Eyeworld

EW CORNEA 58 May 2016 by Liz Hillman EyeWorld Staff Writer Caregivers should consider avoiding the vaccine in patients with a history of zoster keratitis, expert says T hanks to a widespread vaccination program in the U.S., gone are the days—for the most part—of children being lathered up with cal- amine lotion as they're told not to scratch the itchy, red dots covering them from head to toe. But even though the varicella zoster virus vac- cine has been relatively mainstream for more than 2 decades, the long- term effects of the solution meant to prevent one from acquiring irksome chickenpox are still emerging. Recent research from the University of Missouri School of Medicine found a link between the chickenpox vaccine and corne- al inflammation. A review of the National Registry of Drug-Induced Ocular Side Effects, which collects data from the U.S. Food and Drug Administration's Adverse Events Reporting System, found 20 cases of keratitis occurring shortly after vaccination. According to the review, adults who developed keratitis symptoms did so within 24 days of vaccination, while pediatric cases of inflamma- tion occurred within 14 days. Fredrick Fraunfelder, MD, chair, Department of Ophthalmol- ogy, University of Missouri School of Medicine, and director of the National Registry of Drug-Induced Ocular Side Effects, said, "This is a relatively small number of case reports from a vaccine administered millions of times in subjects around the world. However, most cases of corneal inflammation associated with the vaccine are probably not re- ported at all as patients and doctors probably do not suspect the vaccine as causal in the keratitis." The likelihood that the vaccine was responsible for these symp- toms, based on the World Health Organization's criteria according to the research, is "probable," given that there is "a plausible biological mechanism, there is a temporal re- lationship, there is dechallenge and rechallenge data, and it occurred in both children and adults," Dr. Fraunfelder said. Based on these findings, Dr. Fraunfelder recommended that primary care physicians counsel patients on this possible reaction, however rare, and consider avoiding the vaccine altogether if the patient has a history of zoster keratitis. If a keratitis reaction does occur, Dr. Fraunfelder said it should be treated with oral acyclovir within 72 hours of diagnosis. This is not the first evidence of zoster vaccines being related to ocular complications. Chickenpox vaccine linked to rare cases of corneal inflammation DISCOVISC ® OVD IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician. INDICATIONS: DisCoVisc ® Oph- thalmic Viscosurgical Device is indicated for use during surgery in the anterior segment of the eye. It is designed to create and maintain space, to protect the corneal endothelium and other intraocular tissues and to manipulate tissues during surgery. It may also be used to coat intraocular lenses and instruments during cataract extraction and IOL insertion. WARNINGS: Fail- ure to follow assembly instructions or use of an alternate cannu- la may result in cannula detachment and potential patient injury. PRECAUTIONS: Precautions are limited to those normally as- sociated with the surgical procedure being performed. Although sodium hyaluronate and sodium chondroitin sulfate are highly purifi ed biological polymers, the physician should be aware of the potential allergic risks inherent in the use of any biological material. ADVERSE REACTIONS: DisCoVisc ® Ophthalmic Vis- cosurgical Device was very well tolerated in nonclinical and clin- ical studies. A transient rise in intraocular pressure in the early postoperative period may be expected due to the presence of sodium hyaluronate, which has been shown to aff ect such a rise. It is therefore recommended that DisCoVisc ® OVD be re- moved from the anterior chamber by thorough irrigation and/ or aspiration at the end of surgery to minimize postoperative IOP increases. ATTENTION: Reference the Directions for Use for a complete listing of warnings and precautions. © 2016 Novartis 2/16 US-VIS-16-E-0527 Advancing CATARACT SURGERY DisCoVisc ® OPHTHALMIC VISCOSURGICAL DEVICE 93472 EW 5/1/16

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