Antiadenoviral agents
Research is directed toward finding a treatment for adenovirus. Several HIV medications and other novel molecules appear promising and have entered phase 2 clinical trials. An antiadenoviral effect has been observed with zalcitabine, sanilbudine, stampidine, interferon beta, aganocide, and antiosteopontin peptide. Antiadenoviral activity occurs in nucleoside reverse transcriptase inhibitors (zalcitabine and sanilbudine) but not in non-nucleoside reverse transcriptase inhibitors or protease inhibitors.[105]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
[106]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. In one in vitro study, povidine-iodine was found to extinguish infectivity of free adenovirus after 10 minutes of exposure, but was less effective against intracellular adenovirus.[107]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.[108]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
[109]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.[110]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 antiadenoviral activity in vitro.[111]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 randomized, 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.[112]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 randomized controlled trials has shown that tacrolimus is effective in treating vernal keratoconjunctivitis.[113]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