Topical treatment of acute adenoviral keratoconjunctivitis with 0.2% cidofovir and 1% cyclosporine: a controlled clinical pilot study.
Topical treatment of acute adenoviral keratoconjunctivitis with 0.2% cidofovir and 1% cyclosporine: a controlled clinical pilot study.
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局部％20治疗％20的％20急性％20腺病毒％20角结膜炎％20与％200.2％％20西多福韦％20和％201％％20环孢素：％20a％20控制％20临床％20试点％20研究。
DOI：
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
Rainer Sundmacher
中科院分区：
文献类型：
--
作者：
J. Hillenkamp;Thomas Reinhard;R. Ross;D. Böhringer;O. Cartsburg;Michael Roggendorf;E. Clercq;E. Godehardt;Rainer Sundmacher
目的
比较0.2%西多福韦滴眼液和1%环孢素滴眼液每日4次（qid）治疗急性腺病毒性角结膜炎的疗效。
方法
对39例新近发作的急性腺病毒性角结膜炎患者进行了随机、对照、双盲研究。患者分为4个治疗组：（1）西多福韦qid，（2）环孢素qid，（3）西多福韦+环孢素qid，（4）氯化钠qid（对照）。诊断证实使用腺病毒聚合酶链反应从结膜拭子。治疗持续时间为21天。
主要观察指标
使用临床评分评价治疗期间结膜充血、结膜球结膜水肿、浅表点状角膜炎的严重程度，以及角膜上皮下浸润的存在和严重程度。记录症状主观改善的持续时间。
结果
环孢素组局部症状的主观改善速度加快。所有其他临床相关变量显示4个治疗组之间无统计学显著差异。特别是，我们没有发现治疗结束时角膜上皮下浸润的频率有差异。
结论
与自然感染过程相比，使用西多福韦、环孢霉素或两者并没有加速急性腺病毒性角膜结膜炎临床症状的改善，正如本初步研究所证明的那样。这可能是因为感染的临床过程的广谱性、对西多福韦的低敏感性、西多福韦的浓度太低或在感染过程中病毒复制的早期停止。更高浓度的局部西多福韦与和不环孢菌素的效果需要在更大的患者群体中进行调查。
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.
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