Rushmia Karim – [email protected] Update 9 contact Cataract & refractive

per cent of respondents in favour of and 12-month regimen of acyclovir could 41.2 per cent against the practice, Dr Karim reduce recurrences of herpetic stromal said. Among those in favour of antiviral keratitis by around half, from 28 per cent to HSV and cataract prophylaxis, acyclovir was the treatment of 14 per cent, during six months of follow- choice and 85 per cent said they would start up (Herpetic Eye Disease Study Group N Survey finds practice variations in prophylaxis treatment seven days preoperatively. Engl J Med. 1998 ;339:300-306). However, against recurrence of herpetic eye disease On the other hand, 72.48 per cent said that study did not concern patients they would not start topical antiviral undergoing cataract surgery. by Roibeard O’hEineachain in Warsaw treatment and 81.9 per cent said they would “At present we have no prospective not change the steroid regimen from their comparative studies that look at the usual practice in such cases. relationship between herpetic eye disease Regarding the quiescent period necessary and cataract surgery. And our own Royal survey of UK corneal specialists Royal College of Ophthalmologists in the before cataract surgery among patients College of Ophthalmologists in the United reflects the lack of guidelines for United Kingdom currently registered as currently receiving systemic antiviral Kingdom has no specific guidelines for the prevention of the recurrence cornea consultants. They received 72 replies treatment, 10 per cent of consultants said patients with HSV [herpes simplex virus] of herpetic eye disease in from the 106 cornea consultants contacted. that they would operate on patients with who are going to undergo cataract surgery. patients undergoing cataract surgery, The questionnaire consisted of two A under three months of quiescent disease, There are also no published guidelines in said Rushmia Karim MD, Whipps Cross parts, the first part dealt with patients with 39.57 per cent said they would require three the medical literature in Australia, America University Hospital, London, UK. Evripidis cataracts and herpetic eye disease who were to six months disease quiescence, 19.1 per or Europe,” Dr Karim said. Sykakis MD, from the same hospital, not currently receiving acyclovir, and the cent would require between six to12 months She noted that the apparent consensus supervised the research. second part dealt with patients with the two and 8.8 per cent would require over 12 among UK corneal specialists is that there The results of the survey showed that the pathologies who were currently receiving months. Oral antiviral treatment was not should be a minimum period of quiescence great majority of respondents advocated a the antiviral agent. increased in 80.9 per cent of replies. ranging from three months to one year disease quiescent period of several months prior to cataract surgery but consultants before performing cataract surgery, but Quiescent period necessary Dr Karim noted that are almost equally divided on the use of there was much less agreement regarding Regarding patients not currently receiving Better guidelines ocular herpes simplex disease is the leading antiviral prophylaxis. Among those in antiviral prophylaxis, Dr Karim told the antiviral treatment, nearly all respondents infectious cause of corneal blindness in the favour of antiviral prophylaxis all would opt 17th ESCRS Winter Meeting. recommended a period of several months of developed world. Furthermore, in a UK for acyclovir, most likely because it is easily “This survey highlights the need for disease quiescence before offering surgery. study, a third of patients with the condition available and cost-effective and because it further clinical studies regarding pre-, peri- That is, 62.3 per cent of consultants said had vision loss severe enough to warrant was the agent used in HEDS trial. and postoperative prophylaxis for patients they would require a quiescent period of penetrating keratoplasty. That degree of “Our survey’s findings indicate that with herpetic eye disease undergoing three to six months before surgery, 24.6 vision loss occurred after a mean of 6.8 in patients with herpetic eye disease the cataract surgery. At present, there is only per cent said they would require a period recurrences (Claoué et al, Br J Ophthalmol cataract pathway is different from the anecdotal evidence to support initiation of more than six months, 10.1 per cent 1988; 72 ; 530-533). routine cataract surgery pathway that we of prophylactic treatment prior to cataract said they would require at least 12 months Ocular surgery is one of many factors usually deal with, and I think we do need surgery, or for recommendations regarding quiescence, and 0.9 per cent said they which can contribute to the re-activation some prospective clinical studies for this the timing of drug initiation, dosage and would require less than three months. of herpetic eye disease. The Herpetic Eye condition,” Dr Karim concluded. duration of treatment,” she added. Opinions were more divided regarding Disease Study Group were able to show The paper will be published in the June Dr Karim and associates sent a practice- the use of systemic antiviral prophylaxis in in a randomised controlled trial that a edition of JCRS. style questionnaire to all members of the patients not receiving such agents, with 58.8

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EUROTIMES | Volume 18 | Issue 6