Topical treatment of acute adenoviral keratoconjunctivitis with 0.2% cidofovir and 1% cyclosporine: a controlled clinical pilot study.
OBJECTIVE
To evaluate the efficacy of 0.2% cidofovir eyedrops and 1% cyclosporine eyedrops administered 4 times daily (qid) to treat acute adenoviral keratoconjunctivitis.


METHODS
A randomized, controlled, double-masked study was conducted on 39 patients with acute adenoviral keratoconjunctivitis of recent onset. Patients were divided into 4 treatment groups: (1) cidofovir qid, (2) cyclosporine qid, (3) cidofovir + cyclosporine qid, and (4) sodium chloride qid (control). The diagnosis was confirmed using adenoviral polymerase chain reaction from conjunctival swabs. Duration of treatment was 21 days.


METHODS
Severity of conjunctival hyperemia, conjunctival chemosis, superficial punctate keratitis during treatment, and presence and severity of corneal subepithelial infiltrates were evaluated using a clinical score. Duration until subjective improvement of symptoms was recorded.


RESULTS
Subjective improvement of local symptoms was accelerated in the cyclosporine group. All other clinically relevant variables showed no statistically significant difference among the 4 treatment groups. Particularly, we did not find a difference in the frequency of corneal subepithelial infiltrates at the end of treatment.


CONCLUSIONS
Use of cidofovir, cyclosporine, or both did not accelerate the improvement of clinical symptoms of acute adenoviral keratoconjunctivitis compared with the natural course of the infection as demonstrated by this pilot study. This might be because of the wide spectrum of the clinical course of the infection, low sensitivity to cidofovir, too low of a concentration of cidofovir, or early cessation of viral replication in the course of the infection. The effect of a higher concentration of topical cidofovir with and without cyclosporine requires investigation in a larger group of patients.
Hillenkamp
J
J
The Eye Hospital, Heinrich-Heine University, Düsseldorf, Germany. hillenka@hotmail.com
Reinhard
T
T
Ross
R S
RS
Böhringer
D
D
Cartsburg
O
O
Roggendorf
M
M
De Clercq
E
E
Godehardt
E
E
Sundmacher
R
R
D000208:Acute Disease; D000258:Adenovirus Infections, Human / Q000188:drug therapy* / Q000821:virology; D000260:Adenoviruses, Human / Q000235:genetics / Q000302:isolation & purification*; D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000077404:Cidofovir; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D003596:Cytosine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use*; D017931:DNA Primers / Q000737:chemistry; D004279:DNA, Viral / Q000032:analysis; D004311:Double-Blind Method; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D015828:Eye Infections, Viral / Q000188:drug therapy* / Q000821:virology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007637:Keratoconjunctivitis / Q000188:drug therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D010865:Pilot Projects; D016133:Polymerase Chain Reaction; D016896:Treatment Outcome
D000998:Antiviral Agents; D017931:DNA Primers; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D016572:Cyclosporine; D003596:Cytosine; D000077404:Cidofovir