Purpose: The aim of this study was to assess the interplay between 2 important viral infections and their management, herpes zoster ophthalmicus (HZO) and COVID-19. Methods: A subanalysis from the Zoster Eye Disease Study, a prospective randomized controlled study examining prophylactic valacyclovir in HZO, and data collected on COVID-19 vaccination and infection from July 2020 were evaluated. Participants were included if enrolled from January 1, 2019, ensuring that their 18-month follow-up overlapped with the COVID-19 pandemic. Recurrence was defined as new or worsening stromal keratitis without ulceration, endothelial keratitis, iritis, dendritiform epithelial keratitis, or stromal keratitis with ulceration requiring a substantial increase or recommencement of topical steroid therapy. Results: A total of 402 participants were included in the analysis. Attenuated zoster vaccination live was given to 35 (8.7%) and recombinant zoster vaccine to 40 (10.0%) before study commencement. No difference was observed in incidence or severity of COVID-19 infection in those with previous zoster vaccination, and no difference was observed in those treated with valacyclovir prophylaxis. COVID-19 infection occurred in 71 participants (17.7%) during the study period, and COVID-19 vaccination was received by 170 participants (42.3%). No association was observed between HZO recurrence and COVID-19 infection ( P = 0.39) or vaccination ( P = 0.75) during the 18-month follow-up. The study was powered to detect a hazard ratio of 1.19 for COVID-19 infection or vaccine-associated recurrence. Conclusions: No significant association was observed between zoster vaccination or valacyclovir use and COVID-19 incidence or severity. In addition, no significant increase in HZO recurrence was observed following COVID-19 infection or vaccination.
Purpose: The purpose of this study was to investigate clinical characteristics and 1-year outcomes of glaucoma surgery–associated bullous keratopathy (BK), comparing eyes with prior incisional glaucoma surgery (IGS-BK) and laser iridotomy (LI-BK), using data from the Japanese National Survey on Corneal Transplantation. Methods: Among 1941 BK eyes, 404 IGS-BK and 353 LI-BK eyes were analyzed. Clinical parameters and 1-year graft clarity were compared. Within IGS-BK, glaucoma subtypes were examined. Univariate (n = 382) and multivariable (n = 371, excluding cytomegalovirus and pediatric glaucoma) logistic regression identified predictors of graft failure. Results: IGS-BK patients were younger (72.8 vs. 77.2 years, P <0.001) and predominantly male (64.6% vs. 18.4%). Primary open-angle/normal-tension glaucoma (34.7%) and exfoliation glaucoma (XFG) (30.0%) were most common. Descemet stripping automated endothelial keratoplasty was the predominant procedure (81.7% IGS-BK; 78.2% LI-BK). One-year graft clarity was lower in IGS-BK (82.2% vs. 90.5%, P = 0.002), with XFG showing the poorest outcomes (73.0%). Univariate analysis identified male sex [odds ratio (OR) = 1.83, P = 0.046], younger age (OR = 0.75 per 10-year increase, P = 0.008), and XFG (OR = 2.63, P = 0.004) as predictors of graft failure. After multivariable adjustment, XFG remained an independent risk factor (OR = 3.00, 95% confidence interval: 1.50–5.99, P = 0.002), as did younger age (OR = 0.72, P = 0.019). Complication profiles differed between groups. Conclusions: XFG independently predicts poor outcomes in IGS-BK, underscoring the importance of glaucoma subtype stratification. Patients with XFG require intensified perioperative management and postoperative monitoring to optimize graft survival.
Purpose: The aim of this study was to evaluate the performance, diagnostic yield, and longitudinal outcomes of a dedicated tomography-based keratoconus (KC) screening program for children with Down syndrome (DS). Methods: A retrospective cohort study was performed involving all children with DS referred to a dedicated KC screening program between March 2019 and April 2026. Demographic characteristics, visual acuity, tomographic indices, KC diagnosis status, and corneal cross-linking outcomes were reviewed. Results: Forty-five children with DS were screened (mean age 13.5 years, 53.3% female). Fifteen children (33.3%) were classified as having KC or suspected KC at their initial screening visit. Clinically useful corneal tomography was obtained in 40 of 45 children (88.9%), demonstrating the feasibility of outpatient screening in this population. During surveillance, 2 children with initially normal examinations developed suspicious tomographic findings and 3 children with either a normal or suspicious initial examination progressed to confirmed KC, increasing the cumulative screen-positive rate to 18 of 45 children (40.0%). Fourteen eyes of 8 children underwent corneal cross-linking under general anesthesia without intraoperative or postoperative complications, with stable tomographic parameters on follow-up. Conclusions: Dedicated tomography-based screening was feasible in most children and identified a high burden of KC, while longitudinal surveillance detected additional children requiring intervention after an initially reassuring assessment. These findings support repeated tomography-based surveillance as part of routine ophthalmic care for children with DS.
