[Clinical and immunological comparisons of therapeutic regimens for corneal infiltrates secondary to adenoviral keratoconjunctivitis].
The problem with post-adenoviral corneal infiltrates is that they cause a significant and persistent decrease in visual function, while corticosteroids in monotherapy bring only temporary improvement.


OBJECTIVE
to perform a comparative evaluation of topical corticosteroids and 0.05% cyclosporine A efficacy in the treatment of post-adenoviral corneal infiltrates on the basis of clinical presentation and local cytokine status.


METHODS
The study involved two groups of patients after adenoviral keratoconjunctivitis: group 1 (25 patients, 45 eyes) were prescribed a diminishing regimen of corticosteroid eye drops for 12 weeks and corneal protectors; group 2 (24 patients, 42 eyes) received the same treatment as described above plus topical 0.05% cyclosporine A for 6 months. The follow-up period was from 6 to 12 months. Visual acuity measurements, biomicroscopy, and pneumatic tonometry were performed at months 1, 3, and 6. Local cytokine status was assessed by studying cytokine gene expression in cell culture from conjunctival scrapings and cytokines levels in the supernatant. The tests were done before the beginning of the treatment in both groups, at month 1 in group 1, at month 4 in group 2 (i.e. in a month after the cessation of dexamethasone) and also in a group of healthy volunteers (30 persons, 30 eyes).


RESULTS
Long-term combined anti-inflammatory therapy with corticosteroids and 0.05% cyclosporine A in patients with post-adenoviral corneal infiltrates has yielded positive clinical results, including a persistent increase in visual acuity and complete resolution of corneal opacities (92.8%). In addition, we revealed a correlation between local cytokine status changes and clinical results.


CONCLUSIONS
The proposed therapeutic regimen enabled complete suppression of residual interferon-α antiviral activity, an increase in interleukin-4 that regulates local humoral immunity, and a decrease (down to a complete suppression) in anti-inflammatory interleukin-2, which is responsible for activation of cell-mediated immunity, thus, resulting in resolution of the immune-mediated inflammation in the cornea.
Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 59А Beskudnikovskiy bulvar, Moscow, Russian Federation, 127486.
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Maychuk
Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 59А Beskudnikovskiy bulvar, Moscow, Russian Federation, 127486.
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Vasil'eva
D.I. Ivanovsky Research Institute of Virology, N.F. Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of the Russian Federation, 16 Gamalei St., Moscow, Russian Federation, 123098.
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Russu
D.I. Ivanovsky Research Institute of Virology, N.F. Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of the Russian Federation, 16 Gamalei St., Moscow, Russian Federation, 123098.
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Mezentseva
D000258:Adenovirus Infections, Human / Q000150:complications*; D000287:Administration, Topical; D000328:Adult; D003315:Cornea / Q000473:pathology; D003316:Corneal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000503:physiopathology; D016572:Cyclosporine / Q000008:administration & dosage*; D016207:Cytokines / Q000032:analysis; D016903:Drug Monitoring; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007637:Keratoconjunctivitis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014792:Visual Acuity
D016207:Cytokines; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine