Cataract surgery in herpes simplex virus ocular disease

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: visual outcome, complications, recurrence. Results: Thirty-seven eyes of 37 subjects were included. Intraoperative complications occurred in one subject (2.7%) with iris prolapse. Keratitis or uveitis recurred postoperatively in 17 subjects (45.9%); 22.5% experienced recurrences in the first year following surgery. One case of postoperative cystoid macular edema (2.7%) and one postoperative endophthalmitis (2.7%) occurred. Corrected distance visual acuity at three months was >20/50 in 21 subjects (70.0%), 20/50 – 20/200 in 4 subjects (12.9%), and ≤20/200 in 6 subjects (19.4%). Vision improved in 26 eyes (83.9%) and worsened in only one eye (3.2%). Risk of recurrent inflammation was associated with 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 prior HSV disease may improve visual acuity for the majority of eyes but overall carries a guarded prognosis, particularly in eyes with corneal scarring. There is a significant risk of recurrent inflammation in the first year following surgery. As possible, surgeons should ensure a period of disease quiescence prior to surgery.