[Recurrence of herpetic eye disease following cataract surgery: risk factors and prevention]

Herpetic eye disease poses a significant challenge in cataract surgery. On the one hand, patients with a history of herpes infections develop cataracts more rapidly and the surgery itself is associated with a higher rate of intraoperative complications. On the other hand, the risk of herpetic recurrence after cataract surgery is markedly increased (46% for herpes simplex virus and up to 40% for herpes zoster virus). The prognosis is significantly worse in the event of a recurrence, which is why reducing the recurrence rate is of great clinical interest. Preoperatively, attention should be paid to signs of prior herpes infections, such as corneal scars, neovascularization, synechiae and neurotrophic keratopathy. Risk factors for recurrence include the duration of quiescence, the number of previous episodes, a temporal tunnel incision, immunosuppressive therapy, diabetes mellitus and atopy. Prophylactic perioperative antiviral therapy is frequently used; however, randomized data specifically addressing cataract surgery are lacking, so that current recommendations are largely based on indirect evidence and expert consensus.