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% cyclo sporine 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. Patien ts were divided into 4 treatment groups: (1) cidofovir qid, (2) cyclosporin e qid, (3) cidofovir + cyclosporine qid, and (4) sodium chloride qid (Contr ol). The diagnosis was confirmed using adenoviral polymerase chain reaction from conjunctival swabs. Duration of treatment was 21 days. Main Outcome Measures: Severity of conjunctival hyperemia, conjunctival che mosis, superficial punctate keratitis during treatment, and presence and se verity 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 cy closporine group. All other clinically relevant variables showed no statist ically significant difference among the 4 treatment groups. Particularly, w e did not find a difference in the frequency of corneal subepithelial infil trates 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 p ilot study. This might be because of the wide spectrum of the clinical cour se of the infection, low sensitivity to ciclofovir, too low of a concentrat ion of cidofovir, or early cessation of viral replication in the course of the infection. The effect of a higher concentration of topical cidofovir wi th and without cyclosporine requires investigation in a larger group of pat ients.