title: Prevalence of Ocular Manifestations and Visual Outcomes in Patients With Herpes Zoster Ophthalmicus.
abstract: OBJECTIVE
  To investigate the prevalence of ocular manifestations and visual outcomes in patients with herpes zoster ophthalmicus (HZO).
  
  
  METHODS
  Consecutive cases diagnosed with HZO who attended 2 hospitals between July 1, 2011, and June 30, 2015, were retrospectively reviewed. Patient demographics, clinical presentations, and management were reviewed. The logistic regression model was used to estimate the odds ratio of visual loss with ocular manifestations.
  
  
  RESULTS
  A total of 259 patients were included. Of these, 110 (42.5%) patients were <60 years old and 149 patients (57.5%) were ≥60 years old. None of the patients had received zoster vaccination before presentation. Ocular manifestations were present in 170 (65.6%) patients with no difference between both age groups (P = 0.101). Conjunctivitis was the most common ocular manifestation, followed by anterior uveitis and keratitis. After resolution of HZO, 58.7% of patients had a visual acuity of 6/12 or worse. Epithelial keratitis and stromal keratitis were independent risk factors for visual loss after resolution of HZO (P = 0.003 and P = 0.004, respectively). The corresponding odds ratio was 6.59 [95% confidence interval (CI): 1.87-23.19] and 7.55 (95% CI: 1.88-30.30), respectively. The number of ocular manifestations was also associated with an increased risk of visual loss with an odds ratio of 1.49 (95% CI: 1.01-2.20; P = 0.043).
  
  
  CONCLUSIONS
  A substantial proportion of patients with HZO were <60 years old in this study. The absence of zoster vaccination across the study cohort was noteworthy. Keratitis was the main reason for poor visual outcome in these patients.
authors.affiliation: *Hong Kong Eye Hospital, Kowloon, Hong Kong, China; †Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China; and ‡Department of Ophthalmology, The University of Hong Kong, Hong Kong, China.
authors.forename: Simon K H
authors.initials: SK
authors.lastname: Szeto
authors.forename: Tommy C Y
authors.initials: TC
authors.lastname: Chan
authors.forename: Raymond L M
authors.initials: RL
authors.lastname: Wong
authors.forename: Alex L K
authors.initials: AL
authors.lastname: Ng
authors.forename: Emmy Y M
authors.initials: EY
authors.lastname: Li
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
mesh_terms: D015075:2-Aminopurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D003236:Conjunctivitis, Viral / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D000077595:Famciclovir; D005260:Female; D006563:Herpes Zoster Ophthalmicus / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D014605:Uveitis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D014786:Vision Disorders / Q000453:epidemiology / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015075:2-Aminopurine; D000077595:Famciclovir; D000212:Acyclovir