Recurrence of herpetic keratouveitis following cataract surgery

Herpetic eye disease (HED) is a leading cause of infectious vision loss worldwide. Cataract surgery is known to be implicated in triggering the recurrence of herpes keratouveitis. This study evaluates the current evidence on the association between HED and cataract surgery, focusing on the risk factors and potential pathogenic mechanisms and preventive strategies involved with reactivation or new-onset herpes-related keratitis, uveitis, or keratouveitis.

A comprehensive search of databases (Cinahl, Embase, Scopus, ProQuest, Web of Science, and PubMed) was conducted to identify articles describing the association between new onset or reactivation of HED after cataract surgery up to March 2024. A total of 24 studies were included.

The heterogeneity of the studies precluded systematic analysis. However, the findings suggest that the herpetic recurrence rate, mainly in the form of keratitis, after cataract surgery is high (approximately 40%), mostly occurring ≤ 2 years after surgery, and can be influenced by factors such as topical corticosteroids, the quiescent time before surgery, and history of prior recurrences, and the patient's comorbidities, including diabetes and atopy. The current evidence for prescribing perioperative HED prophylaxis is of inadequate quality.

Available evidence suggests that herpetic recurrences tend to occur in the first two years after cataract surgery. A longer quiescent time before surgery might reduce the risk of recurrence. Prospective studies analyzing the effects of perioperative prophylaxis are needed.