Researchers recently found that phacoemulsification in eyes with herpes zoster-related keratitis, uveitis or both posed a mildly increased risk for intraoperative and postoperative complications and that herpes zoster disease recurrence after surgery was common and severe in some cases.

This retrospective case series evaluated 57 eyes of 57 patients with herpes zoster-related keratitis, uveitis or both who had cataract surgery in the ipsilateral eye. The team notes that 66.7% had recurrent disease before cataract surgery.

Intraoperative complications occurred in 14.0% of patients and included posterior capsule tear in 3.5% of study participants.  Postoperative complications included intraocular pressures of 30mm Hg or higher in 3.5% of patients and central corneal edema in 14.0%, all of which were resolved by one month. They add that cystoid macular edema occurred in another 3.5%.

The team also discovered that median corrected distance visual acuity at 12 months was 20/40, corneal scarring was associated with poorer vision and herpes zoster recurred in 40.4% after surgery. An increased risk for recurrence was associated with shorter periods of quiescence and a greater number of recurrences before surgery. They add that one eye was eviscerated because of the severity of the disease.

The study authors concluded that clinicians should address herpes zoster-related ocular disease preo-op and consider antiviral prophylaxis. 

Lu LM, McGhee CNJ, Sims JL, et al. High rate of recurrence of herpes zoster-related ocular disease after phacoemulsification cataract surgery. J Cat Refrac Surg. January 9, 2019. [Epub ahead of print].