DOI: 10.1097/01.ico.0000139180.52954.21
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PMID: 15778618
Issn Print: 0277-3740
Publication Date: 2005/04/01
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Excerpt
I read the editorial by Starr with interest.1 Only few studies regarding prophylaxis and therapy of adenoviral opacities have been published within the past 3 decades. Side effects of topical steroids used in the chronic phase of adenoviral infection are well known. The use of topical steroids during the acute inflammatory phase, as proposed by Starr, may result in permanent severe dry eye symptoms.2 This was the main outcome of a well-controlled prospective study with 215 patients performed by Trauzettel-Klosinski et al in 1980.2 Frequency of corneal opacities was not influenced by topical steroids in that study.2 Steroids, therefore, should be avoided in the acute as well as in the chronic phase of adenoviral conjunctival and corneal infection.
For both phases, especially for the chronic phase, alternative immunosuppressants, therefore, should be tested. In a pilot study topical cyclosporine A was shown to be effective in 40 of 56 eyes with severe adenoviral corneal opacities.3,4 About two thirds of the eyes treated effectively in that study did not experience recurrences after stopping topical treatment with cyclosporine A. In these patients, the treatment period averaged 8.1 months.4 On the other hand, one third of the eyes treated effectively experienced recurrences.4 With the reapplication of topical cyclosporine A the corneal opacities disappeared again.4 In these eyes the immunosuppressant was administered up to 48 months.4 Other than some burning, side effects were not observed.4 Most of the eyes in that pilot study had received steroids before therapy with topical cyclosporine A and had experienced multiple recurrences after stopping steroid treatment.4
A further candidate drug for treatment of adenoviral opacities is FK506. In a case report this immunosuppressant was shown to be effective in a patient with adenoviral opacities that did not respond to topical cyclosporine A and steroids.5
Prospective randomized trials, however, must follow in order to determine the exact therapeutic potential of these topical immunosuppressants. Furthermore, therapy of adenoviral opacities should not focus on an immunosuppressive regimen alone but on the combination of an immunosuppressant with an antiviral drug. From my point of view, the antiviral cidofovir does not seem to be appropriate for that task. In a controlled randomized study it was effective in preventing corneal opacities.6,7 Its administration, however, is very limited because of severe local toxicity.
