Herpetic uveitis: The effect of prophylactic medications following cataract surgery

Elena Y. Q. Zhu, Sophie L. Roger, Lyndell L. Lim

Meeting:  2022 RANZCO


Date:      -

Session Title: UVEITIS

Session Time:      -

Purpose: To investigate outcomes in eyes with herpetic uveitis following intra-ocular surgery.

Methods: Retrospective cohort study of patients with herpetic uveitis undergoing cataract surgery from the Royal Victorian Eye and Ear Hospital, Melbourne, from 2007 through to 2020[SR1].

Results: Sixteen patients (11 females) with aqueous PCR-confirmed recurrent/persistent herpetic uveitis were reviewed: six eyes with Herpes simplex and 10 eyes with Varicella Zoster. Median age at initial diagnosis was 68 years (range 52-88), and 71 years (range 54-73) at the time of surgery. Median duration of quiescence prior to surgery was 7.8 months (range 0-51). Increased topical steroid was used prophylactically pre- operatively in 67% Herpes simplex eyes (N = 4) and 50% (N = 5) of the Varicella Zoster eyes. Ten eyes overall were treated with concurrent antiviral prior to surgery (one with aciclovir ointment; nine with oral antiviral). In nine of 16 eyes topical steroids were ceased completely within a median of 23 weeks follow- ing surgery, which led to a relapse in six of the nine. Four of six relapses had no oral antiviral coverage at the time.

Conclusion: Increasing topical steroid with ongoing antiviral treatment was the preferred prophylactic mea- sure used in herpetic uveitis prior to cataract surgery. Oral antiviral treatment appears effective in reducing relapses. Complete cessation of topical steroid post- operatively was associated with high rates of relapse, particularly in the absence of concurrent antiviral prophylaxis and this should therefore be done extremely cautiously