Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions

Labib, Bisant A; Minhas, Bhawanjot K; Chigbu, DeGaulle I

In 2001, Goosens et al discussed the antiviral activity of anti-Ad IgG on gene transfer to synovial fluid. This was attributed to the antibodies' ability to target adenoviral capsid proteins, subsequently inhibiting infection by the virus. 58 Topically, immunoglobulin (Ig) may offer the same effect on ocular tissue and prevent transmission and replication of the virus, to some degree. In addition to its antiviral properties, Ig has the added benefit of antiinflammatory effects, which can aid in sub-epithelial infiltrate management. 59 Nwanegbo et al found that Ig was actually comparable to cidofovir in its antiviral activity. While cidofovir acts intracellularly to block DNA replication, Ig neutralizes the virus on the ocular surface. In comparison to cidofovir and saline titers, Ig was more effective during the acute phase of the infection. 59 It worked to aid in the clearance of the virus, shortening the duration of the infection, and thereby limiting the transmission of the virus. Additionally, Ig may be beneficial in prophylaxis to prevent clinical infections. Though both cidofovir and Ig were effective in this study, cidofovir demonstrated a significantly shorter duration of viral shedding. This is likely due to the mechanism of intracellularmediated adenoviral DNA polymerase-blocking activities and prolonged tissue half-life after rapid uptake into cells. This study yielded promising results in the future of topical Ig use on ocular HAdV infections. The limitation lies in product consistency as Ig is derived from serum pooled by various donors, though anti-adenoviral efficacy appears stable over different lots. 59, 60 Topical Anti-Inflammatory Therapy