IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 18, Issue 1 Ser. 11 (January. 2019), PP 42-44 www.iosrjournals.org DOI: 10.9790/0853-1801114244 ww.iosrjournals.org 42 | Page Use of Topical Cyclosporine A 0.05% in Treatment of Adenoviral Keratoconjunctivitis-Related Subepithelial Infiltrates Dr Harvinder Nagpal 1 , Dr Mandeep Kaur 2 1 Associate Professor , 2 Junior Resident, Department of Ophthalmology, Government Medical College, District Patiala, Punjab 147001 India Corresponding author: Dr Harvinder Nagpal Abstract Aim : To evaluate the treatment with topical cyclosporine A (CsA) in patients with subepithelial infiltrates (SEI). Material & Methods: Hospital-based study was conducted over a period of one year. A total of 25 patients, 36 eyes with supepithelial infiltrates following adenoviral keratoconjunctivitis were included in the study. All patients had been previously treated with topical corticosteroids without any improvement. Data was recorded in form of best corrected visual acuity (BCVA), evaluation of corneal subepithelial infiltrate score (CSIS) prior to treatemt and after the last follow up visit. Results:10 females(40 %) and 15 males (60 %) were included in the study, best corrected visual acuity (BCVA) was in range 6/6-6/60 pre-treatement and 6/6-6/18 after treatment.The average followup in patients was after 4- 6 months. After treatment with 0.05 % topical CsA, 28 eyes (77 %) improved to 0 score on CSIS and BCVA of 6/6 in 27 eyes while recurrence occurred in 6 eyes (16.6 %). Conclusion: Topical Cyclosporine A 0.05% is a safe and effective alternative treatment in patients with adenoviral keratoconjunctivitis -related subepithelial infiltrates. Keywords: Epidemic keratoconjunctivitis, subepithelial infiltrates, cyclosporine A --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 07-01-2019 Date of acceptance: 22-01-2019 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Adenoviridae are icosahedral, nonenveloped, double stranded DNA viruses that can cause an array of diseases including conjunctivitis, gastroenteritis, hepatitis, myocarditis and pneumonia. This family of viruses is the most common cause of acute viral infection of the conjunctiva, accounting for up to 75% of all conjunctivitis cases. The most frequent manifestation of ocular adenoviral infection is epidemic keratoconjunctivitis (EKC) 1 . The incubation period of EKC varies between 4 and 24 days, and the symptoms tend to last for 7–21 days. The patient may remain infectious for 10–14 days. The most common symptoms are red eyes, excessive tearing, foreign body sensation, and photophobia. In more severe cases, patients can present with ocular or periorbital pain and decreased visual acuity. Decreased visual acuity is generally seen as a result of multifocal subepithelial infiltrates (SEIs) which are observed in up to 50% of the cases. These SEIs represent a cellular immune reaction against viral antigens deposited in the corneal stroma under the Bowman’s membrane and can persist for weeks to years and cause blurred vision, halos, glare, and photophobia. Topical steroids are effective in the treatment of SEI; however, after stopping steroid eye drops, recurrences may develop, and the patient may become steroid dependent. With long-term treatment, side effects of steroids such as intraocular pressure (IOP) increase, and cataract can develop. Therefore, topical cyclosporine A (CsA) has been proposed as a means of longterm treatment of SEIs 2, 3 . This study is focused to evaluate the treatment with topical cyclosporine A (CsA) in patients with subepithelial infiltrates (SEI). II. Material & Methods Hospital-based study was conducted over a period of one year. A total of 25 patients, 36 eyes with supepithelial infiltrates following adenoviral keratoconjunctivitis were included in the study. Written informed consent was taken from all the study patients. A detailed history and ocular examination of each patient were recorded. All patients had been previously treated with topical corticosteroids without any improvement and in whom SEIs had persisted for more than 3 months. Data was recorded in form of best corrected visual acuity (BCVA) and detailed biomicrocopic anterior segment examination. The corneal subepithelial infiltrate score (CSIS) prior to treatment and after the last follow up visit was recorded. CSIS varied between 0-4 was constituted according to SEI seen on biomicrocopic anterior segment examination (0= no infiltrates, 1=1-5 ,2 =6-10,3=11-15 and 4 constituted more than 16 infiltrates).All patients were treated with topical cyclosporine