Modified Treatment for Epidemic Keratoconjunctivitis (EKC)
Condition: Symptoms and Signs
MeSH terms: Keratoconjunctivitis
Study type: Interventional

Summary: 
      Background: Epidemic Keratoconjunctivitis (EKC) is a form of adenoviral conjunctivitis. It is
      highly infectious disease mainly affect the outer eye surface and has a frequency to happen
      in epidemics especially in closed communities such as hospitals, schools and factories.

      purpose: The purpose of this study to compare between the modified and the ordinary method of
      treatment for EKC.

      Patients and methods: Three hundred fifty patients of EKC were enrolled in the study. The
      diagnosis was made by clinical picture and laboratory investigations. Group 1 had two hundred
      patients 120 males, 80 females (age from 18 to 60 years) were treated by the modified method
      and group 2 had one hundred fifty patients 100 males,50 females (age from 18 to 58 years)
      were treated with the ordinary method. The study was hold between November 2014 to October
      2018 in Security forces Hospital, Riyadh, Saudi Arabia. Patients were followed up for 3
      months up to 2 years. The main outcome were improvement in clinical picture and recovery.
    

Detailed description: 
      Patients and Methods Three hundred fifty patients suffered from EKC were enrolled in the
      study. Their diagnosis was made by clinical picture and laboratory investigations. Group 1
      had two hundred patients 120 males, 80 females (age from 18 to 60 years) were treated by the
      modified method and group 2 had one hundred fifty patients 100 males,50 females (age from 18
      to 58 years) were treated with the ordinary method. The study was done between November 2014
      to October 2018 in Security forces Hospital, Riyadh, Saudi Arabia. Patients were followed up
      for 3 months up to 2 years. The main outcomes were improvement in patients clinical picture
      and recovery. All patients signed a consent for inclusion in the study and the study was
      approved by the ethical committee and it was in agreement with declaration of Helsinki tents.

      All cases were diagnosed by clinical symptoms and signs as shown in table (2& 3) and
      conjunctival smear for some suspected patients which revealed lymphocytes predominance. Slit
      lamp examination and visual acuity measurement were done and grading of ocular symptoms and
      signs were estimated according to severerity into normal, mild, moderate or severe. The
      patients were divided into group 1 in which patients were treated by the modified method
      (Povidone Iodine 5% eye wash irrigation) and group 2 in which patients were treated by the
      ordinary method.

      Modified method The eye was topically anesthetized, then eye wash with Povidone Iodine 5%
      (povidone-iodine, Alcon) eye irrigation every day until the patients recovered. Manual
      removal of pseudo membranes with non toothed forceps and cotton tipped applicator on slit
      lamp. Antibiotic eye drops (moxifloxacin 0.5%) QID. Lubricant eye drops (tears natural free
      minims eye drops) QID. Cold compresses. Topical corticosteroid eye drops (fluorometholone
      0.1%) QID in cases of subepithelial infiltrates or pseudomemrane formation.

      Usual method The same way of management except the eye wash with Povidone Iodine 5% .
      Steroids was used for symptomatic relief but it do not lower the disease pathway. It suppress
      the corneal inflammation, improve overall comfort but they also prolong clearance of the
      virus and the lesions may recur if steroid is prematurely discontinued.
    

Intervention name(s): Povidone-Iodine; Normal Saline Flush
Intervention type(s): Drug; Drug
Intervention description(s): Povidone-Iodine 5% eye wash; Normal Saline eye wash
Other intervention name(s): Group1; Group 2
Intervention MeSH terms: Povidone-Iodine; Povidone
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Group 1 modified method Group 2 ordinary method
Masking: None (Open Label)
Primary purpose: Treatment