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    Taking on surgery in HSV patients

    Surgeons weigh best candidates, benefits against risks of stimulating recurrence of herpes simplex virus

    Cataract and refractive surgeons should use prophylaxis to avoid reactivation of the herpes simplex virus (HSV) in patients with a history of infection with this virus, according to Elizabeth Yeu, MD.

    “We have to be mindful of the examination process and make sure they have as healthy a cornea as possible,” said Dr. Yeu, assistant professor, Eastern Virginia Medical School, and partner, Virginia Eye Consultants, Norfolk, VA.

    Dr. Yeu offered tips on treatment, topical steroid protocols, and postoperative warning signs that the virus has been activated.

    HSV is ubiquitous, she said, citing a study—AAO Basic and Clinical Science Course, External Disease and Cornea, 2010-2011—that found HSV-1, a virus that causes cold sores, present in almost all autopsies of people over the age of 60 years in the United States.

    HSV-1 generally starts with an oral-labial infection, whereas HSV-2 starts with a genital infection. The virus spreads from the site of the initial infection to neurons at other sites. The virus can lie dormant for years until a stressor reactivates it, potentially causing epithelial keratitis, Dr. Yeu said.

    HSV is the one of the most common causes of corneal infections and can cause blindness.

    The fewer episodes of HSV keratitis that the patient has experienced, and the more time has passed since these infections, the safer the surgery is likely to be, she noted.

    Other considerations include the type of recurrence, whether epithelial, stromal, or endotheliitis; the degree of inflammation; and whether the infection developed despite prophylaxis.

    Always risk

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