Abstract
Purpose :
To report the epidemiology of herpes zoster ophthalmicus (HZO) and herpes zoster vaccination in an urban hospital system and to examine rates of ocular complications in HZO.
Methods :
A retrospective chart review of patients with herpes zoster (HZ), HZO with ocular involvement based on ICD-9 and ICD-10 codes, and any shingles vaccination based on CPT codes at University of Illinois Hospital systems from 2010-2021 was performed. For patients with HZO, demographic information, medications, exam findings, and ocular complications at 6 months and 1 year after initial encounter were recorded.
Results :
During the study period, 1872 patients out of 1,009,419 patients over age 18 had HZ (0.19%) and 209 patients had HZO (11.2%).
Of 119 patients diagnosed with HZO with ocular involvement, mean age was 58.7 years, 56.7% were female, and 30.8% were Caucasian. 93.3% received antivirals and 25% were immunocompromised. There was a mean of 5.2 days between symptom onset and treatment initiation.
Ocular involvement included 60 cases of conjunctivitis (50.4%), 51 epithelial keratitis (42.9%), 44 stromal keratitis (37%), 21 endothelial keratitis (17.6%), 40 uveitis (33.6%). In total, 43 patients developed ocular complications within 1 year; 33 and 36 patients at 6 months and 1 year, respectively. Ocular complications included: corneal scarring or neovascularization (42.4%), keratitis (23.5%), reduced corneal sensation (20.5%), glaucoma (7.6%), and uveitis (6.1%).
Of patients who developed complications, 70% were female and 44% were Caucasian. 97.6% were prescribed antivirals, 40% were prescribed steroids, and 35.1% were immunocompromised. Initial ocular presentation included 13 conjunctivitis (32.5%), 17 epithelial keratitis (40.5%), 24 stromal keratitis (57.1%), 10 endothelial keratitis (25%), 16 uveitis (39%). Stromal keratitis (OR 4.7; 95% CI 1.66, 13.42) and female gender (OR 3.7; 95% CI 1.29, 10.82) were significantly associated with a higher risk for ocular complications in HZO.
Of 350,196 adults over 50 years eligible for vaccination, 3280 (0.94%) received Shingrix and 2568 (0.73%) received Zostavax. Of patients who received any shingles vaccination, mean age was 62.6 years, 60% were female, and 48.8% were Black.
Conclusions :
In an urban hospital system and tertiary care ophthalmology clinic, over 35% of patients with HZO developed ocular complications. Rates of shingles vaccination were very low at less than 1% of the eligible population.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.