Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 9 de 9
Filtrar
1.
Optom Vis Sci ; 100(3): 187-193, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36749104

RESUMO

SIGNIFICANCE: This investigation reports the correlation of conjunctival viral titers in adenoviral conjunctivitis with patient-reported symptoms and clinician-graded signs for 21 days of follow-up. PURPOSE: Adenoviral conjunctivitis is a highly contagious viral eye infection with significant morbidity and economic impact. This study investigates whether severity of signs and symptoms and time to viral clearance are correlated with conjunctival viral titers at baseline and during 21 days of follow-up. METHODS: The Reducing Adenoviral Patient Infected Days study was a pilot study of the efficacy of a single in-office administration of ophthalmic 5% povidone-iodine. This article outlines longitudinal analyses after the primary outcome report. Of 212 participants screened, 28 participants with quantitative polymerase chain reaction-confirmed adenoviral conjunctivitis were randomized and had follow-up visits on days 1, 2, 4, 7, 14, and 21. At each visit, clinician-graded signs, participant-reported symptoms, and a conjunctival swab for quantitative polymerase chain reaction analysis were obtained. The correlation of viral titers with symptoms and signs was calculated: (1) cross-sectionally at each visit and (2) longitudinally for 21 days using a repeated-measures mixed-effects model. RESULTS: Twenty-five of 28 participants had sufficient data for this report. Higher viral titers for 21 days were correlated with greater severity of symptoms (tearing, matting, and redness, r ≥ 0.70; P < .02) and greater severity of clinical signs (bulbar redness and serous discharge, r ≥ 0.60; P < .01). Eyes with highest baseline viral titers required longer time to viral clearance ( r = 0.59, P = .008). Signs and symptoms persisted in approximately half of the eyes even after viral clearance. CONCLUSIONS: Higher conjunctival viral titers across 21 days were strongly correlated with more severe signs and symptoms and longer time to viral clearance. Our results also indicate that symptoms and signs can persist after viral clearance.


Assuntos
Conjuntivite , Infecções Oculares Virais , Humanos , Projetos Piloto , Povidona-Iodo , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/tratamento farmacológico , Túnica Conjuntiva , Soluções Oftálmicas , Método Duplo-Cego
2.
Optom Vis Sci ; 98(5): 469-475, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33973917

RESUMO

SIGNIFICANCE: The effectiveness of masking is rarely evaluated or reported in single- or double-masked clinical trials. Knowledge of treatment assignment by participants and clinicians can bias the assessment of treatment efficacy. PURPOSE: This study aimed to evaluate the effectiveness of masking in a double-masked trial of 5% povidone-iodine for the treatment of adenoviral conjunctivitis. METHODS: The Reducing Adenoviral Patient Infected Days study is a double-masked, randomized trial comparing a one-time, in-office administration of 5% povidone-iodine with artificial tears for the treatment of adenoviral conjunctivitis. Masking was assessed by asking participants and masked clinicians at designated time points if they believed the treatment administered was povidone-iodine or artificial tears, or if they were unsure. Adequacy of masking was quantified using a modified Bang Blinding Index. RESULTS: Immediately after treatment, 34% of participants who received povidone-iodine and 69% of those who received artificial tears guessed incorrectly or were unsure of their treatment (modified Bang Indices of 0.31 and -0.38, respectively). On day 4, 38% of the povidone-iodine participants and 52% of the artificial tear participants guessed incorrectly or were unsure of their treatment (modified Bang Indices of 0.24 and -0.05, respectively), indicating adequate and ideal masking. On days 1, 4, 7, 14, and 21, masked clinicians guessed incorrectly or were unsure of treatment in 53%, 50%, 40%, 39%, and 42% among povidone-iodine participants compared with 44%, 35%, 38%, 35%, and 39% among artificial tears participants, respectively. The modified Bang Indices for clinician masking in the povidone-iodine group ranged from -0.05 to 0.25 and from 0.13 to 0.29 in the artificial tears group. CONCLUSIONS: Masking of participants and clinicians was adequate. Successful masking increases confidence that subjective measurements are not biased. We recommend quantitative assessment and reporting the effectiveness of masking in ophthalmic clinical trials.


Assuntos
Infecções por Adenovirus Humanos/tratamento farmacológico , Anti-Infecciosos Locais/uso terapêutico , Conjuntivite Viral/tratamento farmacológico , Infecções Oculares Virais/tratamento farmacológico , Povidona-Iodo/uso terapêutico , Administração Oftálmica , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Lubrificantes Oftálmicos/administração & dosagem , Masculino , Soluções Oftálmicas , Projetos Piloto , Resultado do Tratamento , Adulto Jovem
3.
Cont Lens Anterior Eye ; 47(2): 102110, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38171995

RESUMO

PURPOSE: To report the clinical signs, symptoms, and viral clearance in individuals in the United States with adenoviral conjunctivitis (Ad-Cs). METHODS: Individuals ≥ 18 years presenting within 4 days of symptoms of Ad-Cs who met eligibility criteria and tested positive with both point-of-care immunoassay antigen and quantitative polymerase chain reaction (qPCR) testing were enrolled. Patient-reported symptoms, clinician-graded signs, and qPCR viral titers were collected at baseline, days 1-2, 4 (days 3-5), 7 (days 6-10), 14 (days 11-17) and 21 (days 18-21). RESULTS: There was no detectable viral titers by the day 14 visit in 6/8 patients. By day 21, there was no detectable viral titers in the 7 participants who completed the visit; however, signs and symptoms persisted including: blurry vision (5/7), discomfort (2/7) or redness (1/7). Masked clinicians also noted conjunctival redness (4/7), follicular conjunctivitis (4/7) and bulbar edema (3/7). CONCLUSION: Many patient-reported symptoms and clinical signs persist after viral titers are no longer detectable by qPCR. Using clinical signs and symptoms to determine quarantine duration may result in patients being furloughed longer than the time that the patient is infectious.


Assuntos
Conjuntivite Viral , Conjuntivite , Humanos , Estados Unidos/epidemiologia , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/epidemiologia , Carga Viral , Conjuntivite/diagnóstico , Conjuntivite/epidemiologia
4.
Clin Exp Optom ; 105(7): 702-707, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-34751088

RESUMO

CLINICAL RELEVANCE: This study identifies key signs and symptoms of acute conjunctivitis, that when combined with a point-of-care test, can improve clinician accuracy of diagnosing adenoviral conjunctivitis. BACKGROUND: Adenoviral conjunctivitis is a common ocular infection with the potential for high economic impact due to widespread outbreaks and subsequent furloughs from work and school. In this report, we describe clinical signs and participant-reported symptoms that most accurately identify polymerase chain reaction (PCR)-confirmed adenoviral conjunctivitis. METHODS: Adults with 'red eye' symptoms of four days or less were enrolled. Participants rated 10 ocular symptoms from 0 (not bothersome) to 10 (very bothersome), and indicated the presence or absence of systemic flu-like symptoms. Clinicians determined the presence or absence of swollen lymph nodes and rated the severity of eight ocular signs using a 5-point scale. An immunoassay targeting adenovirus antigen was utilised for the point-of-care test, and conjunctival swab samples were obtained for subsequent adenovirus detection by PCR analyses. Univariate and multivariate logistic regression models were used to identify symptoms and signs associated with PCR-confirmed adenoviral conjunctivitis. The diagnostic accuracy of these clinical findings, and the potential benefit of incorporating point-of-care test results, was assessed by calculating areas under the receiver operating characteristic curves (AUC). RESULTS: Clinician-rated bulbar conjunctival redness, participant-rated eyelid swelling and overall ocular discomfort had the best predictive value in the multivariate logistic regression model with an AUC of 0.83. The addition of the point-of-care test results to these three clinical sign/symptom scores improved diagnostic accuracy, increasing the AUC to 0.94. CONCLUSIONS: Conjunctival redness severity and participant-reported eyelid swelling and overall discomfort, along with adenoviral point-of-care test results, were highly predictive in identifying individuals with PCR-confirmed adenoviral conjunctivitis. Improved diagnostic accuracy by clinicians at the initial presenting visit could prevent unnecessary work furloughs and facilitate earlier treatment decisions.


Assuntos
Infecções por Adenovirus Humanos , Conjuntivite Viral , Conjuntivite , Infecções por Adenovirus Humanos/diagnóstico , Infecções por Adenovirus Humanos/tratamento farmacológico , Adulto , Conjuntivite/diagnóstico , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/tratamento farmacológico , Humanos , Testes Imediatos , Reação em Cadeia da Polimerase/métodos
5.
Am J Ophthalmol ; 231: 28-38, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34102153

RESUMO

PURPOSE: To evaluate the safety and efficacy of a single, in-office administration of 5% povidone-iodine (PVP-I) compared to artificial tears (AT) for adenoviral conjunctivitis (Ad-Cs). DESIGN: Double-masked pilot randomized trial. METHODS: Patients presenting with presumed adenoviral conjunctivitis were screened at 9 U.S. clinics. INCLUSION CRITERIA: ≥18 years of age, symptoms ≤4 days, and a positive AdenoPlus test. EXCLUSION CRITERIA: thyroid disease, iodine allergy, recent ocular surgery, and ocular findings inconsistent with early-stage Ad-Cs. Randomization was to a single administration of 5% PVP-I or AT in 1 eye and examinations on days 1-2, 4, 7, 14, and 21 with conjunctival swabs taken at each visit for quantitative polymerase chain reaction. Primary outcome was percent reduction from peak viral load. Secondary outcomes were improvement in clinical signs and symptoms. RESULTS: Of 56 patients randomized, 28 had detectable viral titers at baseline. Day 4 posttreatment, viral titers in the 5% PVP-I and AT groups were 2.5% ± 2.7% and 14.4% ± 10.5% of peak, respectively (P = .020). Severity of participant-reported tearing, lid swelling, and redness as well as clinician-graded mucoid discharge, bulbar redness, and bulbar edema were lower in the 5% PVP-I group than AT group on day 4 (P < .05). After day 4, viral titers and severity of signs and symptoms decreased markedly in both groups and no differences between groups were detected. CONCLUSIONS: Pilot data suggest a single, in-office administration of 5% PVP-I could reduce viral load and hasten improvement of clinical signs and symptoms in patients with Ad-Cs.


Assuntos
Conjuntivite , Povidona-Iodo , Método Duplo-Cego , Glucocorticoides , Humanos , Lubrificantes Oftálmicos , Soluções Oftálmicas , Resultado do Tratamento
6.
Transl Vis Sci Technol ; 10(9): 30, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34431990

RESUMO

Purpose: Accurate diagnosis of adenoviral conjunctivitis (Ad-Cs) is important for timely and appropriate patient management to reduce disease transmission. This study assessed the diagnostic accuracy of a commercially available point-of-care adenovirus immunoassay and determined whether its predictive accuracy is influenced by signal intensities of test result bands. Methods: Point-of-care immunoassay (AdenoPlus) testing and quantitative polymerase chain reaction (qPCR) testing was performed on conjunctival swab samples obtained from eyes of 186 eligible adult participants with presumed infectious conjunctivitis and symptoms of ≤4 days. Masked observers assessed signal intensities of the immunoassay test and control bands using densitometry. Results: Ad-Cs was confirmed by qPCR in 28 of the 56 eyes that tested positive on the AdenoPlus, a 50% positive predictive value (95% confidence interval [CI] = 36.9, 63.1). No adenovirus was detected by qPCR in 128 of 130 eyes that tested negative on AdenoPlus, a 98.5% negative predictive value (CI = 96.3, 100). Sensitivity and specificity were 93% (CI = 84.4, 100) and 82% (CI = 76.0, 88.1), respectively. Viral titers significantly correlated with ratio of test band signal intensities (R2 = 0.32, P = 0.002). Higher positive predictive value was associated with higher densitometry ratios (receiver operating characteristic [ROC] area = 0.71; 95% CI = 0.59, 0.83). Conclusions: Densitometric analyses suggest that the diagnostic accuracy of AdenoPlus is influenced by the signal intensity of the test result bands. Visual comparison of the test band intensities by clinicians could reduce the false positive rate of point-of-care immunoassays and aid in the diagnosis of viral infections. Translational Relevance: Ratiometric densitometry of point-of-care immunoassays could aid clinicians' decision making in diagnosing infectious diseases, including Ad-Cs.


Assuntos
Infecções por Adenoviridae , Conjuntivite , Infecções por Adenoviridae/diagnóstico , Adulto , Humanos , Imunoensaio , Sistemas Automatizados de Assistência Junto ao Leito , Sensibilidade e Especificidade
7.
Eye Contact Lens ; 34(5): 297-8, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18779671

RESUMO

PURPOSE: To describe a case of a contact lens fitting in a patient with significant vertical imbalance without the use of prism. METHODS: A 56-year-old white female with vertical imbalance presented with the desire to wear contact lenses without the aid of spectacles. She was previously unsuccessful with rigid bifocal contact lenses, which incorporated vertical prism. RESULTS: The patient was successfully fit with monovision contact lenses without prism. CONCLUSIONS: It may be possible to fit a larger percentage of patients with vertical imbalance in contact lenses than previously thought.


Assuntos
Lentes de Contato , Diplopia/terapia , Visão Binocular/fisiologia , Diplopia/fisiopatologia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Acuidade Visual
9.
Eye Contact Lens ; 31(6): 252-3, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16284502

RESUMO

PURPOSE: To describe a case of a contact lens fitting to relieve aniseikonia and photophobia resulting from trauma. METHODS: A 61-year-old man suffered a blunt injury to his left eye resulting in glaucoma and a traumatic cataract with a fixed pupil and iris defects. A vitrectomy, lensectomy, and iris repair were performed leaving him with significant anisometropia. RESULTS: The patient was fitted with a prosthetic contact lens. CONCLUSIONS: Contact lenses can provide significant visual improvement in cases of aniseikonia and photophobia.


Assuntos
Aniseiconia/terapia , Lentes de Contato , Traumatismos Oculares/complicações , Fotofobia/terapia , Ferimentos não Penetrantes/complicações , Aniseiconia/etiologia , Beisebol/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Fotofobia/etiologia , Acuidade Visual
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA