Topical pharmacologic interventions versus placebo for epidemic keratoconjunctivitis

Area of Science:

• Ophthalmology
• Virology
• Infectious Diseases

Background:

• Epidemic keratoconjunctivitis (EKC) is a highly contagious viral eye infection caused primarily by human adenoviruses.
• It leads to severe inflammation, light sensitivity, and potential long-term vision impairment.
• Currently, no definitive pharmacotherapy alters EKC's clinical course, with supportive care being the standard.

Purpose of the Study:

• To evaluate the effectiveness and safety of topical pharmacological treatments compared to placebo, active controls, or no treatment for EKC in adults.
• To synthesize evidence from randomized controlled trials (RCTs) on various antiseptic, virustatic, and immune-modulating therapies.

Main Methods:

• A systematic search of multiple databases (CENTRAL, MEDLINE, Embase, LILACS, ClinicalTrials.gov, ICTRP) was conducted up to April 27, 2021.
• Included were RCTs comparing topical agents (antiseptics, virustatics, immune-modulators) against placebo, active controls, or no treatment.
• Data from 10 studies with 892 participants were analyzed, assessing outcomes like symptom duration, sign resolution, and subepithelial infiltrates (SEI).

Main Results:

• Very low certainty evidence suggests antiviral agents like trifluridine or ganciclovir have inconsistent effects on EKC symptom duration.
• Low certainty evidence indicates povidone-iodine (PVP-I) alone may improve symptom and sign resolution within the first week compared to artificial tears.
• PVP-I or polyvinyl alcohol iodine (PVA-I), with or without steroids, showed a potential reduction in SEI development compared to artificial tears or steroids (very low certainty).

Conclusions:

• The current evidence for EKC treatments is of low to very low certainty, primarily due to high risk of bias and imprecision.
• While PVP-I shows some promise, evidence is insufficient to definitively recommend any intervention over steroids or artificial tears for virus eradication or spread prevention.
• Future research requires larger, high-certainty trials with standardized outcome measures to establish effective EKC management.