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

Asena, Leyla; Şingar, Evin; Burcu, Ayse; Ercan, Ertuğrul; Çolak, Meriç Yavuz; Altınörs, Dilek Dursun

doi:10.1038/eye.2017.4

Cited by 23 publications

(15 citation statements)

References 27 publications

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“…Topical 0.05% to 2% cyclosporine was reported to reduce the formation of subepithelial corneal infiltrates. [ 10 ] However, the result of decrease of subepithelial corneal infiltrates in adenoviral keratitis was probably more related to the use of steroids than cyclosporine. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

Bilateral disciform keratitis of presumed adenoviral etiology

Altan-Yaycıoğlu

Poyraz

2018

Indian J Ophthalmol

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Adenoviral conjunctivitis may lead to subepithelial corneal infiltrates as a late complication. Herein, we aim to present a 19-year-old healthy female, who developed bilateral disciform keratitis three weeks after suffering adenoviral conjunctivitis. She presented with widespread subepithelial corneal infiltrates in addition to central corneal edema with white distinct border resembling immune stromal ring, as well as Descemet's folds and keratic precipitates in the central area. Following topical corticosteroid and ganciclovir for 10 days, her condition improved. After 1 month, she had another episode. Short-term topical corticosteroids in addition to long-term topical cyclosporine and nonpreserved artificial tears were able to prevent further recurrences.

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Section: Discussionmentioning

confidence: 99%

Bilateral disciform keratitis of presumed adenoviral etiology

Altan-Yaycıoğlu

Poyraz

2018

Indian J Ophthalmol

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“…One percent CsA administered 4 times a day for 21 days during the acute infection produced earlier subjective improvement of local symptoms and a trend toward a lower incidence of corneal opacities in a small study with 10 patients in each of 4 arms [82], but the authors recommended further investigation in a greater number of patients [83]. In a study with 3 arms of 30-50 patients each-lubricants, topical prednisolone acetate 1%, or CsA 2%-authors suggest SEI may be less severe in symptoms and findings in patients receiving topical corticosteroids or topical CsA when compared with patients using only topical lubricants.…”

Section: Treatmentsmentioning

confidence: 99%

Adenoviral Keratoconjunctivitis: Diagnosis, Management, and Prevention

Kuo

2019

Curr Ophthalmol Rep

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Purpose of Review This review will provide an updated overview of the diagnosis, management, and prevention of adenoviral keratoconjunctivitis. Recent Findings Human adenovirus (HAdV) is undergoing nomenclature changes because of whole genome sequencing. Recombination has led to newly identified ocular pathogens like HAdV-D53, HAdV-D54, and HAdV-D56. No quick, highly sensitive and specific diagnostic test is available for ocular adenoviral infections. PCR takes a few hours but is not widely available. Results of using PCR in employees at one medical center support the view of endemic HAdV in the community. Summary Infection control is highly important as no treatment for ocular HAdV infections exists, ocular sequelae can be significant, and HAdV is endemic. Diagnosis of HAdVocular infections can be challenging; ophthalmologists are best positioned to diagnose the condition and provide antibiotic stewardship. Development of an accurate diagnostic test with quick turnaround would lead to major benefits in terms of less antibiotic use and fewer work furloughs. Outbreaks occur when infection control becomes lax.

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“…71 However, it is important to note that short-term treatment with topical steroids of limited potency may also delay viral clearance. 72 Nonsteroidal anti-inflammatory drugs (NSAIDs) are another alternative to corticosteroids, in that they are approved for topical, ocular use and exhibit antiinflammatory effects without the substantial risk of glaucoma and cataract effect seen with steroid use. These agents work on the arachidonic acid pathway by inhibiting cyclooxygenase and, subsequently, the formation of prostaglandins, thromboxane, and prostacyclin.…”

Section: Antiviral Therapymentioning

confidence: 99%

“…Both the Cyclosporine A and prednisolone groups were also similarly effective in preventing the development of SEIs when used during the active phase of infection, suggesting possible prophylactic benefit. 72 Tacrolimus is another immunosuppressive agent that also demonstrates anti-inflammatory activity. Like cyclosporine, tacrolimus' initial use was to prevent rejection in organ transplants.…”

Section: Immunotherapy and Cardiotonic Steroidsmentioning

confidence: 99%

“…The idea of combining these elements is to employ the antiseptic properties of PVI in conjunction with symptomatic relief of inflammation, with the added benefit of reducing the risk and/or treatment of SEI formation and scarring. 2,52,72,91 Initial efficacy of combo PVI 0.4%/dexamethasone 0.1% dosed QID for five days was evaluated in a small study of nine eyes utilizing Rapid Pathogen Screening Adeno Detector-positive acute viral conjunctivitis. 91 The pilot study included both clinical (conjunctival injection and discharge) and serological (reduction of quantitative polymerase chain reaction titers and eradication of infectious virus as determined by cell culture with confirmatory immunofluorescence) endpoints.…”

Section: Combination Dexamethasone/pvi Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

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

Labib¹,

Minhas²,

Chigbu³

2020

OPTH

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

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

Cited by 23 publications

References 27 publications

Bilateral disciform keratitis of presumed adenoviral etiology

Bilateral disciform keratitis of presumed adenoviral etiology

Adenoviral Keratoconjunctivitis: Diagnosis, Management, and Prevention

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

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