Researchers evaluated the efficacy and safety of a povidone-iodine (PVP-I)-dexamethasone treatment for acute adenoviral conjunctivitis.
Study design
This was a multicenter, randomized, double-masked phase 2 study conducted in India. The study included 144 patients who exhibited signs of viral conjunctivitis and had a positive Rapid Pathogen Screening Adeno-Detector Plus test. Patients were randomly assigned to receive PVP-I 0.6%-dexamethasone 0.1%, PVP-I alone or a vehicle control 4 times daily for 5 days.
Drug safety, clinical resolution and adenoviral eradication were evaluated at day 3, 6 and 12. Clinical resolution was defined as absence of conjunctival discharge and bulbar conjunctival redness.
Outcomes
On day 6, 31.3% of the PVP-I/dexamethasone arm exhibited clinical resolution compared with 10.9% of the vehicle arm (P=0.02). Adenoviral eradication—measured by a cell culture immunofluorescence assay—was also significantly greater with the combination treatment (79.2% vs. 56.5%; P=0.02). Although clinical resolution and adenoviral eradication were numerically higher with the combination treatment than with PVP-I alone, the differences were not significant.
Mild adverse events occurred more frequently among patients receiving the vehicle (69%) than those receiving PVP-I/dexamethasone (53.4%) or PVP-I (62.7%).
Limitations
The study was limited by a single geographic location (India) and an adult-only study population. The use of steroids in past studies has also been shown to increase risk of viral infection.
Clinical significance
The authors demonstrate the successful use of a PVP-I/dexamethasone drop to reduce the time to clinical resolution and viral eradication in cases of adenoviral conjunctivitis with minimal side effects. If validated in additional studies, the use of this combination therapy could greatly reduce the societal burden of this common ocular infection.