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Vol. 97. Issue 3.
Pages 149-160 (March 2022)
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Vol. 97. Issue 3.
Pages 149-160 (March 2022)
Review
Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery
Evidencia en la prevención de la recurrencia de queratitis por herpes simple y herpes zóster tras cirugía ocular
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M. Gessa-Sorrochea, P. Kanclerzb, J. Alioc,
Corresponding author
rdioa@vissum.com

Corresponding author.
a Hospital Universitario Virgen Macarena, Grupo Miranza, Sevilla, Spain
b Hygeia Clinic, Gdańsk, Poland
c Vissum Grupo Miranza, Alicante, Spain
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Table 1. Level of evidence and grade of recommendation for oral HED prophylaxis after ocular surgery.
Table 2. Available evidence on the prevention of herpetic keratitis after ocular surgery.
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Abstract
Objective

Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.º Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO.

Methods

An exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019.

Results

There is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis.

Conclusions

Penetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals.

Keywords:
Cataract surgery
Herpetic stromal keratitis
Herpes zoster ophthalmicus
Keratoplasty
LASIK
Refractive surgery
Resumen
Propósito

La queratitis herpética, ya sea por herpes simple (HSK) o por herpes zóster (HZO) puede recurrir tras cirugía ocular. Se postula como necesaria una profilaxis para evitarla. El objetivo de este estudio es revisar la evidencia científica sobre los métodos preventivos empleados en el período perioperatorio en pacientes previamente afectados de HSK/HZO.

Métodos

Se ha realizado una búsqueda exhaustiva en las bases de datos PubMed y Web of Science para identificar artículos relevantes sobre profilaxis y riesgo de recurrencia de HSK/HZO en pacientes sometidos a cirugía ocular hasta el 31 de diciembre de 2019.

Resultados

Hay pruebas sólidas de que la profilaxis oral debe recomendarse tras una queratoplastia penetrante en pacientes que hayan sufrido previamente HSK/HZO. Para otros tipos de cirugías, la evidencia es menos convincente; sin embargo, debe considerarse un período latente de inactividad entre la enfermedad y profilaxis oral.

Conclusiones

La queratoplastia penetrante y lamelar, crosslinking corneal, cirugía de catarata y cirugía fotorrefractiva y fototerapéutica provocan una alteración del plexo nervioso sub-basal de la cornea. Debido al traumatismo quirúrgico, así como a la modulación de la respuesta inmunológica ocular causada por los esteroides aplicados en el postoperatorio, es posible inducir la reactivación de HSK/HZO, siendo en algunos casos común. Dentro del presente artículo discutimos la evidencia disponible para la profilaxis de HSK/HZO en cirugía ocular. Son necesarios estudios adicionales para definir el riesgo real de recurrencia de HSK/HZO después de cirugías oculares, particularmente en cirugía de catarata y para confirmar la eficacia de la profilaxis perioperatoria con antivíricos anti HSK/HZO.

Palabras clave:
Cirugía de cataratas
Queratitis estromal herpética
Herpes zoster oftálmico
Queratoplastia
LASIK
Cirugía refractiva

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