Comparative study of topical regimen for adenoviral kearoconjunctivitis by 0.1% fluorometholone with and without polyvin
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CLINICAL INVESTIGATION
Comparative study of topical regimen for adenoviral kearoconjunctivitis by 0.1% fluorometholone with and without polyvinyl alcohol iodine Kazuki Matsuura1 · Yuki Terasaka1 · Dai Miyazaki2 · Yumiko Shimizu2 · Yoshitsugu Inoue2 Received: 2 May 2020 / Accepted: 15 October 2020 © Japanese Ophthalmological Society 2020
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. Keywords Human adenoviruses (HAdV) · Epidemic keratoconjunctivitis (EKC) · Corticosteroids · Polyvinyl alcohol iodine (PAI) · Real-time PCR
Introduction Human adenoviruses (HAdVs) are among the most frequent causes of epidemic keratoconjunctivitis (EKC). No established antiviral medications are available for the treatment of HAdVs conjunctivitis, and usual treatment is mostly Corresponding Author: Kazuki Matsuura * Kazuki Matsuura [email protected]; matsu224@ncn‑k.net 1
Department of Ophthalmology, Nojima Hospital, 2714‑1, Sesaki‑machi, Kurayoshi‑city, Tottori 682‑0863, Japan
Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, 36‑1, Nishi‑cho, Yonago‑city, Tottori 683‑8504, Japan
2
supportive. In Japan, corticosteroids together with antibiotics are often prescribed in order to suppress local inflammation and prevent bacterial superinfection [1]. Although corticosteroids may offer symptomatic relief in the acute phase, this treatment regimen has no effect on viral replication. I
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