Comparative outcomes of ocular surgery in patients with a history of herpes simplex virus: A prospective cohort study of 125 patients

Objectives: To compare surgical outcomes in patients with a known history of ocular herpes simplex virus (HSV) who received prophylactic antiviral treatment versus those who did not. Material and Methods: A prospective cohort study of 125 patients undergoing ocular surgery (cataract, corneal graft, or glaucoma surgery) with prior HSV ocular infection history. Patients were divided into two groups: Group A (n = 65) received antiviral prophylaxis (oral acyclovir), while Group B (n = 60) received no prophylaxis. Outcomes measured included HSV recurrence, graft rejection, inflammation, and visual acuity post-operatively over 12 months. An HSV diagnosis was made based on documented clinical history, signs of past HSV ocular disease, or past use of antivirals with a positive response. Results: HSV recurrence occurred in 4.6% of Group A versus 21.7% in Group B (p < 0.01). Significant inflammation occurred in 6.1% of Group A versus 23.3% of Group B (p < 0.01). Mean improvement in best-corrected visual acuity was better in Group A (+0.31 logMAR) versus Group B (+0.19 logMAR). Graft failure or surgical complications were higher in Group B. Conclusion: Prophylactic antiviral therapy significantly reduces the risk of HSV recurrence and improves surgical outcomes in patients with a prior ocular HSV history. In immunocompromised patients or cases of suspected acyclovir resistance, alternative antivirals such as valacyclovir or foscarnet may be considered.