Question

What precautions are to be taken while operating a cataract in a patient with healed herpetic kerato-uveitis?

Hint:

Careful preoperative antiviral therapy and gentle surgical techniques are essential to minimize the risk of complications in cataract surgery for patients with a history of herpetic kerato-uveitis.

Answer 1

Step 1: Precautions During Cataract Surgery in a Patient with Healed Herpetic Kerato-Uveitis.
Cataract surgery in a patient with a history of herpetic kerato-uveitis requires special care due to the risk of reactivation of herpes simplex virus (HSV) and possible complications such as corneal scarring, inflammation, and secondary infection. The following precautions should be taken:
(1) Preoperative Antiviral Prophylaxis:
- Oral antiviral therapy (e.g., acyclovir or valacyclovir) should be administered preoperatively to suppress the HSV and prevent reactivation during or after surgery. The antiviral course should start a few days before surgery and continue for 1-2 weeks postoperatively.
(2) Careful Handling of the Cornea:
- Since the cornea may be compromised or scarred from previous herpetic episodes, gentle handling during the cataract procedure is crucial. Care must be taken during lens extraction to avoid rupturing the corneal capsule or causing further trauma to the cornea.
(3) Postoperative Steroid Use:
- Topical corticosteroids should be used cautiously after surgery in these patients, as they can trigger reactivation of the HSV. Steroids should only be used once the viral infection has been adequately controlled and under close supervision.
(4) Postoperative Monitoring:
- Close follow-up is necessary to monitor for signs of reactivation, such as increased inflammation, pain, or compromised vision. Early signs of recurrent herpetic keratitis or uveitis should be managed immediately to prevent complications.