In the Journals

Eyes with previous herpes zoster-related ocular disease at greater risk for recurrence after cataract surgery

Eyes with a history of herpes zoster-related keratitis or uveitis were at high risk for herpes zoster disease recurrence after cataract surgery, according to a study.

A retrospective case series included 57 eyes of 57 patients with herpes zoster-related keratitis or uveitis who underwent cataract surgery in the ipsilateral eye. The cohort was evaluated for intraoperative and postoperative complications, postoperative visual acuity and disease recurrence.

“The most surprising finding from this study was the very high rate of recurrence of zoster eye disease following the surgery. Recurrence occurred in 40.4% and was more common in those with a shorter time of quiescence prior to surgery and in subjects with more recurrences; 12.3% of subjects had poorer vision at 12 months than preoperatively, due to complications of zoster recurrence,” study coauthor Rachael L. Niederer, MB, ChB, PhD, FRANZCO, told Healio.com/OSN.

Herpes zoster ophthalmicus recurred in 23 patients after cataract surgery. A multivariate analysis found patients with more than 1 year of disease quiescence before cataract surgery were at significantly lower risk for recurrence. Risk for postoperative recurrence increased with the number of flares before surgery.

Intraoperative complications occurred in eight patients, including anterior capsule tears in three patients, posterior capsule tear in two patients, iris prolapse in two patients and zonular fiber weakness requiring a capsular tension ring in one patient. Patients with chronic anterior uveitis were at a higher risk for intraoperative complications compared with patients without chronic anterior uveitis. Patients with glaucomatous optic neuropathy were also at a higher risk for intraoperative complications.

Eight patients experienced IOP greater than 24 mm Hg at 1 day postoperatively, and two patients experienced IOP greater than 30 mm Hg. Only one patient had an IOP greater than 24 mm Hg at 1 month postoperatively, and no patients had an IOP greater than 30 mm Hg.

“To reduce the rate of recurrence following surgery, we recommend a prolonged period of disease quiescence, where possible, ideally 1 year. The role of antivirals in zoster is still unclear (and we eagerly await the results of the Zoster Eye Disease Study). Within my personal practice, if the patient is not already on antivirals, I will start on the day of cataract surgery. I use a 3-month course of antiviral prophylaxis for those with simple HZO disease, and a 1-year course for those with previous recurrences or less than 1 year of quiescence,” Niederer said. – by Robert Linnehan

Editor’s note: This article has been updated to include comment from Rachael L. Niederer, MB, ChB, PhD, FRANZCO.

Disclosures: The authors report no relevant financial disclosures.

Eyes with a history of herpes zoster-related keratitis or uveitis were at high risk for herpes zoster disease recurrence after cataract surgery, according to a study.

A retrospective case series included 57 eyes of 57 patients with herpes zoster-related keratitis or uveitis who underwent cataract surgery in the ipsilateral eye. The cohort was evaluated for intraoperative and postoperative complications, postoperative visual acuity and disease recurrence.

“The most surprising finding from this study was the very high rate of recurrence of zoster eye disease following the surgery. Recurrence occurred in 40.4% and was more common in those with a shorter time of quiescence prior to surgery and in subjects with more recurrences; 12.3% of subjects had poorer vision at 12 months than preoperatively, due to complications of zoster recurrence,” study coauthor Rachael L. Niederer, MB, ChB, PhD, FRANZCO, told Healio.com/OSN.

Herpes zoster ophthalmicus recurred in 23 patients after cataract surgery. A multivariate analysis found patients with more than 1 year of disease quiescence before cataract surgery were at significantly lower risk for recurrence. Risk for postoperative recurrence increased with the number of flares before surgery.

Intraoperative complications occurred in eight patients, including anterior capsule tears in three patients, posterior capsule tear in two patients, iris prolapse in two patients and zonular fiber weakness requiring a capsular tension ring in one patient. Patients with chronic anterior uveitis were at a higher risk for intraoperative complications compared with patients without chronic anterior uveitis. Patients with glaucomatous optic neuropathy were also at a higher risk for intraoperative complications.

Eight patients experienced IOP greater than 24 mm Hg at 1 day postoperatively, and two patients experienced IOP greater than 30 mm Hg. Only one patient had an IOP greater than 24 mm Hg at 1 month postoperatively, and no patients had an IOP greater than 30 mm Hg.

“To reduce the rate of recurrence following surgery, we recommend a prolonged period of disease quiescence, where possible, ideally 1 year. The role of antivirals in zoster is still unclear (and we eagerly await the results of the Zoster Eye Disease Study). Within my personal practice, if the patient is not already on antivirals, I will start on the day of cataract surgery. I use a 3-month course of antiviral prophylaxis for those with simple HZO disease, and a 1-year course for those with previous recurrences or less than 1 year of quiescence,” Niederer said. – by Robert Linnehan

Editor’s note: This article has been updated to include comment from Rachael L. Niederer, MB, ChB, PhD, FRANZCO.

Disclosures: The authors report no relevant financial disclosures.