Research progress of Posner-Schlossman syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

Posner-Schlossman syndrome(PSS)is a sporadic and recurrent self-limiting anterior uveitis, and its pathogenesis remains unclear. It was considered to be a prostaglandin-mediated inflammatory response. In recent years, it has been found to be related to viral infection, immune genetics, vascular endothelial dysfunction, and other factors. Clinically, the disease is predominantly unilateral. The patients with PSS suffer from increased intraocular pressure, mild pain in the affected eye, as well as blurred vision, and irisopsia. Seldom damage to the optic nerve and visual field was reported. The commonly treatment of PSS is local medication, such as anti-inflammatory drugs and intraocular pressure lowering drugs; otherwise systemic medication can be employed in severe cases. Surgical treatment can be performed for PSS if uncontrolled intraocular pressure elevation, frequent attacks, and optic nerve damage and visual field defect due to prolonged disease course. Early diagnosis and treatment of PSS can effectively reduce glaucoma-related damages. This review discussed the research progress of PSS from various aspects, aiming to provide references for the etiology, pathogenesis, and clinical diagnosis and treatment of this disease.

Clinical characteristics of cytomegalovirus positive Posner-Schlossman syndrome and the effect of 20g/L Ganciclovir eye drops intervention / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the clinical characteristics of cytomegalovirus positive and negative patients with Posner-Schlossman syndrome(PSS), and the clinical efficacy and short-term recurrence of 20g/L ganciclovir eye drops in local treatment of patients with CMV positive PSS were evaluated. <p>METHODS: Differences between CMV positive(86 cases, 86 eyes)and CMV negative(60 cases, 60 eyes)PSS patients were compared. General information, ocular parameters and distribution, IFN-γ and IL-4 levels in aqueous humor, clinical efficacy and recurrence within 1a were compared between the conventional group(30 cases, 30 eyes)and the experimental group(56 cases, 56 eyes).<p>RESULTS: Among the 146 PSS patients included, the CMV positive rate was 58.9%. The average intraocular pressure and the difference in the number of corneal endothelial cells between the onset eye and the contralateral eye in CMV positive patients were significantly increased, and the number of corneal endothelial cells in the onset eye was significantly decreased(<i>P</i><0.05). After treatment, all ocular parameters and distribution in the experimental group were significantly better than those in the conventional group(<i>P</i><0.05), IFN-γ level in the experimental group was significantly lower than that in the conventional group, and IL-4 level was significantly higher than that in the conventional group(<i>P</i><0.05). Compared with the conventional group, the experimental group had a high total effective rate, a short cure time, a low recurrence rate within 1a and a long recurrence interval, with statistically significant differences(<i>P</i><0.05).<p>CONCLUSION: Patients with CMV positive PSS had higher intraocular pressure and greater damage to corneal endothelial cells than PSS patients with CMV negative. 20g/L ganciclovir eye drops can effectively control intraocular pressure and inflammation by resisting CMV infection, with significant clinical efficacy and not easy to relapse in the short term.

Detection and analysis on serum antibodies for five common pathogenic microbes in patients with Posner-Schlossmarm syndrome / 中华实验眼科杂志

Background Posner-Schlossman syndrome (PSS) is often recurrent and is a cause of blindness.The etiology of PSS remains to be elucidated.It is reported that there is a certain association between pathogenic microorganisms and PSS in rather small samples.Objective This study was to analyze the related serum antibody levels of cytornegalovirus (CMV),herpes simplex virus (HSV),rubella virus (RV),helicobacter pylori (HP) and anti-streptolysin O (ASO) and provide a clue for the study on pathogenesis and therapy of PSS.Methods A prospective cases-controlled study was carried out in Shenzhen Eye Hospital from December,2014 to December,2016 under the approval of Ethic Committee of this hospital and informed consent of each subject prior to initial of any medical examination.Peripheral blood samples were collected from 82 PSS patients as the PSS group and 100 age-and gender-matched healthy blood donors as the normal control group.The positive rates of serum CMV IgG,CMV IgM,HSV IgG,HSV IgM,RV IgG,RV IgM,HP IgG and HP IgM in the subjects were detected by indirect ELISA,and the positive rate of serum ASO antibody was determined by immuno-scatter turbidmetry.Results The positive rates of serum CMV-IgG,CMV-IgM,HP-IgG,HP-IgM and ASO antibody were 22.0％,17.1％,22.0％,17.1％ and 17.1％ in the PSS group,which were significantly higher than 5.0％,0.0％,10.0％,2.0％ and 7.0％ in the normal control group (x2 =11.726,18.496,4.943,12.766,4.479,all at P＜0.05).The positive rates of serum HSV-IgG,HSV-IgM,RV-IgG and RV-IgM in the PSS group were not significantly different from those in the normal control group (x2 =3.305,0.986,0.898,0.503,all at P ＞ 0.05).Conclusions CMV,HP and hemolytic streptococcal infection may participate in the occurrence and development of PSS.

Recent advances in the etiology of Posner-Schlossman syndrome / 中华实验眼科杂志

Posner-Schlossman syndrome (PSS) or glaucomatocyclitic crisis is a rare,unilateral recurrent inflammatory ocular hypertensive disease.Although it is typically self-limited and has benign prognosis,some cases were reported with advanced optic nerve cupping and associated visual field loss.Current therapeutic strategies are mainly focused on controlling intraocular pressure and reducing inflammation.These treatments may relieve acute episode of PSS,but could not decrease the recurrences.Therefore,the etiology of PSS is extremely important.This review summarized and analyzed the advances in the etiology and pathogenesis of PSS in recent twenty years,including microbial infection,allergy,abnormal vascular reactivity,autoimmune and endocrine.Infectious theories are most studied at present.The probabilities of varicella-zoster virus and herpes simplex virus as the etiology of PSS were considered to be very small.Heliobacter pylori was thought to be related to the pathogenesis of PSS and glaucomatous optic nerve injury.The most likely cause of PSS is cytomegalovirus infection,but there existed evidences that opposed the theory.Due to the small sample size and limit of technology,the evidences of allergy,abnormal vascular reactivity,autoimmune and endocrinic factors as the pathogenesis of PSS were not definite.In conclusion,no single factor could explain the etiology and pathogenesis of PSS,multiple factors such as external factor,internal factor and autogenous factor might be involved.

Clinical Features and Risk Factors of Glaucomatous Change in Posner-Schlossman Syndrome

PURPOSE: To analyze the clinical features and determine the factors that affect glaucomatous change of patients with Posner-Schlossman syndrome (PSS). METHODS: A retrospective analysis of 51 eyes of 51 patients diagnosed with PSS was performed. We analyzed the factors including age of first attack, highest intraocular pressure (IOP), duration of the disease, number of the attacks and interval between attacks among the patients who developed glaucoma and those who did not and compared the 2 groups. RESULTS: The age of first attack was 34.73 +/- 10.77 years, and highest IOP was 47.75 +/- 9.43 mm Hg. Duration of the disease was 62.06 +/- 69.84 months, number of the attacks was 6.20 +/- 7.73 times, and interval between attacks was 12.65 +/- 8.95 months. Of 51 eyes of 51 patients, 12 eyes (23.5%) of 12 patients showed significant glaucomatous change. In the glaucoma group, highest IOP was 52.81 +/- 7.87 mm Hg, number of attacks was 11.91 +/- 10.63 times, and interval between attacks was 8.07 +/- 3.97 months. In the non-glaucomatous group highest IOP was 46.19 +/- 9.14 mm Hg, number of attacks was 4.59 +/- 5.94 times, and interval between attacks was 14.59 +/- 9.79 months, respectively. Highest IOP was significantly greater, number of attacks was higher, and interval was shorter with statistical significance in the glaucoma group (p = 0.025, p = 0.001, p = 0.028). CONCLUSIONS: A significant number of patients with PSS tend to show glaucomatous change over time. Patients with high IOP during attacks and those having frequent attacks with short intervals should be closely monitored and evaluation for glaucomatous damage is recommended.

Point-of-care monitoring of perioperative intraocular pressure using portable tonometry in a patient with Posner-Schlossman syndrome: a case report / 대한마취과학회지

A 56-year-old man with a rotator cuff injury, scheduled for arthroscopic reconstruction surgery, had a history of recurrent symptoms of eyeball pain and blurred vision for several years. After close examination, he was diagnosed with Posner-Schlossman syndrome. Three weeks before the scheduled surgery, his intraocular pressure (IOP) increased (> 30 mmHg) and he became extremely anxious about the surgery. We monitored his IOP intraoperatively and successfully completed general anesthesia without any sequelae. As Posner-Schlossman syndrome can present with severe complications that may lead to postoperative visual loss, intraoperative monitoring of intraocular monitoring and careful anesthetic management are crucial to protect vision.

Optic Disc Atrophy in Patient with Posner-Schlossman Syndrome

A 32-year-old man with blurred vision in the right eye and headache presented with anterior uveitis, an intraocular pressure (IOP) of 60 mmHg, an open angle, no visual field defects, and normal optic nerve. He had a history of five previous similar attacks. In each of the previous instances, his anterior uveitis and high IOP were controlled with antiglaucoma medications and topical steroids. However, at the fifth attack, his optic disc was pale and a superior paracentral visual field defect was shown. Brain magnetic resonance image studies were normal. This case represents that a recurrent Posner-Schlossman syndrome (PSS)-induced optic disc atrophy likely due to ocular ischemia caused by a recurrent, high IOP. Although PSS is a self-limiting syndrome, we should manage high IOP and prevent ischemia of the optic nerve head by treating with ocular antihypertensive medications.

Clinical Factors of Glaucomatous Change in Patients with Posner-Schlossman Syndrome

PURPOSE: To determine the factors that affect glaucomatous change and the clinical course of patients with Posner-Schlossman syndrome. METHODS: A retrospective analysis of 52 eyes of 51 patients who had been diagnosed with Posner-Schossman syndrome between January 1995 and June 2003 was performed. We analysed the factors by the age of onset, the duration of disease, the number of attacks, the highest intraocular pressure, the cup/disc ratio of affected eye and unaffected fellow eye during attacks, and visual field change. RESULTS: Twelve (23.1%) of 52 eyes revealed significant glaucomatous change. The number of attacks showed statistically significant difference between the two groups who had developed glaucoma and who had not (P=0.021). But the age of onset, the duration of disease, and the highest intraocular pressure during attack did not show statistically significant difference (P>0.1). CONCLUSIONS: From this study, we observed that the only factor influencing glaucomatous change in patients with Posner-Schlossman syndrome was the number of attacks. So in case of recurrent attacks, close observation and aggressive treatment is mandatory.