Purpose
A hospital-based epidemiology study to describe herpes zoster ophthalmicus (HZO) prevalence, and identify risk factors for recurrent and chronic disease.
Design
Retrospective, hospital-based cohort study
Participants
All patients evaluated in the Broward and Miami VA Healthcare System (MIAVHS) during the study period.
Methods
Retrospective medical record review of patients seen in the MIAVHS from January 1, 2010 and December 31, 2014 with a HZO clinical diagnosis. Assessment of the patient's clinical course was defined by the following: an acute episode of HZO was defined as quiescence of disease within 90 days of initial presentation; HZO recurrence was defined as any recurrent eye disease or rash >90 days after quiescence disease was noted off therapy; chronic HZO was defined as active disease persisting greater than 90 days from initial presentation.
Main Outcome Measures
1) Frequency of HZ involving the V1 dermatome (HZO) with and without eye involvement; 2) HZO recurrence rates 3) Risk factors for recurrent or chronic HZO.
Results
90 patients with HZO were included in the study. The mean age at incident episode of HZO was 68±13.8 years (range, 27-95 years). The majority of patients were white (73%), immune competent (79%), and did not receive zoster vaccination at any time point in their follow up (82%). Patients were followed for a mean of 3.9±5.9 years, (range, 0-33 years). The period prevalence of HZ in any dermatome was 1.1%, the frequency of HZ involving V1 (HZO) was 0.07% and the frequency of HZO with eye involvement was 0.05%. The overall 1, 3, and 5-year recurrence rates for either recurrent eye disease or rash were 8%, 17%, 25%, respectively. Ocular hypertension (HR 4.6, 95% Cl 1.3-16.5; OR 6.7, 95% Cl 1.5-31.2) and uveitis (HR 5.7, 95%CI 1.7-19.0; OR 6.7, 95% C1 1.5-31.2) increased the risk of recurrent and chronic disease.
Conclusion
This study supports newer data that a significant proportion of patients experience recurrent and chronic HZO. Further study is needed to guide preventative and therapeutic approaches to recurrent and chronic HZO.
At our center, >40% of patients requiring FRRS for NTOS are competitive athletes. The results of this study show that the majority of them are able to return to their precompetitive state after FRRS, and few experience limitations in their daily living activities. Half can return to competition at or exceeding their premorbid ability level within 6 months of surgery. The majority are pleased with their decision to undergo FRRS. Further investigation is needed to identify predictive factors for successful return to competitive athletics.
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