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Background <p>Epidemic keratoconjunctivitis (EKC) is a&#xa0;highly contagious eye infection caused by adenoviruses. The treatment remains challenging due to limited efficacy and the potential for long-term complications. This study aimed to evaluate the impact of different treatment approaches on the persistence and resolution of nummular keratitis as well as to assess corneal topographic parameters during the posttreatment course.</p> Patients and methods <p>This real-world analysis examined data from 120 patients (146 eyes) with clinically suspected EKC. The patients were divided into three groups based on the initial treatment: (1)&#xa0;antiviral agent with an antibiotic, (2)&#xa0;additional corticosteroids or (3)&#xa0;hyaluronic acid only. In the chronic phase patients were classified into one of four groups depending on the treatment: (A)&#xa0;corticosteroids, (B)&#xa0;cyclosporine, (C)&#xa0;a&#xa0;combination of corticosteroids and cyclosporine or (D)&#xa0;hyaluronic acid only. Clinical parameters, such as the prevalence of nummular keratitis, tear film characteristics and keratometry were monitored for up to 1&#xa0;year.</p> Results <p>Among the 146 examined eyes 27.4% exhibited nummular keratitis at the initial diagnosis. After 6&#xa0;weeks the prevalence increased to 45.2% then decreased to 39% at 6&#xa0;months and further declined to 9.5% after 1 year (<i>p</i> = 0.01). Early corticosteroid treatment at the time of first diagnosis was associated with chronic persistence of nummular keratitis. In contrast, a&#xa0;delayed initiation of combination treatment with corticosteroids and cyclosporine, initiated 6&#xa0;weeks after diagnosis proved to be the most effective. This approach led to the complete resolution of nummular keratitis after 1 year. Monotherapy, particularly cyclosporine alone, showed lower efficacy. Astigmatism fluctuated over the course of up to 1 year following EKC infection.</p> Conclusion <p>Delayed initiation of combination treatment with corticosteroids and cyclosporine demonstrated long-term effectiveness and should be considered as the primary treatment for nummular keratitis. Corneal topographic parameters remained largely stable during the postinfection course. These findings support the superior efficacy of combination treatment in reducing the recurrence of nummular keratitis and stabilizing corneal topography.</p>

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Keratoconjunctivitis epidemica: Therapie subepithelialer Infiltrate und topographische Parameter der Cornea im postinfektiösen Verlauf

  • 期刊论文

  • 发表日期：

    2025年12月15日

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  • Cristina Martin Lesan,
  • Elias Flockerzi,
  • Ursula Löw,
  • Berthold Seitz

摘要

Background

Epidemic keratoconjunctivitis (EKC) is a highly contagious eye infection caused by adenoviruses. The treatment remains challenging due to limited efficacy and the potential for long-term complications. This study aimed to evaluate the impact of different treatment approaches on the persistence and resolution of nummular keratitis as well as to assess corneal topographic parameters during the posttreatment course.

Patients and methods

This real-world analysis examined data from 120 patients (146 eyes) with clinically suspected EKC. The patients were divided into three groups based on the initial treatment: (1) antiviral agent with an antibiotic, (2) additional corticosteroids or (3) hyaluronic acid only. In the chronic phase patients were classified into one of four groups depending on the treatment: (A) corticosteroids, (B) cyclosporine, (C) a combination of corticosteroids and cyclosporine or (D) hyaluronic acid only. Clinical parameters, such as the prevalence of nummular keratitis, tear film characteristics and keratometry were monitored for up to 1 year.

Results

Among the 146 examined eyes 27.4% exhibited nummular keratitis at the initial diagnosis. After 6 weeks the prevalence increased to 45.2% then decreased to 39% at 6 months and further declined to 9.5% after 1 year (p = 0.01). Early corticosteroid treatment at the time of first diagnosis was associated with chronic persistence of nummular keratitis. In contrast, a delayed initiation of combination treatment with corticosteroids and cyclosporine, initiated 6 weeks after diagnosis proved to be the most effective. This approach led to the complete resolution of nummular keratitis after 1 year. Monotherapy, particularly cyclosporine alone, showed lower efficacy. Astigmatism fluctuated over the course of up to 1 year following EKC infection.

Conclusion

Delayed initiation of combination treatment with corticosteroids and cyclosporine demonstrated long-term effectiveness and should be considered as the primary treatment for nummular keratitis. Corneal topographic parameters remained largely stable during the postinfection course. These findings support the superior efficacy of combination treatment in reducing the recurrence of nummular keratitis and stabilizing corneal topography.