Epidemiology of Herpes Zoster Ophthalmicus Recurrence and Chronicity

Kimberly D. Tran, Michelle M. Falcone, Daniel S. Choi, Raquel Goldhardt, Carol Karp, Janet L Davis, Anat Galor

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Purpose 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.

Original languageEnglish (US)
Pages (from-to)1469-1475
Number of pages7
JournalOphthalmology
Volume123
Issue number7
DOIs
StatePublished - Jul 1 2016

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Herpes Zoster Ophthalmicus
Epidemiology
Recurrence
Confidence Intervals
United States Department of Veterans Affairs
Eye Diseases
Exanthema
Chronic Disease
Odds Ratio
Outcome Assessment (Health Care)
Hospital Design and Construction
Delivery of Health Care
Ocular Hypertension
Uveitis
Herpes Zoster

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Epidemiology of Herpes Zoster Ophthalmicus Recurrence and Chronicity. / Tran, Kimberly D.; Falcone, Michelle M.; Choi, Daniel S.; Goldhardt, Raquel; Karp, Carol; Davis, Janet L; Galor, Anat.

In: Ophthalmology, Vol. 123, No. 7, 01.07.2016, p. 1469-1475.

Research output: Contribution to journalArticle

Tran, Kimberly D. ; Falcone, Michelle M. ; Choi, Daniel S. ; Goldhardt, Raquel ; Karp, Carol ; Davis, Janet L ; Galor, Anat. / Epidemiology of Herpes Zoster Ophthalmicus Recurrence and Chronicity. In: Ophthalmology. 2016 ; Vol. 123, No. 7. pp. 1469-1475.
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abstract = "Purpose 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.",
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AU - Falcone, Michelle M.

AU - Choi, Daniel S.

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AU - Karp, Carol

AU - Davis, Janet L

AU - Galor, Anat

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N2 - Purpose 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.

AB - Purpose 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.

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