Cataract surgery in herpes simplex virus ocular disease. Issue 3 (March 2022)

• Record Type: Journal Article
• Authors: Al-Ani, Haya H.; Lu, Lucy M.; Meyer, Jay J.; Niederer, Rachael L.
• Is Part Of: Journal of cataract and refractive surgery. Volume 48:Issue 3(2022)
• Page Start: 304
• Page End: 309
• Publication Date: 2022-03
• Subjects: 617.7
• DOI: 10.1097/j.jcrs.0000000000000745
• Languages: English
• ISSNs: 0886-3350

Abstract

Abstract : Cataract surgery in HSV ocular disease improves visual acuity for most but carries a guarded prognosis and high risk for recurrence of inflammation in the first 12 months. Abstract : Purpose: To investigate the outcomes and complications associated with cataract surgery in eyes with herpes simplex virus (HSV)-related anterior segment ocular disease. Setting: Public tertiary center in Auckland, New Zealand. Design: Retrospective observational cohort study. Methods: Clinical records of patients diagnosed with HSV-related keratitis and/or anterior uveitis who underwent subsequent cataract surgery in the affected eye were reviewed. Main outcomes measured were visual outcome, complications, and recurrence. Results: 37 eyes of 37 patients were included. Intraoperative complications occurred in 1 patient (2.7%) with iris prolapse. Keratitis or uveitis recurred postoperatively in 17 patients (45.9%) 8 patients (22.5%); 22.5% experienced recurrences in the first year postoperatively. 1 case (2.7%) of postoperative cystoid macular edema and 1 (2.7%) postoperative endophthalmitis occurred. Corrected distance visual acuity at 3 months was >20/50 in 21 patients (70.0%), 20/50 to 20/200 in 4 patients (12.9%), and ≤20/200 in 6 patients (19.4%). Vision improved in 26 eyes (83.9%) and worsened in only 1 eye (3.2%). Risk for recurrent inflammation was associated with a greater number of recurrences prior to surgery (hazard rate [HR] 1.31), time quiescent prior to surgery (HR 0.48), and iris transillumination defect at preoperative assessment (HR 57.66). Conclusions: Cataract surgery in eyes with previous HSV disease may improve visual acuity for most of the eyes but, overall, carries a guarded prognosis, particularly in eyes with corneal scarring. There is a significant risk for recurrent inflammation in the first year postoperatively. If possible, surgeons should ensure a period of disease quiescence prior to surgery.