A prospective, randomized study comparing different therapeutic modalities for acute adenoviral conjunctivitis

PURPOSE: To compare the outcomes of three different therapeutic modalities in acute adenoviral conjunctivitis. DESIGN: Prospective randomized study. METHODS: A total of 65 eyes of 65 patients with nested polymerase chain reaction (PCR)-proven adenoviral conjunctivitis were enrolled. The control group (20 eyes) received carbomer gel, whereas the treatment group (15 eyes each) received group 1: Ganciclovir (0.15%) gel five times/day and dexamethasone 0.1% four times/day; group 2: Povidone-iodine (PVP-I) 1% four times/day, and dexamethasone 0.1% four times/day; group 3: PVP-I 1% four times/day, ganciclovir 0.15% five times/day, and dexamethasone 0.1% four times/day in addition to the standard of care. Patients presenting within the first 96 hours were recruited, and antiviral treatment was given for seven days in all groups. The clinical signs and symptoms, as well as the viral load, were documented at enrollment, day 7, and day 14. All the symptoms and signs were graded. RESULTS: Group 3 performed significantly better in terms of foreign body sensation ( P = 0.013), pain ( P = 0.019), and conjunctival congestion ( P = 0.00) compared with all the groups at day 7. The control group had a significantly higher number of subepithelial infiltrates (SEIs) ( P = 0.0001) and pseudomembranes ( P = 0.035) at day 7 than all the other groups. The viral load reduction was variable in all patients in all the groups; thus, a correlation could not be achieved. CONCLUSION: The combination of PVP-I 1% and ganciclovir 0.15% with dexamethasone 0.1% significantly reduced the severity of signs and symptoms in adenoviral conjunctivitis. The addition of dexamethasone was safe and effective in decreasing the incidence of SEI's and pseudomembranes.