Comparative assessment of the potential impact of chronic herpesvirus infection on intra- and postoperative complications in patients with glaucoma

PURPOSE. To evaluate the potential impact of herpesvirus infection (carriage) on early postoperative outcomes of antiglaucoma surgeries.

MATERIAL AND METHODS. The study included 95 patients with stage I, II and III primary open-angle glaucoma (POAG), with indications for surgical treatment. The patients were divided into the main group (group 1, 31 patient) and the control group (group 2, 64 patients). The groups were formed on the basis of information obtained from the anamnesis about a transferred herpes simplex virus of any localization (as a rule, it was labial, oral-facial herpes and its skin manifestation). The indication for surgical treatment was the absence of persistent normalization of intraocular pressure and a decrease in visual functions. Depending on the clinical situation, patients underwent one of the two types of surgical interventions: trabeculectomy and non-penetrating deep sclerectomy. Analysis of postoperative complications was performed on day 7 after surgery.

RESULTS. The most frequent complications in the early postoperative period were ciliochoroidal detachment, hyphema, increased intraocular pressure, shallow anterior chamber syndrome, excessive vascularization in the surgery site, clinical signs of conjunctival-scleral and sclerascleral scarring. On day 7 after antiglaucoma surgery, the IOP level was 9.1±0.8 mm Hg on average in the groups. IOP was 1–2 mm Hg higher in case of non-penetrating surgery. In the same patients, normalization of IOP by the same date was obtained in 63.15% of cases, which required goniopuncture; needling was indicated and performed in 84.2% of patients. Ciliochoroidal detachment was diagnosed in both groups with the same frequency: 9.7 and 9.4%, respectively. Presence of minor hyphema was observed only after trabeculectomy, in 16.1 and 10.9% of cases, respectively.

CONCLUSION. Results of this study, firstly, do not indicate that HSV activates in response to surgical intervention; secondly, in patients who had been infected with it previously, only a tendency for the number of most common intra- and postoperative complications to increase was noted. The obtained results are insufficient for an unambiguous answer to the question posed in this study, which indicates the need for further research.

1. Aragno, V., Labbe, A., Brion, F. et al. The Efficacy of Deep Sclerectomy on Posture-induced Intraocular Pressure Changes. J Glaucoma 2018; 27(7):617-621. https://doi.org/10.1097/IJG0000000000000971

2. Jonas, J.B., Aung, T., Bourne et al. Glaucoma. Lancet 2017; 390(10108); 2183-2193. https://doi.org/10.1016/S0140-6736(17)31469-1

3. Konstas, A.G., Topouzis, F., Leliopoulou, O. et al. 24-hour intraocular pressure control with maximum medical therapy compared with surgery in patients with advanced open-angle glaucoma. Ophthalmology 2006; 113(5):761-765. https://doi.org/10.1016/j.ophtha.2006.01.029

4. Egorov E.A., Kuroyedov A.V., Gorodnichiy V.V. et al. Early and longterm outcomes of glaucoma surgery the results of multicenter study in CIS countries. RMJ Clinical Ophthalmology 2017; 17(1):25-34. https://doi.org/10.21689/2311-7729-2017-17-1-25-34

5. Arora, K.S., Robin, A.L., Corcoran, K.J. et al. Use of Various Glaucoma Surgeries and Procedures in Medicare Beneficiaries from 1994 to 2012. Ophthalmology 2015; 122(8):1615-1624. https://doi.org/10.1016/j.ophtha.2015.04.015

6. Burr, J., Azuara-Blanco, A., Avenell, A. et al. Medical versus surgical interventions for open angle glaucoma. Cochrane Database Syst Rev 2012; 12(9):CD004399. https://doi.org/10.1002/14651858.CD004399.pub3

7. Lusthaus J, Goldberg I. Current management of glaucoma. Med J Aust 2019; 210(4):180-187. https://doi.org/10.5694/mja2.50020.

8. Fan Gaskin JC, Sandhu SS, Walland MJ. Victorian trabeculectomy audit. Clin Exp Ophthalmol 2017; 45(7):695-700. https://doi.org/10.1111/ceo.12948

9. Kirwan JF, Lockwood AJ, Shah P, et al. Trabeculectomy in the 21st century: a multicenter analysis. Ophthalmology 2013; 120(12):2532-2539. https://doi.org/10.1016/j.ophtha.2013.07.049

10. Folgar, F.A., de Moraes, C.G., Prata, T.S. et al. Glaucoma surgery decreases the rates of localized and global visual field progression. Am J Ophthalmol 2010; 149(2):258-264. https://doi.org/10.1016/j.ajo.2009.09.010

11. Broadway, D.C., Chang, L.P. Trabeculectomy, risk factors for failure and the preoperative state of the conjunctiva. J Glaucoma 2001; 10(3):237-249. https://doi.org/10.1097/00061198-200106000-00017.

12. Barron B.A., Gee L., Hauck W.W. et al. Herpetic Eye Disease Study. A controlled trial of oral acyclovir for herpes simplex stromal keratitis. Ophthalmology 1994; 101(12):1871-1882. https://doi.org/10.1016/s0161-6420(13)31155-5

13. Krichevskaya G.I., Anjelov V.O., Katargina L.A. et al. Prevalence and clinical significance of an active cytomegalovirus infection in patients with ocular inflammation. Vestnik oftal’mologii 2000; 116(5):51-54.

14. Barinsky I.F., Kasparov A.A., Lazarenko A.A. et al. Inactivated vaccine against herpes simplex virus types 1 and 2 as an immunocorrection for chromic herpetic infection. Journal of Microbiology, Epidemiology and Immunobiology 1999; 6:98-102.

15. Sampaolesi R., Argento C. Scanning electron microscopy of the trabecular meshwork in normal and glucomatous eyes. Invest Ophthalmol Vis Sci 1977; 16(4):302-314.

16. Gamus D., Romano A. Herpetic imprint on privileged areas of its target organs: local latency and reactivation in herpetic keratitis. Metabolic, pediatric, and systemic ophthalmology (New York, NY: 1985) 1988; 11(1-2):37-40.

17. Amano S. et al. Herpes simplex virus in the trabeculum of an eye with corneal endotheliitis. American journal of ophthalmology 1999; 127(6):721-722. https://doi.org/10.1016/s0002-9394(99)00018-5

18. Detorakis E.T., Kozobolis V.P., Pallikaris I.G. et al. Detection of herpes simplex virus in pseudoexfoliation syndrome and exfoliation glaucoma. Acta Ophthalmologica Scandinavica 2002; 80(6):612-616. https://doi.org/10.1034/j.1600-0420.2002.800610.x

19. Israilov H.T. Avidity as a marker of an acute and chronic herpetic infection (HSV types 1 and 2). Problems of implementation of the results of innovative developments: theses of an international scientific conference. Chelyabinsk, 3 Nov 2016. Chelyabinsk, LLC Omega Science Publ., 2016. pp. 129-131.

20. Murzich A.V., Golubev M.A. Herpetic infection. Yuzhno-Rossiyskiy meditsinskiy zhurnal 1998; 3:33-40.

21. Levi M., Rudén U., Wahren B. Peptide sequences of glycoprotein G-2 discriminate between herpes simplex virus type 2 (HSV-2) and HSV-1 antibodies. Clinical Diagnostic Laboratory Immunology 1996; 3(3):265-269. https://doi.org/10.1128/cdli.3.3.265-269.1996

22. Liljeqvist J.A., Trybala E., Svennerholm B. et al. Localization of typespecific epitopes of herpes simplex virus type 2 glycoprotein G recognized by human and mouse antibodies. Journal of General Virology 1998; 79(5):1215-1224. https://doi.org/10.1099/0022-1317-79-5-1215