day 1) and visual acuity (VA) (baseline and Day 1). Tolerability was assessed using participant-rated overall ocular discomfort (baseline, immediately post-administration and on Day 1. RESULTS In the 5% PVP-I group, corneal staining increased immediately post-administration but returned to baseline levels by Day 1. There was no change in VA between baseline and Day 1 in either 5% PVP-I or AT groups (p = 0.87). In the 5% PVP-I group, there was no change in participant-rated overall discomfort immediately post-administration (p = 0.78) or on day 1 (p = 0.10) compared to baseline. In the AT group, participant-rated overall discomfort was lower immediately post-administration but returned to baseline levels by Day 1. One adverse event was reported in the 5% PVP-I group on Day 1-2 that was classified as not related to treatment. CONCLUSION These results suggest ophthalmic 5% PVP-I used as a one-time treatment is safe and well tolerated by patients with Ad-Cs.
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Affiliation(s)
- Ellen Shorter
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
| | | | | | | | | | | | | | | | | | | | - Tammy Than
- Carl Vinson VA Medical Center, Dublin, GA, USA
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González-Martín-Moro J, Zarallo-Gallardo J. Iodine povidone. A new paradigm in the treatment of adenoviral conjunctivitis? ACTA ACUST UNITED AC 2019; 94:521-522. [PMID: 31500885 DOI: 10.1016/j.oftal.2019.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 07/27/2019] [Accepted: 07/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- J González-Martín-Moro
- Departamento de Oftalmología, Hospital Universitario del Henares, Coslada, Madrid, España; Departamento de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España.
| | - J Zarallo-Gallardo
- Departamento de Oftalmología, Hospital Universitario del Henares, Coslada, Madrid, España; Departamento de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
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Abstract
PURPOSE Conjunctivitis, or inflammation of the conjunctiva, is a common condition that can be caused by infectious (eg, bacterial or viral infections) and noninfectious (eg, allergy) etiologies. Treatment involves diagnosis of the underlying cause and use of appropriate therapies. A broad-spectrum therapy that can address multiple etiologies, and also the accompanying inflammation, would be very useful. In this review, we discuss the usefulness of topical ophthalmic corticosteroids and ophthalmic formulations that combine corticosteroids with anti-infectives/antibiotics for treating acute infectious conjunctivitis. METHODS A review of the published literature and relevant treatment guidelines. RESULTS Topical corticosteroids are useful in treating ocular inflammation, but most treatment guidelines recommend steroid use generally in severe cases of conjunctivitis. This is partly due to risks associated with steroid use. These risks include potential for prolonging adenoviral infections and potentiating/worsening herpes simplex virus infections, increased intraocular pressure, glaucoma, and cataracts. Most of these perceived risks are not, however, supported by high-quality clinical data. They are also associated with long-term steroid uses that are dissimilar to applications for infectious conjunctivitis. Clinical data show that ophthalmic formulations that combine corticosteroids with broad-spectrum anti-infectives could be effective and well tolerated when used for short-term treatment (≤2 weeks). CONCLUSIONS Corticosteroids, in combination with anti-infectives, could be a promising treatment option for acute conjunctivitis subject to development of further evidence on their effectiveness and safety in conjunctivitis treatment.
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Povidone-iodine can be used in the treatment of microbial keratitis. Surv Ophthalmol 2019; 64:891-892. [PMID: 31276735 DOI: 10.1016/j.survophthal.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/17/2019] [Indexed: 11/23/2022]
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Pelletier JS, Devine J, Capriotti K, Barone SB, Capriotti JA. Topical application of povidone-iodine/dimethylsulfoxide ophthalmic gel preparation in Dutch-Belted rabbits. Cutan Ocul Toxicol 2019; 38:221-226. [DOI: 10.1080/15569527.2019.1579225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pepose JS, Narvekar A, Liu W, Haque R. A randomized controlled trial of povidone-iodine/dexamethasone ophthalmic suspension for acute viral conjunctivitis. Clin Ophthalmol 2019; 13:535-544. [PMID: 30962674 PMCID: PMC6433103 DOI: 10.2147/opth.s191275] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the clinical safety and efficacy of povidone-iodine (PVP-I) 0.6%/dexamethasone (DEX) 0.1% ophthalmic suspension vs vehicle in patients with clinically suspected acute viral conjunctivitis. Patients and methods This was a randomized, double-masked, parallel-group, vehicle-controlled study. Adults with a clinical diagnosis of suspected acute viral conjunctivitis were randomized 1:1 to PVP-I/DEX ophthalmic suspension or vehicle bilaterally four times daily for 5 days (Days 1–5). Evaluation was on Days 1, 3 (+1-day window), and 6 (+1). Patients with signs of acute viral conjunctivitis at the Day 6 visit received open-label PVP-I/DEX for five additional days and were evaluated on Day 11–14. The primary efficacy endpoint was clinical resolution of acute viral conjunctivitis in the study eye at the Day 6 visit. Results Overall, 132 patients were randomized and received treatment (PVP-I/DEX, n=66; vehicle, n=66); 38 patients continued into the open-label portion of the study. Not enough patients with confirmed adenoviral conjunctivitis (n=32/132) were enrolled to assess the primary endpoint, although there were some efficacy trends in the PVP-I/DEX group for global clinical score (sum of watery conjunctival discharge and bulbar conjunctival redness). There were no serious treatment-emergent adverse events (TEAEs) and no patients discontinued due to a TEAE. In the masked phase, 56.1% of patients receiving PVP-I/DEX experienced at least one TEAE vs 43.9% in the vehicle group; 78.9% of patients in the open-label phase experienced at least one TEAE. Most TEAEs were mild in severity. Conclusion PVP-I/DEX ophthalmic suspension administered for ≤14 days had a favorable safety profile and was generally well tolerated.
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Affiliation(s)
- Jay S Pepose
- Pepose Vision Institute, Chesterfield, MO, USA, .,Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO, USA,
| | | | - Wenlei Liu
- Biostatistics and Programming, Shire, A Takeda Company, Lexington, MA, USA
| | - Reza Haque
- Ophthalmics, Shire, A Takeda Company, Lexington, MA, USA
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Gonzalez G, Yawata N, Aoki K, Kitaichi N. Challenges in management of epidemic keratoconjunctivitis with emerging recombinant human adenoviruses. J Clin Virol 2019; 112:1-9. [PMID: 30654207 DOI: 10.1016/j.jcv.2019.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/21/2018] [Accepted: 01/08/2019] [Indexed: 01/14/2023]
Abstract
Adenoviral epidemic keratoconjunctivitis (EKC) presents as severe conjunctival inflammations involving the cornea that can lead to the development of corneal opacities and blurred vision, which can persist for months. EKC is highly contagious and responsible for outbreaks worldwide, therefore accurate diagnosis and rapid containment are imperative. EKC is caused by a number of types within Human adenovirus species D (HAdV-D): 8, 37 and 64 (formerly known as 19a) and these types were considered the major causes of EKC for over fifty years. Nonetheless, recent improved molecular typing methodologies have identified recombinant HAdV-D types 53, 54 and 56, as newly emerging etiologic agents of EKC infections worldwide. EKC cases due to these recombinant types have potentially been underdiagnosed and underestimated as a source of new EKC outbreaks. Recombination events among circulating HAdV-D types represent a source of new infectious disease threats. Also, the growing number of adenoviral types enabled genomic and phenotypic comparisons to determine pathological properties related to EKC. This review covers the clinical features of EKC, current challenges in clinical practice and recent progress in EKC-related HAdV research, which focuses on the development of novel diagnostic and therapeutic approaches.
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Affiliation(s)
- Gabriel Gonzalez
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Nobuyo Yawata
- Department of Medicine, Ophthalmology, Fukuoka Dental College, Fukuoka, Japan; Singapore Eye Research Institute, Singapore; Department of Ophthalmology, Kyushu University, Japan; Duke-NUS Medical School, Singapore
| | - Koki Aoki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan.
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Pepose JS, Ahuja A, Liu W, Narvekar A, Haque R. Randomized, Controlled, Phase 2 Trial of Povidone-Iodine/Dexamethasone Ophthalmic Suspension for Treatment of Adenoviral Conjunctivitis. Am J Ophthalmol 2018; 194:7-15. [PMID: 29787732 DOI: 10.1016/j.ajo.2018.05.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate the efficacy/safety of an ophthalmic suspension of povidone-iodine (PVP-I) 0.6% and dexamethasone 0.1% in patients with acute adenoviral conjunctivitis. DESIGN Multicenter, randomized, vehicle-controlled, double-masked trial. METHODS Adults with a positive Rapid Pathogen Screening Adeno-Detector Plus test were randomized 1:1:1 to PVP-I 0.6%/dexamethasone 0.1%, PVP-I 0.6%, or vehicle, bilaterally 4 times daily for 5 days (days 1-5). Patients were evaluated on days 3, 6, and 12 (+1-day window). Efficacy measures included clinical resolution and adenoviral eradication. RESULTS Overall, 144 patients were included in the efficacy analysis (PVP-I/dexamethasone, n = 48; PVP-I, n = 50; vehicle, n = 46). The proportion of patients with clinical resolution (primary study eye with last observation carried forward [LOCF]) at the day 6 visit was higher with PVP-I/dexamethasone (31.3%) than with vehicle (10.9%; P = .0158) and PVP-I (18.0%; P = nonsignificant). The proportion with adenoviral eradication (primary study eye with LOCF) was higher with PVP-I/dexamethasone than with vehicle at the day 3 (35.4% vs 8.7%; P = .0019) and day 6 (79.2% vs 56.5%; P = .0186) visits and vs PVP-I (day 3 visit, 32.0%; day 6 visit, 62.0%; each P = nonsignificant). Treatment-emergent adverse events (AEs) occurred in 69.0% (vehicle), 62.7% (PVP-I), and 53.4% (PVP-I/dexamethasone) of patients in the safety dataset. Discontinuation owing to AEs occurred in 37 patients (vehicle, n = 16; PVP-I, n = 12; PVP-I/dexamethasone, n = 9). CONCLUSION PVP-I/dexamethasone appeared safe and well tolerated, and significantly improved clinical resolution and adenoviral eradication in patients with acute adenoviral conjunctivitis.
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Abstract
Human adenovirus (HAdV) is a ubiquitous virus that infects the mucosa of the eye. It is the most common cause of infectious conjunctivitis worldwide, affecting people of all ages and demographics. Pharyngoconjunctival fever outbreak is due to HAdV types 3, 4, and 7, whereas outbreaks of epidemic keratoconjunctivitis are usually caused by HAdV types 8, 19, 37, and 54. Primary cellular receptors, such as CAR, CD46, and sialic acid interact with fiber-knob protein to mediate adenoviral attachment to the host cell, whereas adenoviral penton base–integrin interaction mediates internalization of adenovirus. Type 1 immunoresponse to adenoviral ocular infection involves both innate immunity mediated by natural killer cells and type 1 interferon, as well as adaptive immunity mediated mainly by CD8 T cells. The resulting ocular manifestations are widely variable, with pharyngoconjunctival fever being the most common, manifesting clinically with fever, pharyngitis, and follicular conjunctivitis. Epidemic keratoconjunctivitis, however, is the severest form, with additional involvement of the cornea leading to development of subepithelial infiltrates. Because there is currently no US Food and Drug Administration-approved treatment for adenoviral ocular infection, current management is palliative. The presence of sight-threatening complications following ocular adenoviral infection warrants the necessity for developing antiadenoviral therapy with enhanced therapeutic index. Future trends that focus on adenoviral pathogenesis, including adenoviral protein, which utilize host receptors to promote infection, could be potential therapeutic targets, yielding shorter active disease duration and reduced disease burden.
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Affiliation(s)
- DeGaulle I Chigbu
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA, USA,
| | - Bisant A Labib
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA, USA,
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