A combination povidone-iodine 0.4%/dexamethasone 0.1% ophthalmic suspension in the treatment of adenoviral conjunctivitis

Pelletier, Jesse; Stewart, Kevin; Trattler, William; Ritterband, David C.; Braverman, Shirley; Samson, C. Michael; Liang, Baoyu; Capriotti, Joseph

doi:10.1007/s12325-009-0062-1

Cited by 63 publications

(46 citation statements)

References 15 publications

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“…However, a clinical trial carried out in children did not fi nd differences in the rate of healing between those treated with 1.25% povidone iodine or with antibiotic [75]. The use of topical antibiotics to prevent bacterial superinfection should be reserved for high-risk pediatric patients [73,75].…”

Section: Therapy Of Epidemic Keratoconjunctivitis (Ekc)mentioning

confidence: 99%

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Human adenovirus: Viral pathogen with increasing importance

Ghebremedhin¹

2014

European Journal of Microbiology and Immunology

286

253

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The aim of this review is to describe the biology of human adenovirus (HAdV), the clinical and epidemiological characteristics of adenoviral epidemic keratoconjunctivitis and to present a practical update on its diagnosis, treatment, and prophylaxis. There are two well-defined adenoviral keratoconjunctivitis clinical syndromes: epidemic keratoconjunctivitis (EKC) and pharyngoconjunctival fever (PCF), which are caused by different HAdV serotypes. The exact incidence of adenoviral conjunctivitis is still poorly known. However, cases are more frequent during warmer months. The virus is endemic in the general population, and frequently causes severe disease in immunocompromised patients, especially the pediatric patients. Contagion is possible through direct contact or fomites, and the virus is extremely resistant to different physical and chemical agents. The clinical signs or symptoms of conjunctival infection are similar to any other conjunctivitis, with a higher incidence of pseudomembranes. In the cornea, adenoviral infection may lead to keratitis nummularis. Diagnosis is mainly clinical, but its etiology can be confirmed using cell cultures, antigen detection, polymerase chain reaction or immunochromatography. Multiple treatments have been tried for this disease, but none of them seem to be completely effective. Prevention is the most reliable and recommended strategy to control this contagious infection.

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Section: Therapy Of Epidemic Keratoconjunctivitis (Ekc)mentioning

confidence: 99%

“…Topical cyclosporine A should only be considered in patients with subepithelial infi ltrates that produce significant visual acuity loss and do not respond to topical corticoid therapy [73,74]. One of the ophthalmic broad spectrum antiseptics is povidone-iodine.…”

Section: Therapy Of Epidemic Keratoconjunctivitis (Ekc)mentioning

confidence: 99%

Human adenovirus: Viral pathogen with increasing importance

Ghebremedhin¹

2014

European Journal of Microbiology and Immunology

286

253

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“…35,36 A study by Pelletier et al investigated a topical combination agent that contained 0.4% povidone-iodine as an anti-viral and 0.1% dexamethasone as a potent steroid. 37 The expectation of the study was to ''effectively treat both the inflammatory and infectious components of acute adenoviral conjunctivitis by decreasing the symptomatic period following infection, shortening the duration of viral shedding and reducing the potential for infectious transmission.'' 37 The study followed the clinical course of positive RPS Adeno Detector conjunctivitis while monitoring serial virology markers by quantitative PCR and CC-IFA.…”

Section: Introductionmentioning

confidence: 99%

“…37 The expectation of the study was to ''effectively treat both the inflammatory and infectious components of acute adenoviral conjunctivitis by decreasing the symptomatic period following infection, shortening the duration of viral shedding and reducing the potential for infectious transmission.'' 37 The study followed the clinical course of positive RPS Adeno Detector conjunctivitis while monitoring serial virology markers by quantitative PCR and CC-IFA. 37 The results demonstrated that all eyes had rapid improvement of conjunctival injection and discharge with a decrease in viral titers at the same time, warranting a need for further study of this combination agent.…”

Section: Introductionmentioning

confidence: 99%

Epidemic keratoconjunctivitis: A review of current concepts in management

Pihos

2013

Journal of Optometry

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Epidemic keratoconjunctivitis (EKC) is an ocular surface infection caused by adenovirus. To date, there are no approved topical antiadenoviral therapeutics to treat EKC. Recent research reveals that treatment with topical corticosteroids for symptomatic relief of EKC enhances adenovirus replication and delays cell shedding from the ocular surface which delays adenovirus elimination. The current management of EKC largely revolves around accurate diagnosis of the condition and implementation of disinfection protocol to prevent its spread. Development of an effective antiviral treatment that addresses inflammation and does not prolong viral shedding would provide significant benefit. The literature reports on a variety of therapeutics that could potentially satisfy this deficiency. Topical ganciclovir and povidoneiodine combination drops have shown the most recent potential, but both therapeutics need to be investigated in larger scale studies. Until an antiadenoviral option is produced, the treatment of EKC should maintain a judicious case by case approach aiming to contain its dissemination and prevent visual consequences. Queratoconjuntivitis epidémica: revisión de los conceptos actuales de tratamientoResumen La queratoconjuntivitis epidémica (QCE) consiste en una infección de la superficie ocular causada por adenovirus. Hasta la fecha no existen terapias antiadenovíricas aprobadas para tratar la QCE. Las investigaciones recientes revelan que el tratamiento con corticoesteroides tópicos para un alivio sintomático de la QCE aumenta la replicación del adenovirus y retrasa la descamación de células en la superficie ocular, retardando la eliminación del virus. El tratamiento actual de la QCE gira alrededor del diagnóstico preciso sobre la condición clínica y la introducción de un protocolo de desinfección que impida su diseminación. El desarrollo de un tratamiento antivírico eficaz que trate la inflamación y no retrase la eliminación vírica supondría un beneficio considerable. La literatura reporta gran variedad de terapias que podrían satisfacer potencialmente esta deficiencia. La aplicación de gotas tópi-cas con una combinación de ganciclovir y iodina-povidona ha demostrado recientemente su potencial, aunque ambas terapias precisan investigarse mediante estudios a gran escala. Hasta A.M. Pihos que aparezca una opción antiadenovírica el tratamiento de la QCE debería realizarse utilizando un enfoque caso a caso, a fin de contener su diseminación y prevenir consecuencias visuales.

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“…Successful use has been reported in human adenoviral conjunctivitis. 6 Although adenoviruses are often the cause of prolonged ocular morbidity and outbreaks of infectious conjunctivitis, other, more virulent, organisms may rapidly destroy ocular tissue. Some of these microbes are highly resistant bacteria with multiple virulence factors.…”

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confidence: 99%