Current Practice Patterns and Opinions on the Management of Recent-Onset or Chronic Herpes Zoster Ophthalmicus of Zoster Eye Disease Study Investigators

Lo, Danielle; Jeng, Bennie H.; Gillespie, Colleen; Wu, Mengfei; Cohen, Elisabeth J.

doi:10.1097/ico.0000000000001732

Cited by 21 publications

(10 citation statements)

References 14 publications

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“…The treatment of HZK centres on oral and/or topical antivirals for active epithelial disease and topical steroids for immunemediated stromal and endothelial disease. [22][23][24]27 HZK is often recurrent or chronic, sometimes complicated by NK, and can ultimately lead to stromal scarring or endothelial dysfunction, possibly requiring surgery. 8 Vaccination is an effective method of decreasing the incidence of HZO.…”

Section: Discussionmentioning

confidence: 99%

“…8 In a survey from 2012, 27 56% of corneal specialists reported that they believed oral antiviral prophylaxis was effective, and that number increased to 71% in a 2019 survey. 22 In a retrospective study by Miserocchi and colleagues, 35% of eyes affected by HZO and 39% of eyes affected by HSV had fewer episodes of inflammation with use of low-dose antiviral prophylaxis. 35 As this decrease in HSV recurrence was similar to that found in the Herpetic Eye Disease Study, 36 it is possible that low-dose, suppressive antiviral therapy could also work for HZ.…”

Section: Chronic and Recurrent Herpes Zoster Keratitismentioning

confidence: 99%

“…21 Oral antiviral treatment options for HZ include 1 g valacyclovir three times daily, 800 mg acyclovir five times daily or 500 mg famciclovir three times daily, with initiation of therapy within 72 hours of symptom onset for a duration of 7-10 days. [22][23][24]…”

Section: General Presentation and Management Of Herpes Zoster Ophthal...mentioning

confidence: 99%

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A Review of Treatment for Herpes Zoster Keratitis

Mohammed¹,

Cohen²,

Jeng³

2021

US Ophthalmic Review

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Section: Discussionmentioning

confidence: 99%

Section: Chronic and Recurrent Herpes Zoster Keratitismentioning

confidence: 99%

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A Review of Treatment for Herpes Zoster Keratitis

Mohammed¹,

Cohen²,

Jeng³

2021

US Ophthalmic Review

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“…Surveys of ZEDS study investigators at the start of enrollment in 2017 and 2 years later showed that an increasing percentage of investigators believe that suppressive antiviral treatment is effective in HZO and that this is contributing to enrollment below expectations. 13,14 Challenges with enrollment below expectations led to expansion of participating clinical centers (PCCs) to Canada and New Zealand, as well as modifications in statistical power and study population calculations (see PCC selection and Statistical considerations sections).…”

Section: Trial Overview and Aimsmentioning

confidence: 99%

Zoster Eye Disease Study: Rationale and Design

Cohen

Hochman

Troxel

et al. 2022

Cornea

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The purpose of this study was to describe the rationale and design of the Zoster Eye Disease Study (ZEDS).Methods: ZEDS is a National Eye Institute-supported randomized clinical trial designed to determine whether 1 year of suppressive valacyclovir in patients with herpes zoster ophthalmicus (HZO) reduces complications because there is currently no high-quality evidence to support its use. Eligible patients are 18 years and older, immunocompetent, have a history of a typical rash at disease onset, and have had a record of active epithelial or stromal keratitis or iritis within 1 year before enrollment. Exclusion criteria include estimated glomerular filtration rate less than 45 or pregnancy. The primary endpoint is the time to first occurrence of new or worsening dendriform epithelial keratitis, stromal keratitis without or with ulceration, endothelial keratitis, or iritis due to HZO during 12 months of study treatment requiring prespecified treatment changes. The study has 80% power to detect a 30% difference between treatment groups, with a 30% rate of endpoints by 1 year assumed among controls. Secondary and exploratory questions include whether there is a persistent treatment benefit during the 6 months after treatment, whether development of postherpetic neuralgia varies by treatment group, and whether vaccinations against herpes zoster affect study outcomes and coronavirus disease 19 status.Results: Over approximately 4 years, over 400 study participants have been enrolled.Conclusions: ZEDS aims to provide scientific evidence on whether suppressive valacyclovir treatment improves outcomes in HZO and should become the standard of care.

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“…Currently, many clinicians use prolonged oral antivirals in this patient population; studies, such as the Zoster Eye Disease Study (ZEDS), are currently being undertaken to determine optimal practice. 16 Finally, a comprehensive review of a patient's complete history of systemic pathologies and initiation of appropriate topical antimycotic therapy are of paramount importance to help decrease the need for surgical intervention and optimize the potential for visual rehabilitation in this challenging patient population. In our patient's situation, despite advanced PLK at the time of presentation, she responded favorably well to topical voriconazole and did not require any surgical intervention.…”

Section: Dovepressmentioning

confidence: 99%

<p>Temporal Profile and Treatment of <em>Purpureocillium lilacinum</em> Keratitis Secondary to Herpes Zoster Reactivation Following Influenza Vaccination</p>

Nguyen

Parikh

Batliwala

et al. 2020

IMCRJ

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Purpose: To report a temporal profile of Purpureocillium lilacinum keratitis (PLK) secondary to immune dysfunction induced by the combination of reactivation of herpes zoster dermatitis and recent influenza vaccination that suggests a possible association, including successful medical management. Methods: A 64-year-old contact lens wearer presented with left eye keratitis days after receiving an influenza vaccination and subsequent development of herpes zoster lesions on the flank. Patient was initially treated for bacterial keratitis with fortified antibiotics and oral valacyclovir for her concurrent zoster. Pharmacotherapy was changed to topical voriconazole after cultures were positive for Purpureocillium lilacinum. Topography and anterior segment OCT demonstrated scarring at multiple levels within the cornea with irregular astigmatism. A literature review was conducted to identify mechanisms that demonstrate a temporal link between influenza vaccination, herpes zoster reactivation, and fungal keratitis. Results: After the conclusion of topical therapy, the central corneal infiltrate regressed and a partial light-blocking anterior stromal scar remained. Best corrected visual acuity improved from 20/400 to 20/25. Conclusion: Transient systemic immune dysregulation, secondary to influenza vaccination and reactivation of systemic herpetic disease, compounded by contact lens wear, may create a favorable environment for opportunistic fungal keratitis. This case highlights the importance of adequately assessing and treating for existing comorbidities in the successful treatment of mycotic keratitis.

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Current Practice Patterns and Opinions on the Management of Recent-Onset or Chronic Herpes Zoster Ophthalmicus of Zoster Eye Disease Study Investigators

Cited by 21 publications

References 14 publications

A Review of Treatment for Herpes Zoster Keratitis

A Review of Treatment for Herpes Zoster Keratitis

Zoster Eye Disease Study: Rationale and Design

<p>Temporal Profile and Treatment of <em>Purpureocillium lilacinum</em> Keratitis Secondary to Herpes Zoster Reactivation Following Influenza Vaccination</p>

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