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(searched for: doi:10.1016/j.jcrs.2013.06.005)
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Uwe Pleyer, , Argyrios Chronopoulos, Ina Kötter, Daniel J. Salchow, Stephan Thurau, Nóra Szentmáry, Berthold Seitz, Karoline Walscheid, Christoph Tappeiner, et al.
Published: 16 December 2021
Entzündliche Augenerkrankungen pp 413-471; https://doi.org/10.1007/978-3-662-60399-4_21

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Haya H. Al-Ani, Lucy M. Lu, Jay J. Meyer,
Journal of Cataract and Refractive Surgery, Volume 48, pp 304-309; https://doi.org/10.1097/j.jcrs.0000000000000745

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.
Published: 3 April 2021
Strabismus, Volume 29, pp 86-89; https://doi.org/10.1080/09273972.2021.1914676

Abstract:
The authors describe the case of bilateral herpes simplex keratoconjunctivitis (HSK) following uncomplicated 7 mm bilateral lateral rectus recessions in a 3-year-old child. The recovery was initially unremarkable, and the standard postoperative drops of dexamethasone and chloramphenicol (non-preservative free) were prescribed. The child presented 8 days postoperatively with fever, right upper lid swelling and ptosis. She was admitted for intravenous antibiotics for suspected pre-septal cellulitis. Over the next 2 days, she deteriorated with bilateral lid involvement. An examination under anesthesia (EUA) revealed bilateral corneal epithelial (dendritic and geographical) ulcers with conjunctival erosions and pseudo membranes prompting a diagnosis of HSK. This was confirmed by polymerase chain reaction (PCR) testing. The child recovered within 2 weeks after starting oral and topical antiviral medication. This case highlights the importance of EUA in infections not responding to standard treatment. Although HSK is known to occur after topical steroid use and ocular surgery, we were not able to find any other cases in the literature and believe this is the first reported case of bilateral HSK in the immediate postoperative period after strabismus surgery.
, Dallin C Milner, Preston A Baker, , , Phillip C Hoopes
Published: 1 November 2020
Clinical Ophthalmology, pp 3891-3901; https://doi.org/10.2147/opth.s282070

Abstract:
Abstract: The incidence of herpes simplex keratitis (HSK) in patients following corneal refractive surgery is higher than in the general population, and several case reports of ocular morbidity in HSK infection following corneal refractive surgery have been published. HSK is listed by the American Academy of Ophthalmology as a relative contraindication to corneal refractive surgery, although specifics have not been further elucidated. This review summarizes the current literature regarding reactivation of HSK following corneal refractive surgery and provides a guideline for considering corneal refractive surgery in a patient with a previous history of HSK. Based on the current literature, we recommend that corneal refractive surgery is appropriate for patients with a history of HSK without multiple recurrences who have had no evidence of disease for at least one year. In addition to a thorough history and physical examination, we also recommend these patients begin 400 mg twice daily of oral acyclovir or valacyclovir 500 mg once daily for two weeks prior to surgery and continue this regimen for at least two weeks postoperatively or while on topical steroids.
Jennifer Lee, Debra A. Goldstein
Published: 28 January 2020
Complications in Uveitis pp 43-59; https://doi.org/10.1007/978-3-030-28392-6_5

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Ming Zou, Yi Zhang, Xi Huang, Sheng Gao, Chunling Liu
Abstract:
Epithelial keratitis is a common complication after cataract surgery. Many factors have been attributed to this clinical phenomenon. An 82-year-old woman without previous herpes simplex keratitis (HSK) underwent an uncomplicated clear corneal phacoemulsification procedure in the right eye. In the late postoperative period, epithelial keratitis developed in this same eye. An initial diagnosis of HSK was made clinically. The lesion was refractory to antiviral treatment and had progressed. After topical acyclovir cessation and vigorous lubrication, a diagnosis of toxic keratitis was finally made. The corneal epithelial defect and dendritic lesion presented initially. Responding to antiviral treatment, this corneal lesion aggravated and revealed large epithelial erosion. After topical acyclovir cessation and initiation of vigorous lubrication, the toxic keratitis was completely resolved. Epithelial keratitis following cataract surgery is a common complication and can be misdiagnosed early in its disease course. Physicians should be alert to the possibility of HSK. Polymerase chain reaction detection is helpful in diagnosing this disease.
, Karoline Walscheid, Uwe Pleyer
Klinische Monatsblätter für Augenheilkunde, Volume 235, pp 568-575; https://doi.org/10.1055/a-0586-3974

Abstract:
Zusammenfassung: Eine häufige Komplikation bei Uveitis ist die Katarakt, deren Management anspruchsvoll sein kann. Die Operationsplanung setzt eine Kenntnis von Ursache (z. B. infektiös versus nichtinfektiös) und Verlauf der Uveitis voraus, einschließlich aller intraokularen Komorbiditäten (z. B. Makulaödem). Die präoperative Patientenselektion ist bei Uveitispatienten zum Erzielen guter Operationsergebnisse bei Uveitis besonders bedeutsam. Mit steroidsparenden krankheitsmodifizierenden antirheumatischen Medikamenten (DMARDs) kann die Rate postoperativer Komplikationen reduziert und das Visusergebnis verbessert werden. Vor der Operation muss eine stabile Entzündungskontrolle erzielt werden. Die Operation sollte minimalinvasiv erfolgen. Eine IOL-Implantation sollte nicht bei Patienten mit unvorhersehbarem Entzündungsverlauf erfolgen. Durch die Verwendung von intraokularen Kortikosteroiden (z. B. Dexamethason-Azetonid-Implantat, Triamcinolon-Azetonid) kann die Komplikationsrate reduziert werden. Postoperativ sollte die entzündungshemmende Medikation intensiviert und diese bis zu 3 Monate lang fortgesetzt werden. Bei sorgsamer Patientenauswahl, Planung und Durchführung der Kataraktoperation sowie postoperativer Nachsorge können bei Uveitispatienten zufriedenstellende anatomische und visuelle Operationsergebnisse erzielt werden.
Soon-Phaik Chee, Nicole Shu-Wen Chan, Seng-Ei Ti
Published: 1 January 2017
Indian Journal of Ophthalmology, Volume 65, pp 1329-1339; https://doi.org/10.4103/ijo.ijo_740_17

Abstract:
The visual outcome of uveitic cataract surgery depends on the underlying uveitic diagnosis, the presence of vision-limiting pathology and perioperative optimization of disease control. A comprehensive preoperative ophthalmic assessment for the presence of concomitant ocular pathology, with particular emphasis on macula and optic nerve involvement, is essential to determine which patients will benefit from improved vision after cataract surgery. Meticulous examination in conjunction with adjunct investigations can help in preoperative surgical planning and in determining the need for combined or staged procedures. The eye should be quiescent for a minimum of 3 months before cataract surgery. Perioperative corticosteroid prophylaxis is important to reduce the risk of cystoid macular edema and recurrence of the uveitis. Antimicrobial prophylaxis may also reduce the risk of reactivation in eyes with infectious uveitis. Uveitic cataracts may be surgically demanding due to the presence of synechiae, membranes, and pupil abnormalities that limit access to the cataract. This can be overcome by manual stretching, multiple sphincterotomies or mechanical dilation with pupil dilation devices. In patients <2 years of age and in eyes where the inflammation is poorly controlled, intraocular lens implantation should be deferred. Intensive local and/or oral steroid prophylaxis should be given postoperatively if indicated. Patients must be monitored closely for disease recurrence, excessive inflammation, raised intraocular pressure, hypotony, and other complications. Complications must be treated aggressively to improve visual rehabilitation. With proper patient selection, improved surgical techniques and optimization of peri- and post-operative care, patients with uveitic cataracts can achieve good visual outcomes.
Sabite E. Gokce, Koray Gumus, Adam Garibay, Zaina N. Al-Mohtaseb
International Ophthalmology Clinics, Volume 56, pp 1-28; https://doi.org/10.1097/iio.0000000000000126

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