Topical Pharmacologic Interventions Versus Active Control, Placebo, or No Treatment for Epidemic Keratoconjunctivitis: Findings From a Cochrane Systematic Review

center dot PURPOSE: To summarize key findings from a Cochrane systematic review of the effectiveness and safety of topical pharmacologic interventions compared with active con-trol or placebo for epidemic keratoconjunctivitis (EKC). center dot DESIGN: Systematic review. center dot METHODS: We included randomized controlled tri-als that compared antiseptic agents, virustatic agents, or immune-modulating topical therapies with placebo or an active control. We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis. center dot RESULTS: Ten randomized controlled trials with 892 participants with acute or chronic EKC were included. Eight trials compared interventions with artificial tears or saline (n = 4) or with steroids (n = 4); two 3-arm tri-als contributed data to both comparisons. Estimates sug-gested that compared with tears, after povidone-iodine (PVP-I) alone (2 studies, 409 participants) more par-ticipants with acute EKC had resolution of symptoms (risk ratio [RR] 1.15 [95% confidence interval {CI} 1.07-1.24]) and signs (RR 3.19 [95% CI 2.29-4.45]) within 10 days. In 2 trials comparing treatments with steroid alone or steroid with levofloxacin, fewer eyes treated with PVP-I or polyvinyl alcohol iodine (PVA-I) plus steroid developed subepithelial infiltrates within 21 days (RR 0.08 [95% CI 0.01-0.55]; 69 eyes). No treatment was shown to improve resolution of infiltrates. center dot CONCLUSIONS: Low-to very low-level certainty of ev-idence suggested that PVP-I or PVA-I with steroid may confer some benefit in acute EKC, but imprecision from small sample sizes, the potential risk of bias from inade-quate reporting or trial design, and variability in partici-pant selection, outcome measurement, and reporting limit the amount and quality of evidence. (Am J Ophthalmol 2022;240: 265-275. (c) 2022 Elsevier Inc. All rights re-served.)