Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions

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

The potential benefits of PVI as well as topical immunosuppressive therapies gave rise to the development of combined PVI/steroid ophthalmic solutions. 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. 91 Combination treatment dosed QID for seven days has also been shown to improve clinical scores for scleral inflammation, ocular neovascularization, eyelid inflammation, friability of vasculature, inflammatory discharge, and epiphora as compared to treatment with 0.5% cidofovir, tobramycin/dexamethasone ophthalmic suspension, and balanced salt solution in rabbit models. 52 Moreover, PVI/ dexamethasone combination has proven effective in reducing viral titers and delaying viral shedding. 52 When comparing PVI/dexamethasone combination treatment with that of dexamethasone alone, combination drops not only increase recovery but also, reduce the risk of development of SEIs more effectively than steroids alone. 92 It is well documented that sole topical corticosteroid therapy has the risk of increased viral replication and prolonged shedding, further delaying the resolution of active infection. This significant treatment challenge is alleviated with the addition of PVI. 92 In addition to the mentioned treatment benefits, combination PVI/dexamethasone ophthalmic formulation displayed a favorable safety profile and was well tolerated when administered for up to 14 days. 93 There was also no statistically significant effect on intraocular pressure, as is often associated with topical corticosteroid use. Reported side effects were limited to increased stinging upon instillation when compared to treatment with palliative artificial tears. 94