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Aileen Sy, Tom Lietman, Stephen McLeod, Todd Margolis, Elisabeth Cohen, Mark J. Mannis, Nisha Acharya; Practice Patterns and Opinions in the Management of Recurrent or Chronic Herpes Zoster Ophthalmicus. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1503.
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The objective of this survey was to assess practices and opinions amongst cornea specialists for treating recurrences of herpes zoster ophthalmicus (HZO).
In November 2010, a survey was distributed to the Cornea Society listserv via the internet-based program, SurveyMonkey. Questions identified respondents’ treatment practices given the clinical scenario of a patient with signs of recurrent HZO (stromal keratitis and anterior uveitis). Opinions were elicited on the efficacy of prolonged antiviral prophylaxis and experience with zoster vaccine. Descriptive statistical analyses were performed.
Of the 75 respondents, 85% were cornea specialists. In our recurrent HZO clinical scenario, the majority of respondents chose to treat with a combination of oral antiviral and topical steroid (67%). The most common choice of steroid and dose was prednisolone acetate 1% QID (51%). Among respondents who chose to treat with oral antivirals, 39% chose to treat for 7-14 days, 16% for one year or longer, 16% for as long as steroids were being administered, and 15% some other duration. Fifty-six percent of respondents believed that prolonged acyclovir prophylaxis could prevent or reduce recurrent signs of HZO during the period of administration; 32% believed recurrences would be reduced after the period of administration. The majority of respondents said they are not recommending the zoster vaccine to patients with a history of HZO (66%), but 49% of respondents believed the vaccine could reduce recurrent signs or did not know. The majority (86%) of physicians reported treating recurrent or chronic cases of HZO in the last year.
Many cornea specialists are seeing recurrent or chronic cases of HZO, but there is variability in the use of topical steroids and antivirals, particularly in the duration of oral antiviral therapy. Respondents were highly divided over the efficacy of prolonged antiviral therapy to reduce chronic or recurrent disease. Most ophthalmologists are not recommending the zoster vaccine to patients with a history of HZO; however, respondents were uncertain whether or not the vaccine could reduce recurrences. The results of this survey demonstrate the need for further systematic study of treatment and prophylaxis for recurrent and chronic HZO.
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