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Topical Treatment of Acute Adenoviral Keratoconjunctivitis With 0.2% Cidofovir and 1% Cyclosporine
A Controlled Clinical Pilot Study
Jost Hillenkamp, MD;
Thomas Reinhard, MD;
Rudolf S. Ross, MD;
Daniel Böhringer, MD;
Olaf Cartsburg, MD;
Michael Roggendorf, MD;
Erik De Clercq, MD, PhD;
Erhard Godehardt, PhD;
Rainer Sundmacher, MD
Arch Ophthalmol. 2001;119:1487-1491.
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.
Main Outcome Measures 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.
From the Eye Hospital (Drs Hillenkamp, Reinhard, Böhringer, Cartsburg,
and Sundmacher) and the Department of Biometry in the Department of Cardiovascular
and Thoracic Surgery (Dr Godehardt), Heinrich-Heine-University, Düsseldorf,
Germany; the Institute of Virology, Essen University, Essen, Germany (Drs
Ross and Roggendorf); and the Rega Institute for Medical Research, Catholic
University, Leuven, Belgium (Dr De Clercq).
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