MAY 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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April 2013 EW CORNEA Contact information 51 Liesegang: tliesegang@mayo.edu Pepose: 636-728-0111, jpepose@peposevision.com Chan: clarachanmd@gmail.com Holland: 859-331-9000, eholland@holvision.com I/A HANDPIECE Excellent for Use in ALL Phases of I/A HZO iridocyclitis Source (all): Vincent de Luise, MD Jay Pepose, MD, director, Pepose Vision Institute, and professor of clinical ophthalmology, Washington University School of Medicine, St. Louis, agreed that it remains unclear whether the recurrence stems from a reactivation of latent varicella-zoster, from the vaccine strain itself or from a boost in immunity. Reports of acute retinal necrosis—including isolation of the vaccine strain in one—and exacerbation of zoster interstitial keratitis and keratouveitis after vaccination have led Dr. Pepose to elicit histories of any immunosuppressive drugs or immunosuppressive conditions in patients that may contraindicate vaccination. Dr. Pepose does not recommend the vaccine in patients who are immunocompromised, including those who have HIV/AIDS or cancers affecting the bone marrow or leukemias or lymphoma, or those undergoing chemotherapy or taking immunosuppressive medications. He also recommends against the zoster vaccine for patients who are allergic to neomycin, gelatin, or other components of the vaccine. Ultimately, Dr. Pepose recommends the zoster vaccine for patients with a history of HZO but he carefully monitors them following vaccination. "I would schedule patients with a history of prior HZO to be examined after zoster vaccination and warn them of symptoms to look for," he said. EW References 1. Hwang CW, Steigleman WA, SaucedoSanchez E, Tuli SS. Reactivation of herpes zoster keratitis in an adult after varicella zoster vaccination. Cornea. 2013; 32 (4): 508509. 2. Sham CW, Levinson RD. Uveitis exacerbation after varicella-zoster vaccination in an adult. Arch Ophthalmol. 2012; 130 (6): 793794. 3. Khalifa YM, Jacoby RM, Margolis TP. Exacerbation of Zoster interstitial keratitis after zoster vaccination in an adult. Arch Ophthlmol. 2010; 128 (8): 1079. 4. Nagpal A, Vora R, Margolis TP, et al. Interstitial keratitis following varicella vaccination. Arch Ophthalmol. 2009; 127(2): 222-223. 5. Naseri A, Good WV, Cunningham ET Jr. Herpes zoster virus sclerokeratitis and anterior uveitis in a child following varicella vaccination. Am J Ophthalmol. 2003; 135(3): 415417. 6. Mills R, Tyring SK, Levin MJ, et al. Safety, tolerability and immunogenicity of zoster vaccine in subjects with a history of herpes zoster. Vaccine 2010; 28: 4204-4209. Editors' note: The physicians have no financial interests related to this article. Flexible Tip Smooth Irrigation and Aspiration Ports www.StorzEye.com/CapsuleGuard MICS 1.8mm Incision Enhanced Visualization from Semi-transparent Silicone 2.2mm - 2.8mm Incision Flexible Sleeve Design Conforms to Wound to Seal Incision Designed with No Sharp Edges to Reduce Risk of Capsule Rupture Straight Curved 45° Available in 3 Tip Styles and 2 Incision Sizes Available in Tip Styles and Incision Sizes CALLYOUR INSTRUMENT SPECIALIST CALLYOUR INSTRUMENT SPECIALIST AT 1-800-338-2020 TO ORDER AT 1-800-338-2020 TO ORDER OR TO REQUEST A TRIAL OR TO REQUEST TRIAL ®/™ are trademarks of Bausch & Lomb Incorporated or its afliates.. © Bausch & Lomb Incorporated.. ®/™ are trademarks of Bausch Lomb Incorporated or its afliates Bausch Lomb Incorporated

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