Abstract
Objectives
To analyze the effect of the employment of polyvinylpyrrolidone-iodine (PVP-I) 0.6% eye drop on the clinical course of patients affected by Adenoviral Keratoconjunctivitis (AKC).
Methods
Consecutive patients with clinical signs of AKC and positive results of AdenoPlus test were enrolled from four Italian Centres. Patients were randomized to receive: PVP-I 0.6% eye drops four times/daily for 20 days (Group A) or hyaluronate-based tear substitutes four times/daily for 20 days (Group B). Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) Optovue iVue pachymetry map; corneal haze; conjunctival injection and chemosis; subepithelial corneal infiltrates (SEIs); corneal and conjunctival staining and corneal densitometry were recorded at diagnosis and at every follow-up visit. The primary outcome was the resolution time of AKC.
Results
Overall, 59 AKC patients (34 for Group A and 25 for Group B) completed the study. Patients of Group A showed a significantly shorter resolution time and lower incidence of SEIs compared to patients of Group B. In particular, SEIs were present at the last visit in 3/34 (8.82%) patients of the Group A vs 11/25 (44%) of the Group B (pā=ā0.005). Patients of Group A showed a significantly lower incidence of corneal haze compared to patients of Group B (0/34 vs 3/25; pā=ā0.038). No side effects were reported for both groups.
Conclusions
Although further clinical evaluations are needed, according to our data the use of PVP-I 0.6% eye drop in the setting of AKC reduces the risk of SEIs as well as the resolution time of the disease.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Mueller AJ, Klauss V. Main sources of infection in 145 cases of epidemic keratoconjunctivitis. Ger J Ophthalmol. 1993;2:224ā7.
Aoki A, Isobe K, Ohno S. Nationwide surveillance program of epidemic conjunctivitis in Japan. In: Bialasiewicz AA, Schaal KP, editors. Infectious diseases of the eye. Philadelphia: Butterworth-Heinemann; 1994. p. 309ā16.
Hillenkamp Jost, Reinhard T, Ross RS, Bƶhringer D, Cartsburg O, Roggendorf M, et al. Topical treatment of acute adenoviral keratoconjunctivitis with 0.2 cidofovir and 1% cyclosporine. A pilot study. Arch Ophthalmol. 2001;119:1497ā1491.
Varu DM, Rhee MK, Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ, et al. American Academy of Ophthalmology Preferred Practice Pattern Cornea and External Disease Panel. Conjunctivitis Preferred Practice Pattern. Ophthalmology. 2019;126:P94āP169. https://doi.org/10.1016/j.ophtha.2018.10.020.
Pepose JS, Ahuja A, Liu W, Narvekar A, Haque R. Randomized, controlled, phase 2 trial of povidone-iodine/dexamethasone ophthalmic suspension for treatment of adenoviral conjunctivitis. Am J Ophthalmol. 2018;194:7ā15.
OYong K, Killerby M, Pan CY, Huynh T, Green NM, Wadford DA, et al. Outbreak of epidemic keratoconjunctivitis caused by human adenovirus type D53 in an eye care clinic - Los Angeles County, 2017. Morb Mortal Wkly Rep. 2018;67:1347ā9.
Harvey SA, Romanowski EG, Yates KA, Gordon YJ. Adenovirus directed ocular innate immunity: the role of conjunctival defensin-like chemokines (IP-10, I-TAC) and phagocytic human defensin-Ī±. Investig Ophthalmol Vis Sci. 2005;46:3657ā65.
Chigbu DI, Labib BA. Pathogenesis and management of adenoviral keratoconjunctivitis. Infect Drug Resist 2018;11:981ā93.
Sambursky R, Trattler W, Tauber S, Starr C, Friedberg M, Boland T, et al. Sensitivity and specificity of the AdenoPlus test for diagnosing adenoviral conjunctivitis. JAMA Ophthalmol 2013;131:17ā22.
Kam KY, Ong HS, Bunce C, Ogunbowale L, Verma S. Sensitivity and specificity of the AdenoPlus point-of-care system in detecting adenovirus in conjunctivitis patients at an ophthalmic emergency department: a diagnostic accuracy study. Br J Ophthalmol. 2015;99:1186ā9.
Holtz KK, Townsend KR, Furst JW, Myers JF, Binnicker MJ, Quigg SM, et al. An assessment of the adenoplus point-of-care test for diagnosing adenoviral conjunctivitis and its effect on antibiotic stewardship. Mayo Clin Proc Innov Qual Outcomes 2017;1:170ā5.
Olive M, Eisenlohr L, Flomenberg N, Hsu S, Flomenberg P. The adenovirus capsid protein hexon contains a highly conserved human CD4 T-cell epitope. Hum Gene Ther 2002;10:1167ā78.
Workshop, Dry eye. Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye Workshop. Ocul Surf. 2007;5:108ā52.
Bialasiewicz A. Adenoviral Keratoconjuunctivitis. Sultan Qaboos Univ Med J. 2007;7:15ā23.
Rajaiya J, Chodosh J. New paradigms in infectious eye disease: adenoviral keratoconjunctivitis. Arch Soc Esp Oftalmol. 2006;81:493ā8.
Burgert HG, Ruzsics Z, Obermeier S, Hilgendorf A, Windheim M, Elsing A. Subversion of host defense mechanisms by adenoviruses. Curr Top Microbiol Immunol. 2002;269:273ā318.
Freyler H, Sehorst W. The fate of corneal infiltrations in cases of epidemic keratoconjunctvitis. Wien Klin Wochenschr. 1976;28:341ā3.
Lachapelle J-M, Castel O, Casado AF, Leroy B, Micali G, Tennstedt D, et al. Antiseptics in the era of bacterial resistance: a focus on povidone iodine. Clin Pract. 2013;10:579ā92.
Kovalyuk N, Kaiserman I, Mimouni M, Cohen O, Levartovsky S, Sherbany H, et al. Treatment of adenoviral keratoconjunctivitis with a combination of povidone-iodine 1.0% and dexamethasone 0.1% drops: a clinical prospective controlled randomized study. Acta Ophthalmol. 2017;95:e686āe692.
Yates KA, Shanks RMQ, Kowalski RP, Romanowski EG. The in vitro evaluation of povidone-iodine against multiple ocular adenoviral types. J Ocul Pharmacol Ther. 2019;35:132ā6.
Pinto RD, Lira RP, Abe RY, Zacchia RS, Felix JP, Pereira AV, et al. Dexamethasone/povidone eye drops versus artificial tears for treatment of presumed viral conjunctivitis: a randomized clinical trial. Curr Eye Res. 2015;40:870ā7.
BASF SEāCare Chemical Division. PVP-iodine grades. Technical information, August 2010, https://industries.basf.com/bin/bws/documentDownload.en.8805242644949.
Musumeci R, Bandello F, Martinelli M, Calaresu E, Cocuzza CE. In vitro bactericidal activity of 0.6% povidone-iodine eye drops formulation. Eur J Ophthalmol. 2019;29:673ā7.
Kaufman HE. Adenovirus advances: new diagnostic and therapeutic options. Curr Opin Ophthalmol. 2011;22:290ā3.
Kaufman HE, Haw WH. Ganciclovir ophthalmic gel 0.15%: safety and efficacy of a new treatment for herpes simplex keratitis. Curr Eye Res. 2012;37:654ā60.
Hillenkamp J, Reinhard T, Ross RS, Bƶhringer D, Cartsburg O, Roggendorf M, et al. The effects of cidofovir 1% with and without cyclosporin a 1% as a topical treatment of acute adenoviral keratoconjunctivitis: a controlled clinical pilot study. Ophthalmology. 2002;109:845ā50.
Lenaerts L, Naesens L. Antiviral therapy for adenovirus infections. Antivir Res. 2006;71:172ā80.
Monnerat N, Bossart W, Thiel MA. Povidone-iodine for treatment of adenoviral conjunctivitis: an in vitro study. Klin Monbl Augenheilkd. 2006;223:349ā52.
Sunil KP, Raja BP, Jagadish RG, Uttam A. Povidone iodine-revisited. Indian J Dent Adv. 2011;3:617ā20.
Visscher KL, Hutnik CM, Thomas M. Evidence-based treatment of acute infective conjunctivitis: breaking the cycle of antibiotic prescribing. Can Fam Physician. 2009;55:1071ā5.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisherās note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ricciardelli, G., Giannaccare, G., Di Zazzo, A. et al. Efficacy and tolerability of polyvinylpyrrolidone-iodine 0.6% treatment in adenoviral keratoconjunctivitis: a Prospective Randomized Controlled Study. Eye 36, 160ā166 (2022). https://doi.org/10.1038/s41433-020-01344-6
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41433-020-01344-6
This article is cited by
-
Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management
Ophthalmology and Therapy (2023)
-
Antiseptics and the Ocular Surface: In Vitro Antimicrobial Activity and Effects on Conjunctival and Corneal Epithelial Cells of a New Liposomal Ocular Spray Containing BiosecurĀ® Citrus Extract
Ophthalmology and Therapy (2022)
