Prevention of herpetic reactivation

Ophthalmic surgeons should take precautions in eyes with a history of herpes simplex ophthalmicus (HSO) and herpes zoster ophthalmicus (HZO), said Marc Labetoulle MD, Hôpital Bicêtre, Paris, France. Speaking at the 23rd ESCRS Winter Meeting in Athens, Dr Labetoulle noted that surgery involving the cornea brings with it several triggering factors for the reactivation of HSV and HZO, including nerve trauma and steroids and inflammation. It is therefore vital to check the herpes simplex virus (HSV) and Varicella zoster virus (VZV) status when planning corneal surgery. If a patient is at risk, they should receive prophylactic treatment with antiviral medication such as acyclovir or famciclovir at least two days before the procedure and the treatment should be prolonged at least as long as postoperative steroid treatment. He added that only systemic treatment is logical in such cases. Research indicates that the recurrence rate Is only 12% with systemic treatment, compared to over 50% with topical treatment. In addition, the rate of graft rejection is 52% with topical treatment compared to 20% in systemic treatment. Dr Labetoulle pointed out that the epidemiology of HZO has already been changing since the advent it the Varicella vaccine. “Doctors should promote vaccination and that needs more medical education to the general populace,” he added