Corneal Transplants Effective for Shingles-Related Complications

A Kellogg Eye Center study finds great promise in corneal transplants for patients who suffer shingles and develop subsequent vision-limiting corneal scarring.

7:00 AM

Author | Shantell M. Kirkendoll

Dr. Christopher Hood and corneal transplant patient Calvin Schlemmer

Corneal transplants are an effective treatment for complications of shingles, which can reduce vision to legal blindness if the painful rash spreads to the eye.

Shingles is caused by the same virus that causes chickenpox, and 10 to 20 percent of patients will develop herpes zoster ophthalmicus. The most common complication is corneal scarring.

LISTEN UP: Add the new Michigan Medicine News Break to your Alexa-enabled device, or subscribe to our daily audio updates on iTunes, Google Play and Stitcher.

But even in eyes with preoperative risks, corneal transplants can help older adults regain their vision, according to a large study conducted by the University of Michigan Kellogg Eye Center.

Dr. Christopher Hood

There was a reported 94 percent graft survival a year after surgery among patients with herpes zoster who underwent corneal transplant, and vision improved significantly.

The study in the British Journal of Ophthalmology is the largest of its kind and involved retrospective analysis of 53 eyes of 53 patients treated by Kellogg doctors. In most cases, patients had surgery six years after shingles.

Quiet eyes

Christopher Hood, M.D., a Kellogg cornea specialist and one of the study authors, stresses the importance of choosing surgical candidates conservatively, operating on quiet eyes that are absent of disease whenever possible and monitoring the patient closely after surgery.

"What we learned is corneal transplants can make a significant difference in visual acuity, but it's important to control inflammation before transplant," Hood says.

Hood performed a corneal transplant on Calvin Schlemmer, of Angola, Indiana, whose vision loss resulted from a bout with shingles diagnosed a decade ago.

MORE FROM MICHIGAN: Sign up for our weekly newsletter

The diagnosis was life-changing for Schlemmer, who was healthy, in his 60s and working as an accountant.

The first sign was a facial itch that progressed to a rash covering one side of his face, his forehead and around his eye. While the rash resolved in weeks, the nerve pain lingered, and he lost vision in one eye.

"I could see figures in front of me, but I couldn't tell what they were," says Schlemmer, 79.

SEE ALSO: What's It Worth? New Shingles Vaccine Offers a Chance to Measure the Value of Prevention

Even with steroid eyedrops and antiviral treatment, many patients like him will develop vision-limiting corneal complications that are difficult to treat.

By 2018, his eyes were healthy enough, Hood believed, for a transplant. It worked well enough for Schlemmer to be in the driver's seat during a cross-country road trip.

Study outcomes

All surgeries in the study involved use of an oversized donor cornea. Interrupted nylon sutures were used alone or in combination with continuous nylon sutures. After surgery, all patients received subconjunctival injections of an antibiotic and a corticosteroid.

Postoperatively, corticosteroid drops were used every two to six hours and tapered at the surgeon's discretion, typically over the first year. Some patients were prescribed oral acyclovir, an antiviral medicine.

Nearly half of patients had corneal anesthesia, a loss of corneal sensation, at the start of the study, while 30 percent had deep corneal neovascularization in four quadrants of the eye. Also, 47 percent of eyes had comorbid ocular disease, including cataract, glaucoma and macular disease.

Twenty patients, or 37.8 percent, were given acyclovir for the entire postoperative period.

Grafts remained clear at one year (94 percent), two to four years (82 percent) and five or more years (70 percent) of follow-up.

Although most grafts remained clear, long-term visual potential may be limited by comorbid ocular diseases, according to the study.

Improvement not sustained

Visual acuity improved at one year postoperatively; however, the improvement was not sustained.

Further, long-term acyclovir conferred no significant benefit on visual acuity or graft survival.

The most common complications were difficulty healing the ocular surface and glaucoma. Thirty percent of eyes required additional postoperative procedures, most commonly tarsorrhaphy and amniotic membrane graft.

Corneal anesthesia  is common after herpes zoster and can lead to graft failure.

But new procedures like corneal neurotization can restore sensation and nerve function and improve transplant outcomes. Kellogg is one of the few places in the country where it's offered.

Adults are taking precautions to prevent shingles of the eye and its complications by getting vaccinated.

Two shingles vaccines are available in the U.S. — Shingrix and Zostavax — and are in high demand among people over age 50.


More Articles About: Lab Report Eye Disorders Kellogg Eye Center Corneal Transplant Health Care Delivery, Policy and Economics Eye Care & Vision
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories Minding Memory with a microphone and a shadow of a microphone on a blue background
Minding Memory
Vision Impairment as a Risk Factor for Dementia
The population of older adults living with dementia is expected to swell to nearly 14 million by 2050 and is estimated to cost the US economy more than 500 billion each year. In the absence of a cure for Alzheimer's disease, the primary cause of dementia, there's interest in understanding modifiable risk factors. In theory, getting a handle on the modifiable risk factors for dementia, would enable public health efforts to reduce cognitive decline in dementia at the population level. We've come a long way in understanding the risk factors for Alzheimer's disease and other related dementias. However, there's still work to be done. In this episode, we'll speak with Dr. Josh Ehrlich, a researcher at the University of Michigan, who has examined vision impairment as a risk factor for dementia.
person holding walker with nurse next to them closer up on hands lower body
Health Lab
Long COVID happens in nursing homes, too
Post-acute sequelae of Sars-COV2 (PASC, long COVID) caused a decrease in independence and cognitive ability after coronavirus infection in nursing home residents
expert at stand hearing in suit
Health Lab
Keep telehealth alive and well, experts tell Senate subcommittee
Telehealth coverage by Medicare is scheduled to expire at the end of 2024; experts told Senators what they think should happen to preserve it.
older woman on phone with credit card in hand
Health Lab
Health plays a role in older adults' vulnerability to scams
Most older adults have faced an attempted scam, and some have been defrauded, but rates were higher among those with health problems or disabilities.
graphic drawing of colonoscopy scan with large intestine vials patient on bed doctor
Health Lab
Investment in free follow up colonoscopies will pay off
Free colonoscopies for people whose at-home stool tests (such as Cologuard and FIT) turn up signs of potential cancer are now covered by insurance, and a study shows this will save money.
Syringes in a row on yellow backfround
Health Lab
New COVID-19 vaccine a good value for U.S., U-M team finds
A cost effectiveness analysis of the updated COVID-19 vaccine shows that it will save money in older adults and give good value for other adults.