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.
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.
“Our primary concern was the high rate of severe sequelae from herpes zoster disease recurrence after surgery. Thus, we recommend careful patient selection, detailed informed consent, a long period of disease quiescence before cataract surgery (minimum 6 months; ideally 1 year) and consideration of oral antiviral therapy in those with a history of multiple disease recurrences,” the study authors wrote. – by Robert Linnehan
Disclosures: The authors report no relevant financial disclosures.