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Rachael Niederer, Kevin Liu, Helen Danesh-Meyer; Long term complications and vision loss following herpes zoster ophthalmicus (HZO). Invest. Ophthalmol. Vis. Sci. 2020;61(7):5386.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the long-term sequelae of HZO and risk factors for vision loss.
Retrospective review of all subjects with HZO seen between 1st January 2006 and 31st December 2016 at Auckland District Health Board. Moderate vision loss (MVL) was defined as ≤20/50 and severe vision loss (SVL) as ≤ 20/200.
869 subjects were included in the study with a median follow up of 6.3 years (total 5504.4 patient-years follow up). Median age was 65.5 years, 52.6% were male and 71.5% were Caucasian. Immunosuppression was present in 83 subjects (9.6%) and 102 subjects (11.7%) were diabetic. Conjunctivitis was present in 76.1%, corneal involvement in 445 subjects (51.2%) and uveitis in 413 subjects (47.6%). Cranial nerve palsy occurred in 30 subjects (3.5%), optic neuropathy in 15 subjects (1.7%) and proptosis in 3 subjects (0.3%). Systemic antiviral therapy was commenced in 765 subjects (88.0%) and was received within 72 hours of rash onset in 468 subjects (54.9%). Topical steroid was required in 437 subjects (50.4%). Corneal scar developed in 151 (15.4%), neurotrophic keratitis in 58 (6.7%), corneal melt in 22 (2.5%) and perforation in 5 (0.6%). Elevated intraocular pressure (≥24mmHg) occurred in 169 subjects (19.5%), but glaucoma only developed in 33 subjects (3.8%). 551 recurrences were observed during the study period, with at least one recurrence in 200 subjects (23.0%). Median final visual acuity was 6/7.5 (IQR 6/6 – 6/12). MVL occurred in 169 eyes (19.8%), of whom 83 (9.6%) were due to HZO. SVL occurred in 65 eyes (7.6%), of whom 31 (3.6%) were due to HZO. On multivariate analysis older age (HR 1.038 p<0.001), Caucasian ethnicity (HR 2.344 p=0.036), poor presenting visual acuity (HR 1.978 p=0.010) and uveitis (HR 3.882 p<0.001) were associated with increased risk of MVL due to HZO. For SVL due to HZO, significant risk factors on multivariate analysis were older age (HR 1.059 p=0.001), immunosuppression (HR 3.125 p=0.028), poor presenting visual acuity (HR 2.821 p=0.002) and uveitis (HR 4.777 p=0.004).
HZO is associated with a high rate of complications and vision loss. Older age, Caucasian ethnicity, poor presenting visual acuity and uveitis are risk factors for moderate vision loss.
This is a 2020 ARVO Annual Meeting abstract.
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