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Microbiology and Immunology Group
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2021 OMIG Abstract
Herpes Zoster Ophthalmicus: Incidence and Risk Factors for Developing Severe Ocular Manifestations
Aidan Dmitriev1, Jamie Odden1, David Mora-Boellstorff1, John Viehman2, Kathleen Sheridan2,
Paul Kinchington1, Regis P. Kowalski1, José-Alain Sahel1, Vishal Jhanji1, and Marie-Hélène Errera1
1Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA; 2Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA
Purpose: To investigate the incidence of herpes zoster ophthalmicus (HZO) and associated ocular manifestations, and to identify risk factors for developing rare and severe ocular manifestations..
Methods: We reviewed institutional databases of uveitis and herpes zoster (HZ) ICD codes to determine the incidence of HZO relative to uveitis cases of all causes and to HZ cases involving any dermatome. Clinical information was also obtained for polymerase chain reaction-confirmed cases of HZO to determine the incidence of specific ocular manifestations thereof and risk factors for developing rare and severe manifestations. All cases were seen at the University of Pittsburgh Medical Center between January 2011 and January 2021.
Results: There were 1052 cases of HZO, 5948 cases of uveitis of all causes, and 52261 cases of HZ involving any dermatome over the study period. The incidence of HZO among all HZ cases was significantly higher in 2016-2020 (22.2 – 25.2 cases/1000 person-years) than in 2011 (9.2 cases/1000 person-years; P < .0001 by chi-squared test). A similar increase in incidence of HZO was also seen among all uveitis cases, with 21.6 – 24.6 cases/100 person-years in 2016-2020 compared to 10.9 cases/100 person-years in 2011 (P < .0001 by chi-squared test). Of 50 PCR-confirmed cases, 19 were classified as rare and severe including 15 of acute retinal necrosis and 1 each of optic neuritis, orbital apex syndrome, panuveitis, and preseptal cellulitis complicated by sepsis. The other cases that occur more frequently in HZO included 13 of keratitis, 10 of anterior uveitis, 4 of conjunctivitis, and 2 each of preseptal cellulitis and blepharitis. Patients who developed rare and severe manifestations were more likely to be immunosuppressed (OR 4.55, 95% CI 1.29 – 13.83) or diabetic (OR 4.68, 95% CI 1.32 – 16.83) compared to those with more frequent manifestations.
Conclusions: To our knowledge, there are only three existing studies of trends in HZO incidence. At our institution, the incidence of HZO has increased between 2011 and 2020, although it remained relatively stable between 2016 and 2020. Several PCR-confirmed cases of HZO were classified as rare and severe, and these were more likely to occur in immunosuppressed and diabetic patients.
Disclosure: N
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