Microbiology and Immunology Group
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OMIG Abstract 1
Epidemiology of Herpes Zoster Ophthalmicus: Recurrence and Chronicity
Kimberly D. Tran, MD1,2, Michelle M. Falcone, BS3, Daniel S. Choi, MD1,2, Raquel Goldhardt, MD1,2,
Carol L. Karp, MD2, Janet L. Davis, MD2, Anat Galor, MD, MSPH1,2
1Ophthalmology service, Miami Veterans Administration Medical Center, Miami, Florida, USA
2Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
3University of Miami Miller School of Medicine, Miami, Florida, USA
Purpose – To provide a hospital-based epidemiology study on the prevalence of herpes zoster ophthalmicus (HZO) with ocular involvement, and identify risk factors associated with recurrent and chronic disease.
AAO DISCLOSURE CODE: S Funding: Supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research and Development’s Career Development Award CDA-2-024-10S (Dr. Galor), NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant, Department of Defense (DOD- Grant#W81XWH-09-1-0675 and Grant# W81XWH-13-1-0048 ONOVA) (institutional), The Ronald and Alicia Lepke Grant, The Lee and Claire Hager Grant, The Jimmy and Gaye Bryan Grant
Design – Retrospective, hospital-based cohort study
Participants – All patients evaluated in the Broward and Miami VA Healthcare System (MIAVHS) during the study period January 1, 2010 and December 31, 2014 (N=119,569).
Methods – Retrospective review of all patients in the MIAVHS with a confirmed HZ diagnosis from January 1, 2010 to December 31, 2014 using medical records review. Simple frequencies were calculated, and when appropriate, frequencies and means were compared using Chi-squared tests and two-sample t-tests, respectively. Kaplan-Meier survival curve was used to describe recurrence of disease, Cox proportional hazard analysis was used to evaluate risk factors for recurrence, and logistic regression to evaluate risk factors for chronicity.
Main Outcome Measures – 1) Clinical diagnosis of HZO with eye involvement; 2) Recurrence of disease.
Results – 119,569 patients total were evaluated at the MIAVHS within the study period. 90 patients had a confirmed medically documented episode of HZO, and 60 had documented ocular involvement. First reactivation of HZ was most common in the 5th, 6th, and 7th decades of life (18%, 32%, 22%, respectively). The most frequent ophthalmic manifestations on first episode included conjunctivitis/episcleritis (44%), uveitis (26%), and epithelial keratitis (25%), followed by ocular hypertension (12%), stromal keratitis (11%), and endotheliitis (5%). 69% had an acute course, 17% had recurrent disease following resolution of the acute episode, and 13% had chronic disease that required either greater than 90 days to resolution, and/or never resolved. The 1, 2, and 5 year recurrence rates in those with initial resolution of disease were 5%, 8%, and 24%, respectively. Furthermore, the risk of recurrence continued to increase even after 5 years. Immune status, gender, age, and vaccination status were not significant predictors of recurrence. Risk factors associated with chronic disease were uveitis (OR=7.00, CI 1.78-27.56, p=0.01), elevated intraocular pressure (OR=8.00, CI 1.68-38.06, p=0.01), post herpetic neuralgia (PHN) (OR=4.50, CI 1.22-16.66, p=0.02), and increased number of ophthalmic complications on presentation (OR=2.57, CI 1.31-5.05, p=0.01).
Conclusion – Traditionally studied as a monophasic illness, this study supports newer data that a significant proportion of patients experience disease recurrence and chronic sequelae. Further study is needed to guide preventative and therapeutic approaches in those with recurrent disease.
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