Anti-adenoviral agents
Research is directed towards finding a treatment for adenovirus. Several HIV medicines and other novel molecules appear promising and have entered phase 2 clinical trials. An anti-adenoviral effect has been observed with zalcitabine, sanilbudine, stampidine, interferon beta, aganocide, and anti-osteopontin peptide. Anti-adenoviral activity occurs in nucleoside reverse transcriptase inhibitors (zalcitabine and sanilbudine) but not in non-nucleoside reverse transcriptase inhibitors or protease inhibitors.[104]D'Cruz OJ, Uckun FM. Stampidine: a selective oculo-genital microbicide. J Antimicrob Chemother. 2005 Jul;56(1):10-9.
http://www.ncbi.nlm.nih.gov/pubmed/15919769?tool=bestpractice.com
[105]Gordon YJ, Romanowski EG, McDermott AM. A review of antimicrobial peptides and their therapeutic potential as anti-infective drugs. Curr Eye Res. 2005 Jul;30(7):505-15.
http://www.ncbi.nlm.nih.gov/pubmed/16020284?tool=bestpractice.com
Another potential treatment is povidone-iodine (PVI). In one in vitro study, povidone-iodine was found to extinguish infectivity of free adenovirus after 10 minutes of exposure, but was less effective against intracellular adenovirus.[106]Monnerat N, Bossart W, Thiel MA. Povidone-iodine for treatment of adenoviral conjunctivitis: an in vitro study [in German]. Klin Monbl Augenheilkd. 2006 May;223(5):349-52.
http://www.ncbi.nlm.nih.gov/pubmed/16705502?tool=bestpractice.com
A prospective clinical trial in children found povidone-iodine ineffective against adenovirus, although another retrospective study showed that povidone-iodine safely improved recovery times compared with controls.[107]Isenberg SJ, Apt L, Valenton M, et al. A controlled trial of povidone-iodine to treat infectious conjunctivitis in children. Am J Ophthalmol. 2002 Nov;134(5):681-8.
http://www.ncbi.nlm.nih.gov/pubmed/12429243?tool=bestpractice.com
[108]Yazar H, Yarbag A, Balci M, et al. The effects of povidone iodine (pH 4.2) on patients with adenoviral conjunctivitis. J Pak Med Assoc. 2016 Aug;66(8):968-70.
http://www.ncbi.nlm.nih.gov/pubmed/27524529?tool=bestpractice.com
A combination of povidone-iodine and dexamethasone has been shown to produce a significant reduction in DNA copies by day 5.[109]Pelletier JS, Stewart K, Trattler W, et al. A combination povidone-iodine 0.4%/dexamethasone 0.1% ophthalmic suspension in the treatment of adenoviral conjunctivitis. Adv Ther. 2009 Aug;26(8):776-83.
http://www.ncbi.nlm.nih.gov/pubmed/19756415?tool=bestpractice.com
Topical cobalt chelate CTC-96, or doxivir, showed anti-adenoviral activity in vitro.[110]Epstein SP, Pashinsky YY, Gershon D, et al. Efficacy of topical cobalt chelate CTC-96 against adenovirus in a cell culture model and against adenovirus keratoconjunctivitis in a rabbit model. BMC Ophthalmol. 2006 Jun 5;6:22.
https://bmcophthalmol.biomedcentral.com/articles/10.1186/1471-2415-6-22
http://www.ncbi.nlm.nih.gov/pubmed/16753060?tool=bestpractice.com
Tacrolimus or interferon alfa
One randomised, double-masked study has shown that both tacrolimus and interferon alfa-2b appear to be effective and safe in the treatment of recalcitrant vernal keratoconjunctivitis.[111]Zanjani H, Aminifard MN, Ghafourian A, et al. Comparative evaluation of tacrolimus versus interferon alpha-2b eye drops in the treatment of vernal keratoconjunctivitis: a randomized, double-masked study. Cornea. 2017 Jun;36(6):675-78.
http://www.ncbi.nlm.nih.gov/pubmed/28399035?tool=bestpractice.com
One meta-analysis of randomised controlled trials has shown that tacrolimus is effective in treating vernal keratoconjunctivitis.[112]Zhao M, He F, Yang Y, et al. Therapeutic efficacy of tacrolimus in vernal keratoconjunctivitis: a meta-analysis of randomised controlled trials. Eur J Hosp Pharm. 2020 Nov 3 [Epub ahead of print].
https://ejhp.bmj.com/content/early/2020/11/03/ejhpharm-2020-002447
http://www.ncbi.nlm.nih.gov/pubmed/33144336?tool=bestpractice.com