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Li A, Soifer M, Cox AR, Debiec M, Matsyaraja T, Khanna S, Kodati S. Herpes Zoster Chorioretinopathy: A Case Series. Ocul Immunol Inflamm 2024:1-7. [PMID: 38639557 DOI: 10.1080/09273948.2024.2338271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE To report two patients with herpetic zoster panuveitis and chorioretinopathy with choroidal hypopigmentation. METHODS Retrospective chart review of two patients. RESULTS We report a series of two patients with a history of HZO with orbital inflammation and panuveitis, who developed patchy choroidal depigmentation consistent with a choroidopathy. The lesions were extensive and involved the posterior pole and mid-periphery in both cases. Both cases demonstrated scattered areas of ellipsoid zone loss, and fluorescein angiography showed corresponding late hyperfluorescence. OCTA in one case demonstrated flow voids at the level of choriocapillaris. CONCLUSIONS Our series suggests that herpetic chorioretinopathy may be a relatively benign process that presents late and may involve large areas of the posterior choroid.
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Affiliation(s)
- Ashley Li
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Matias Soifer
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anthony R Cox
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Matthew Debiec
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tejaswini Matsyaraja
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Sangeeta Khanna
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
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Walia A, Sun Y, Acharya NR. Risk of Herpes Zoster Ophthalmicus Recurrence After Recombinant Zoster Vaccination. JAMA Ophthalmol 2024; 142:249-256. [PMID: 38358762 PMCID: PMC10870220 DOI: 10.1001/jamaophthalmol.2023.6830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/10/2023] [Indexed: 02/16/2024]
Abstract
Importance The recombinant zoster vaccine (RZV) is currently recommended for immunocompetent adults aged 50 years or older and immunocompromised adults aged 19 years or older and is effective in preventing herpes zoster ophthalmicus (HZO). However, questions about the safety of RZV in patients with a history of HZO remain. Objective To evaluate whether there is an increased risk of HZO recurrence after RZV in patients with a history of HZO. Design, Setting, and Participants This retrospective cohort study used medical and outpatient pharmacy claims data for commercial and Medicare Advantage enrollees from the Optum Labs Data Warehouse. Patients with incident HZO from January 1, 2010, to December 31, 2021, were identified; the study period ended on March 31, 2022. The vaccinated group consisted of patients with at least 1 dose of RZV more than 90 days following the initial HZO diagnosis. The unvaccinated group consisted of patients without any record of RZV in the study period. Vaccinated and unvaccinated patients were matched using exact k:1 matching without replacement. Exposure Recombinant zoster vaccination. Main Outcomes and Measures The main outcome was the number of HZO recurrences with and without RZV exposure. Results A total of 16 408 patients were included in the matched analysis, of whom 12 762 were unvaccinated (7806 [61.2%] female; mean [SD] age at diagnosis, 68.8 [10.3] years) and 3646 were vaccinated (2268 [62.2%] female; mean [SD] age at diagnosis, 67.4 [9.8] years). Within the primary risk period of 56 days after the index date (ie, the start of follow-up for the outcome), the incidence of HZO recurrence after any RZV exposure was 37.7 per 1000 person-years compared with 26.2 per 1000 person-years in the unexposed group. After controlling for race and ethnicity, inpatient stays, emergency department visits, concomitant vaccines, and eye care practitioner visits, the association between vaccination status and HZO exacerbation in the primary risk period had an adjusted hazard ratio for any RZV exposure of 1.64 (95% CI, 1.01-2.67; P = .04). Conclusions and Relevance In this study, RZV exposure was associated with a higher likelihood of HZO recurrence in patients with a history of HZO compared with no RZV exposure. These findings support consideration that patients with a history of HZO may benefit from monitoring after receiving RZV in case of HZO recurrence.
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Affiliation(s)
- Anushka Walia
- School of Medicine, University of California, San Francisco
| | - Yuwei Sun
- F.I. Proctor Foundation, University of California, San Francisco
| | - Nisha R Acharya
- F.I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Srimanan W, Panyakorn S. Orbital apex syndrome due to herpes zoster infection in a patient with chronic kidney disease: A case report. Clin Case Rep 2023; 11:e6839. [PMID: 36654694 PMCID: PMC9834609 DOI: 10.1002/ccr3.6839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
We report the case of an 89-year-old man with typical herpes zoster ophthalmicus on the left side of his face with delayed clinical presentation of orbital apex syndrome. After treatment with intravenous antiviral agents and corticosteroids, the patient fully recovered. Clinical suspicion should be concerned in immunocompromised cases.
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Presumed Herpes Zoster Ophthalmicus Reactivation Following Recombinant Zoster Vaccination. Cornea 2021; 40:248-250. [PMID: 32947398 DOI: 10.1097/ico.0000000000002537] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of herpes zoster ophthalmicus (HZO) reactivation after recombinant zoster vaccination. METHODS A 78-year-old woman, with a history of HZO 20 years ago, was referred for progressive corneal thinning in her left eye that started 1 week after her second dose of recombinant zoster vaccination. RESULTS At presentation, visual acuity was counting fingers. Corneal sensation was markedly decreased. Slit lamp examination revealed a temporal paracentral epithelial defect 1.5 × 2.0 mm in size with 40% thinning and surrounding stromal inflammation suggestive of stromal keratitis with ulceration. The patient was started on oral valacyclovir, topical erythromycin ointment, and hourly topical lubrication. A bandage contact lens was placed and was replaced 1 week later with self-retained cryopreserved amniotic membrane ring. The ring was removed in the following week when the thinned area was epithelialized with no further evidence of stromal lysis. CONCLUSIONS HZO reactivation after recombinant zoster vaccination is uncommon but possible. Ophthalmologists should remain aware of potential risks of zoster vaccination and take special precautions in patients with HZO history.
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Como CN, Bubak AN, Blackmon AM, Jones D, Mueller NH, Davidson R, Nagel MA. Varicella Zoster Virus Induces Differential Cell-Type Specific Responses in Human Corneal Epithelial Cells and Keratocytes. Invest Ophthalmol Vis Sci 2019; 60:704-711. [PMID: 30786281 PMCID: PMC6383726 DOI: 10.1167/iovs.18-25801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose While VZV DNA and antigen have been detected in acute and chronic VZV keratitis, it is unclear whether productive infection of corneal cells is ongoing or whether residual, noninfectious VZV antigens elicit inflammation. Herein, we examined VZV-infected primary human corneal epithelial cells (HCECs) and keratocytes (HKs) to elucidate the pathogenesis of VZV keratitis. Methods HCECs and HKs were mock- or VZV infected. Seven days later, cells were examined for morphology, proinflammatory cytokine and matrix metalloproteinase (MMP) release, ability to recruit peripheral blood mononuclear cells (PBMCs) and neutrophils, and MMP substrate cleavage. Results Both cell types synthesized infectious virus. VZV-infected HCECs proliferated, whereas VZV-infected HKs died. Compared to mock-infected cells, VZV-infected HCECs secreted significantly more IL-6, IL-8, IL-10, and IL-12p70 that were confirmed at the transcript level, and MMP-1 and MMP-9; conditioned supernatant attracted PBMCs and neutrophils and cleaved MMP substrates. In contrast, VZV-infected HKs suppressed cytokine secretion except for IL-8, which attracted neutrophils, and suppressed MMP release and substrate cleavage. Conclusions Overall, VZV-infected HCECs recapitulate findings of VZV keratitis with respect to epithelial cell proliferation, pseudodendrite formation and creation of a proinflammatory environment, providing an in vitro model for VZV infection of corneal epithelial cells. Furthermore, the proliferation and persistence of VZV-infected HCECs suggest that these cells may serve as viral reservoirs if immune clearance is incomplete. Finally, the finding that VZV-infected HKs die and suppress most proinflammatory cytokines and MMPs may explain the widespread death of these cells with unchecked viral spread due to ineffective recruitment of PBMCs.
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Affiliation(s)
- Christina N Como
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Andrew N Bubak
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Anna M Blackmon
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Dallas Jones
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Niklaus H Mueller
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States.,Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Richard Davidson
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Maria A Nagel
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, United States.,Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States
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Should Antiviral/Anti-Varicella Zoster Virus Treatment Be Used in Patients With Giant Cell Arteritis? J Neuroophthalmol 2018; 39:134-141. [PMID: 29877905 DOI: 10.1097/wno.0000000000000664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Cruzat A, Hamrah P, Cavalcanti BM, Zheng L, Colby K, Pavan-Langston D. Corneal Reinnervation and Sensation Recovery in Patients With Herpes Zoster Ophthalmicus: An In Vivo and Ex Vivo Study of Corneal Nerves. Cornea 2016; 35:619-25. [PMID: 26989956 DOI: 10.1097/ico.0000000000000797] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To study corneal reinnervation and sensation recovery in Herpes zoster ophthalmicus (HZO). METHODS Two patients with HZO were studied over time with serial corneal esthesiometry and laser in vivo confocal microscopy (IVCM). A Boston keratoprosthesis type 1 was implanted, and the explanted corneal tissues were examined by immunofluorescence histochemistry for βIII-tubulin to stain for corneal nerves. RESULTS The initial central corneal IVCM performed in each patient showed a complete lack of the subbasal nerve plexus, which was in accordance with severe loss of sensation (0 of 6 cm) measured by esthesiometry. When IVCM was repeated 2 years later before undergoing surgery, case 1 showed a persistent lack of central subbasal nerves and sensation (0 of 6). In contrast, case 2 showed regeneration of the central subbasal nerves (4786 μm/mm) with partial recovery of corneal sensation (2.5 of 6 cm). Immunostaining of the explanted corneal button in case 1 showed no corneal nerves, whereas case 2 showed central and peripheral corneal nerves. Eight months after surgery, IVCM was again repeated in the donor tissue around the Boston keratoprosthesis in both patients to study innervation of the corneal transplant. Case 1 showed no nerves, whereas case 2 showed new nerves growing from the periphery into the corneal graft. CONCLUSIONS We demonstrate that regaining corneal innervation and corneal function are possible in patients with HZO as shown by corneal sensation, IVCM, and ex vivo immunostaining, indicating zoster neural damage is not always permanent and it may recover over an extended period of time.
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Affiliation(s)
- Andrea Cruzat
- *Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA;†Department of Ophthalmology, Pontificia Universidad Católica de Chile, Santiago, Chile;‡New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA;§Eye Center, Somerville Hospital, Department of Surgery, Cambridge Health Alliance, Somerville, MA; and¶Department of Ophthalmology, University of Chicago, Chicago, IL
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Abstract
There are a number of autoimmune disorders which can affect visual function. There are a very large number of mechanisms in the visual pathway which could potentially be the targets of autoimmune attack. In practice it is the retina and the anterior visual pathway (optic nerve and chiasm) that are recognised as being affected in autoimmune disorders. Multiple Sclerosis is one of the commonest causes of visual loss in young adults because of the frequency of attacks of optic neuritis in that condition, however the basis of the inflammation in Multiple Sclerosis and the confirmation of autoimmunity is lacking. The immune process is known to be highly unusual in that it is not systemic and confined to the CNS compartment. Previously an enigmatic partner to Multiple Sclerosis, Neuromyelitis Optica is now established to be autoimmune and two antibodies - to Aquaporin4 and to Myelin Oligodendrocyte Glycoprotein - have been implicated in the pathogenesis. The term Chronic Relapsing Inflammatory Optic Neuropathy is applied to those cases of optic neuritis which require long term immunosuppression and hence are presumed to be autoimmune but where no autoimmune pathogenesis has been confirmed. Optic neuritis occurring post-infection and post vaccination and conditions such as Systemic Lupus Erythematosus and various vasculitides may cause direct autoimmune attack to visual structures or indirect damage through occlusive vasculopathy. Chronic granulomatous disorders such as Sarcoidosis affect vision commonly by a variety of mechanisms, whether and how these are placed in the autoimmune panoply is unknown. As far as the retina is concerned Cancer Associated Retinopathy and Melanoma Associated Retinopathy are well characterised clinically but a candidate autoantibody (recoverin) is only described in the former disorder. Other, usually monophasic, focal retinal inflammatory disorders (Idiopathic Big Blind Spot Syndrome, Acute Zonal Occult Outer Retinopathy and Acute Macular Neuroretinitis) are of obscure pathogenesis but an autoimmune disorder of the post-infectious type is plausible. Visual loss in autoimmunity is an expanding field: the most significant advances in research have resulted from taking a well characterised phenotype and making educated guesses at the possible molecular targets of autoimmune attack.
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Affiliation(s)
- Axel Petzold
- The Dutch Expert Center for Neuro-ophthalmology, VU University Medical Center, Amsterdam, The Netherlands and Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Sui Wong
- Moorfields Eye Hospital and St. Thomas' Hospital, London, UK
| | - Gordon T Plant
- Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery and St. Thomas' Hospital, London, UK.
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Johnson RW, Alvarez-Pasquin MJ, Bijl M, Franco E, Gaillat J, Clara JG, Labetoulle M, Michel JP, Naldi L, Sanmarti LS, Weinke T. Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective. THERAPEUTIC ADVANCES IN VACCINES 2015; 3:109-20. [PMID: 26478818 PMCID: PMC4591524 DOI: 10.1177/2051013615599151] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Herpes zoster (HZ) is primarily a disease of nerve tissue but the acute and longer-term manifestations require multidisciplinary knowledge and involvement in their management. Complications may be dermatological (e.g. secondary bacterial infection), neurological (e.g. long-term pain, segmental paresis, stroke), ophthalmological (e.g. keratitis, iridocyclitis, secondary glaucoma) or visceral (e.g. pneumonia, hepatitis). The age-related increased incidence of HZ and its complications is thought to be a result of the decline in cell-mediated immunity (immunosenescence), higher incidence of comorbidities with age and social-environmental changes. Individuals who are immunocompromised as a result of disease or therapy are also at increased risk, independent of age. HZ and its complications (particularly postherpetic neuralgia) create a significant burden for the patient, carers, healthcare systems and employers. Prevention and treatment of HZ complications remain a therapeutic challenge despite recent advances. This is an overview of the multidisciplinary implications and management of HZ in which the potential contribution of vaccination to reducing the incidence HZ and its complications are also discussed.
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Affiliation(s)
- Robert W. Johnson
- Senior Research Fellow, Clinical Sciences, University of Bristol, 9 Ridgeway Road, Long Ashton, Bristol, BS41 9EX, UK
| | | | - Marc Bijl
- Department of Internal Medicine and Rheumatology, Martini Hospital, Groningen, The Netherlands
| | - Elisabetta Franco
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Jacques Gaillat
- Annecy-Genevois Hospital, Infectious Diseases Department, Annecy, France
| | - João G. Clara
- Lisbon Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Marc Labetoulle
- Service d’Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris-Sud, France Département de Virologie, Institute for Integrative Biology of the Cell (I2BC), CNRS, Gif/Yvette, France
| | - Jean-Pierre Michel
- Department of Geriatrics, University Hospitals of Geneva, Belle Idée, Geneva, Switzerland
| | - Luigi Naldi
- Department of Dermatology, Azienda Ospedaliera papa Giovanni XXIII, Bergamo, Italy
| | | | - Thomas Weinke
- Klinikum Ernst von Bergmann, Klinik für Gastroenterologie und Infekiologie, Potsdam, Germany
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Rousseau A, Nasser G, Chiquet C, Barreau E, Gendron G, Kaswin G, M’Garrech M, Benoudiba F, Ducreux D, Labetoulle M. Diffusion tensor magnetic resonance imaging of trigeminal nerves in relapsing herpetic keratouveitis. PLoS One 2015; 10:e0122186. [PMID: 25830672 PMCID: PMC4382307 DOI: 10.1371/journal.pone.0122186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 02/09/2015] [Indexed: 01/27/2023] Open
Abstract
Background Corneal hypoesthesia is the landmark of HSV and VZV keratitis and can lead to neurotrophic keratitis. Diffusion tensor imaging (DTI) is a new magnetic resonance imaging (MRI) derived technique, which offers possibilities to study axonal architecture. We aimed at assessing the potential impact of recurrent HSV or VZV-related keratitis on the axonal architecture of trigeminal nerves using DTI. Design Prospective non-interventional study. Participants Twelve patients and 24 controls. Methods DTI using MRI of the trigeminal fibers and corneal esthesiometry using the Cochet-Bonnet esthesiometer were acquired for patients affected by unilateral and recurrent HSV or VZV-related keratitis (3 months after the last corneal inflammatory event), and control subjects with no history of ocular or neuronal disease affecting the trigeminal pathways. Main Outcome Measures Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were compared between the 2 eyes of both patients and controls, and correlated with corneal esthesiometry. Results FA was lower in the trigeminal fibers ipsilateral to the affected eye compared to the non-affected side (0.39±0.02 versus 0.46±0.04, P=0.03). This difference was more important than the intra-individual variability observed in controls. Concomitantly, the asymmetry in ADC results was significantly correlated with the loss of corneal sensitivity in the affected eye. Conclusions Corneal hypoesthesia related to HSV and VZV keratitis is associated with persistent modifications in the architecture and functionality of the trigeminal fibers. These results add further explanation to the pathogenesis of HSV and VZV-induced neurotrophic keratitis, which may occur despite an apparent quiescence of the disease.
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Affiliation(s)
- Antoine Rousseau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Ghaïdaa Nasser
- Department of Neuroradiology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Christophe Chiquet
- Department of Ophthalmology, Grenoble University Hospital, Grenoble, France
| | - Emmanuel Barreau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Gael Gendron
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Godefroy Kaswin
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Mohamed M’Garrech
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Farida Benoudiba
- Department of Neuroradiology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Denis Ducreux
- Department of Neuroradiology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
- * E-mail: (ML); (DD)
| | - Marc Labetoulle
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
- * E-mail: (ML); (DD)
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Ocular herpes: the pathophysiology, management and treatment of herpetic eye diseases. Virol Sin 2014; 29:327-42. [PMID: 25547680 PMCID: PMC8206444 DOI: 10.1007/s12250-014-3539-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 11/13/2014] [Indexed: 12/19/2022] Open
Abstract
Herpesviruses are a prominent cause of human viral disease, second only to the cold and influenza viruses. Most herpesvirus infections are mild or asymptomatic. However, when the virus invades the eye, a number of pathologies can develop and its associated sequelae have become a considerable source of ocular morbidity. The most common culprits of herpetic eye disease are the herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV). While primary infection can produce ocular disease, the most destructive manifestations tend to arise from recurrent infection. These recurrent infections can wreck devastating effects and lead to irreversible vision loss accompanied by a decreased quality of life, increased healthcare usage, and significant cost burden. Unfortunately, no method currently exists to eradicate herpesviruses from the body after infection. Treatment and management of herpes-related eye conditions continue to revolve around antiviral drugs, although corticosteroids, interferons, and other newer therapies may also be appropriate depending on the disease presentation. Ultimately, the advent of effective vaccines will be crucial to preventing herpesvirus diseases altogether and cutting the incidence of ocular complications.
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Increasing use of the vaccine against zoster through recommendation and administration by ophthalmologists at a city hospital. Am J Ophthalmol 2013; 155:787-95. [PMID: 23394910 DOI: 10.1016/j.ajo.2012.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/16/2012] [Accepted: 11/27/2012] [Indexed: 11/22/2022]
Abstract
PURPOSE To increase the vaccination rate and identify barriers to administration of the vaccine against herpes zoster by having ophthalmologists screen and provide the vaccine. DESIGN Prospective interventional cohort study. METHODS SETTING Academic City Hospital, Bellevue Hospital. PARTICIPANTS A total of 100 eligible patients based on recommended Centers for Disease Control (CDC) criteria and ability to speak English and Spanish who received the herpes zoster vaccine were compared with 66 patients who declined the vaccine. INTERVENTIONS The vaccine was administered after written informed consent was obtained to complete a screening questionnaire evaluating the participants' eligibility and interest in receiving the vaccine. MAIN OUTCOME MEASURES Barriers to administration of the vaccine were evaluated. RESULTS A total of 170 consenting patients, including 100 patients who were vaccinated, 66 patients who declined vaccination, and 4 patients who were ineligible, were analyzed. The proportion of subjects who would consider receiving the vaccine if recommended by a doctor among those who received the shingles vaccine, 98.0% (95% CI: 95%-100%), was significantly greater than the proportion in the group that declined, 74.2% (95% CI: 64%-85%) (P ≤ .0001). The most common reason that patients declined the vaccine was wanting to speak with their primary care physician, 46.9% (95% CI: 33%-61%). CONCLUSIONS Ophthalmologists can screen, educate, and prescribe the vaccine against herpes zoster in order to increase utilization of this vaccine. Nonfinancial or access barriers of this vaccine among underserved eligible patients include absence of recommendation by their primary care doctor.
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Ghaznawi N, Virdi A, Dayan A, Hammersmith KM, Rapuano CJ, Laibson PR, Cohen EJ. Herpes zoster ophthalmicus: comparison of disease in patients 60 years and older versus younger than 60 years. Ophthalmology 2011; 118:2242-50. [PMID: 21788078 DOI: 10.1016/j.ophtha.2011.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 04/03/2011] [Accepted: 04/04/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To study the clinical course of herpes zoster ophthalmicus (HZO) and to compare the demographics, treatments, and outcomes in patients aged <60 years versus patients aged ≥60 years at the time of diagnosis. DESIGN Retrospective chart review of all 112 patients presenting for management of HZO from January 1, 2008 to December 31, 2008. PARTICIPANTS A total of 112 patients (58 aged <60 years and 54 aged >60 years) at the time of HZO onset. INTERVENTIONS Anterior segment complications, treatments, and surgical procedures were documented at 3 months, 6 months, and 1 year, and then annually for the remainder of the follow-up period. MAIN OUTCOME MEASURES Intraocular pressure, inflammation, steroid use, surgical procedures, anterior segment complications, post-herpetic neuralgia, and delayed herpes zoster pseudodendrites. RESULTS Equal numbers of patients were affected with HZO in the younger and older age groups (51.8%, n = 58 vs. 48.2%, n = 54, respectively, P = 0.69). The most common decade of HZO onset was between 50 and 59 years. Younger patients were more likely to be healthy compared with older patients (P = 0.05). Delayed herpes zoster pseudodendrites were more common in the younger patients (36.7% vs. 16.7%, P = 0.03). The mean number of flares per patient-years was significantly higher in the younger patients (z test, P = 0.024). Post-herpetic neuralgia, neurotrophic keratopathy, and secondary infectious keratitis were more frequent in the older patients (P = 0.05). Prevalence of corneal perforation, corneal thinning, cataract formation, and glaucoma was similar between the 2 groups. Most patients in both groups (84.2% of younger patients and 89.5% of older patients) were taking topical steroids 3 years after referral for HZO. CONCLUSIONS Herpes zoster ophthalmicus affects individuals aged younger than and older than 60 years in similar numbers, with the most common decade of onset between age 50 and 59 years. Younger patients had more episodes of delayed pseudodendritiform keratitis and flares of inflammation compared with older patients, who had more problems related to neurotrophic keratopathy. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Neelofar Ghaznawi
- Wills Eye Institute, Cornea Service, Department of Ophthalmology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Athanasiadis I, Konstantinidis A, Papaioannou A, Kyprianou I, Georgiadis N. A Case of Herpes Zoster Ophthalmicus Associated with Multiple Ocular and Extraocular Manifestations. Neuroophthalmology 2008. [DOI: 10.1080/01658100801951923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Tabery HM. Corneal epithelial keratitis in herpes zoster ophthalmicus: "delayed" and "sine herpete". A non-contact photomicrographic in vivo study in the human cornea. Eur J Ophthalmol 2002; 12:267-75. [PMID: 12219995 DOI: 10.1177/112067210201200403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the origin of corneal epithelial keratitis occurring without accompanying herpes zoster ophthalmicus (HZO) cutaneous rash. METHODS Corneal epithelial lesions in seven patients (four with a history of classical HZO with cutaneous rash, one of herpes zoster oticus, and two with no history of herpes zoster, were examined with the slit lamp and photographed by non-contact in vivo photomicrography. The findings were compared with lesions in classical acute HZO. Polymerase chain reaction (PCR) was done in three patients. RESULTS Slit lamp appearance, morphology at higher magnification, and kinetics of the lesions were indistinguishable from classical acute HZO. PCR was positive for varicella-zoster virus DNA in all three samples. CONCLUSIONS The findings strongly suggest that HZO typical corneal epithelial lesions occurring in the absence of cutaneous rash are in fact recurrent episodes of virus shedding.
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Affiliation(s)
- H M Tabery
- Department of Ophthalmology, Malmö University Hospital, Sweden.
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Robert PY, Traccard I, Adenis JP, Denis F, Ranger-Rogez S. Multiplex detection of herpesviruses in tear fluid using the "stair primers" PCR method: prospective study of 93 patients. J Med Virol 2002; 66:506-11. [PMID: 11857529 DOI: 10.1002/jmv.2173] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human herpesviruses can infect the eye and be excreted subsequently in tears. The aim of the present study was to use a multiplex PCR to detect herpesviruses (HSV-1, -2, VZV, CMV, EBV, HHV-6) in tears from normal subjects and from patients with pathological conditions (acute herpes, zoster, papillary conjunctivitis, and dry eye). Schirmer test strips were used to collect tear fluid from 93 patients, sampling both eyes. DNA was then extracted from the 186 samples by chromatography, and viral DNA amplified using a commercialised multiplex "stair primer" method. Thirty-four samples (18.3%) contained Taq inhibitors. The multiplex test gave positive results for HSV and VZV in tear fluid from patients with acute dendritic keratitis (3 patients) and acute ocular zoster (4 patients) and was, therefore, considered effective in testing samples from patients with acute lesions. HSV-1 and HSV-2 were found in two samples from patients with metaherpetic corneal scarring. Among 28 cases of dry eye, two were positive for HHV-6, the latter being associated with EBV in one patient. HHV-6 was also found in 4 out of 54 cases of papillary conjunctivitis. This raised occurrence of HHV-6 in dry eye or papillary conjunctivitis, suggests new clinical patterns for HHV-6 latency or reactivation. Detection of EBV in 1 out of 80 healthy eyes confirms previous evidence that lacrimal glands constitute potentially a site for latent-phase EBV.
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Abstract
BACKGROUND Herpes zoster ophthalmicus (HZO) is a common condition occurring mostly in healthy people. Approximately 50% of HZO patients develop ocular complications, with iridocyclitis occurring in about 43%. This study aimed to identify the clinical features of uveitis secondary to HZO. METHOD A retrospective case study was performed of consecutive patients with HZO and secondary uveitis seen in the past 10 years at the Royal Victorian Eye and Ear hospital as well as those seen in the private clinics of two ocular immunology consultants. The information collected included the time relationship between onset of rash and uveitis, duration and treatment of the uveitis, and rate and nature of ocular complications. RESULTS Thirty-four patients fulfilled the enrolment criteria. The age range was from 24 to 83 years with an average age of 62.5 years. Of these, 28 patients (82%) were immunocompetent and six patients (18%) had underlying immunosuppression from various causes. Twenty-three patients had a uniphasic episode of uveitis and 11 patients (32%) had a chronic relapsing course of uveitis. The duration of the uveitis was variable, ranging from 1 week to 3 years, with 68% of episodes resolving within 2 months. Nineteen patients (56%) developed secondary glaucoma. Five of these patients (26%) required trabeculectomies to control their intraocular pressures. Three patients (9%) had bilateral ocular involvement and five patients (15%) had a reduction in final Snellen visual acuity of more than two lines. CONCLUSION In this study, most patients were immunocompetent individuals. The course of the uveitis was generally uniphasic in nature and of a relatively short duration. There was a high incidence of secondary glaucoma with 15% of all patients requiring surgical intervention. The visual loss in the five patients was not directly related to the uveitis and secondary glaucoma but to other complications associated with HZO.
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Affiliation(s)
- J H Thean
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
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McKelvie PA, Francis IC, Watson S, Nuovo G. Multifocal chorioretinal atrophy associated with herpes zoster ophthalmicus. Clin Exp Ophthalmol 2001; 29:429-32. [PMID: 11778816 DOI: 10.1046/j.1442-9071.2001.d01-30.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 73-year-old woman developed multiple depigmented lesions in the fundus 4-6 months after an episode of acute Herpes zoster ophthalmicus. Post-mortem examination of the globe 15 years after this acute episode confirmed multiple old chorioretinal scars probably due to vasculitis of the short posterior ciliary arteries and branches. Patchy old infarcts were also noted in the iris.
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Affiliation(s)
- P A McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia.
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Nordlund ML, Holland EJ, Osher RH. cataract surgical problem. J Cataract Refract Surg 2001. [DOI: 10.1016/s0886-3350(01)00948-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
The three most common indications for enucleation are intraocular malignancy, trauma, and a blind, painful eye. Recommending enucleation is one of the most difficult therapeutic decisions in ophthalmology. In some cases of malignancy, cryotherapy, laser photocoagulation, diathermy, chemotherapy, and radiation therapy may be viable alternatives to surgery. When surgery is chosen, evisceration or exenteration may be alternatives to enucleation. Once the decision is made to perform enucleation or evisceration, the surgeon must choose from several types of implants and wrapping materials. These devices can be synthetic, autologous, or eye-banked tissues. With certain implants, the surgeon must decide when and if to drill for subsequent peg placement. In this review, the authors discuss choices, techniques, complications, and patient consent and follow-up before, during, and after enucleation. Controversies and results of the Controlled Ocular Melanoma Study are summarized.
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Affiliation(s)
- D M Moshfeghi
- The New York Eye Cancer Center and the Ocular Tumor Service, New York Eye and Ear Infirmary, New York, USA
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Abstract
Herpes zoster is cause of considerable morbidity, especially among elderly patients, with a suggestion of a slight increase in incidence among female patients. Substantial research on the biology of the varicella zoster virus has led to advances in our knowledge of the pathophysiology of the disease along with more successful therapy for the acute episodes of herpes zoster. Ophthalmic zoster is more common than zoster in other cranial nerves and is associated with pronounced suffering. This article reviews the epidemiology, biology, and latency of herpes zoster, discusses the pathophysiology of the disease, and describes treatment options with antivirals and corticosteroids. The pathophysiology and treatment options for postherpetic neuralgia are also addressed. The varicella vaccine is now available, and initial results suggest that this may lessen the effect of herpes zoster in the future.
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Affiliation(s)
- T J Liesegang
- Department of Ophthalmology, Mayo Clinic Jacksonville, FL 32224, USA
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