Epidemiology of Herpes Zoster Ophthalmicus: Recurrence and Chronicity

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• 作者：Kimberly D. Tran ; MD¹ ; ² ; Michelle M. Falcone ; BS² ; Daniel S. Choi ; MD¹ ; ² ; Raquel Goldhardt ; MD¹ ; ² ; Carol L. Karp ; MD² ; Janet L. Davis ; MD² ; Anat Galor ; MD ; MSPH¹ ; ² ; ^{AGalor@med.miami.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：CI ; confidence interval ; HR ; hazard ratio ; HZO ; herpes zoster ophthalmicus ; HZ ; herpes zoster ; HTV ; herpes zoster virus ; MIAVHS ; Broward and Miami Veterans Administration Healthcare System ; OR ; odds ratio ; PHN ; postherpetic neuralgia ; VZV ; varicella zoster virus ; V1 ; ophthalmic branch of fifth cranial nerve
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：123
• 期：7
• 页码：1469-1475
• 全文大小：355 K

文摘

A hospital-based epidemiology study to describe herpes zoster ophthalmicus (HZO) prevalence and risk factors for recurrent and chronic disease.

Design

Retrospective, hospital-based cohort study.

Participants

All patients evaluated in the Broward and Miami Veterans Administration Healthcare System (MIAVHS) during the study period.

Methods

Retrospective medical record review of patients seen in the MIAVHS from January 1, 2010, through 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 or more after quiescence of disease was noted off therapy, and chronic HZO was defined as active disease persisting more than 90 days from initial presentation.

Main Outcome Measures

Main outcome measures included the frequency of HZO with and without eye involvement, HZO recurrence rates, and risk factors for recurrent or chronic HZO.

Results

Ninety 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). Most patients were white (73%), immune competent (79%), and did not receive zoster vaccination at any point during the 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%, and 25%, respectively. Ocular hypertension (hazard ratio [HR], 4.6; 95% confidence interval [CI], 1.3–16.5; odds ratio [OR], 6.7; 95% CI, 1.5–31.2) and uveitis (HR, 5.7; 95% CI, 1.7–19.0; OR, 6.7; 95% CI, 1.5–31.2) increased the risk of recurrent and chronic disease.

Conclusions

This study supports newer data indicating 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.