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.

A meta-analysis of the rate and related factors of glaucomatous optic nerve damage in patients with Glaucomatocyclitic Crisis.

PURPOSE: To systematic analysis of domestic and foreign literature on the incidence and related factors of glaucomatous optic nerve damage (GOND) in patients with Glaucomatocyclitic Crisis (PSS). METHODS: A computerized literature search was carried out in PubMed database, Wanfang Medical Database, China National Knowledge Infrastructure to collected domestic and foreign research studies on the incidence and related factors of glaucomatous optic nerve damage of Glaucomatocyclitic Crisis. Using Stata 15.1 software, select the indicators: incidence, gender, age, single/double eyes, duration of disease, and intraocular pressure (IOP) at onset for meta-analysis. OR (odds risk) was used as the effect variable for the binary variables, and mean difference was used as the effect variable for the continuous variables. The results are expressed by each effect amount and its 95% Confidence interval (CI). If there was heterogeneity among the original studies, a random effects model was used; otherwise, a fixed effects model was used. RESULTS: A total of 13 studies were included. The incidence of GOND in PSS was 0.251 (95%CI: 0.175-0.327). Three studies include the relevant factor analysis and the results showed: there was a statistically significant difference in age, and duration of disease in PSS patients with/without GOND (p = 0.000, p = 0.000), there was no statistical difference between the two groups in gender, single /double eyes, and IOP at onset (p = 0.468, 0.053, 0.065). CONCLUSION: Glaucomatocyclitic Crisis can cause glaucomatous optic nerve damage. GOND is more likely to occur in patients who are older, and have a long course of the disease. For such patients, special attention should be paid to the detailed examination of visual function and follow-up.

Posner-Schlossman Syndrome.

We present the case of a patient who presented to the Emergency Department with Posner-Schlossman syndrome, also known as glaucomatocyclitic crisis. While this condition is uncommon, it is essential that physicians be aware of its characteristics and how to treat it, otherwise affected patients are at risk of developing permanent complications such as optic nerve atrophy and loss of vision.

The characteristic of intraocular pressure dynamic change in patients with glaucomatocyclitic crisis.

PURPOSE: To investigate the characteristic of intraocular pressure (IOP) dynamic change from episode to intermittent period in patients with Posner-Schlossman syndrome (PSS). PATIENTS AND METHODS: Seventeen cases of typical PSS were collected in this study. Both their random IOP in episodes/intermittent period and 24-h IOP in intermittent period were measured. The mean IOP as well as the peak and the valley value of 24-h IOP were calculated. Those data were statistically analyzed. RESULTS: The IOP in affected eye in episodes is higher than that of the contralateral eye statistically; while in intermittent period the mean IOP (p = 0.001), the peak (p = 0.029) and the valley (p = 0.004) value of 24-h IOP in affected eye are statistically different with that of the contralateral eye. All of these parameters of the affected eye in intermittent period are lower than that of the contralateral eye obviously. CONCLUSION: The dynamic observations of IOP in episodes and intermittent period confirmed the IOP crossover phenomenon inpatients with typical PSS and this observation may be important in the differential diagnosis of PSS.

Detection of the progression of retinal nerve fiber layer loss by optical coherence tomography in a patient with glaucomatocyclitic crisis.

A 30-year-old man presented with glaucomatocyclitic crisis, also known as Posner-Schlossman syndrome, and acute intraocular pressure elevation. Changes in the longitudinal retinal nerve fiber layer (RNFL) and the cup-to-disc (C/D) ratio of the optic disc were detected by Stratus optical coherence tomography (OCT). The average RNFL thickness in the affected eye was greater than that in the unaffected eye on Day 3 (132.99 µm, C/D ratio: 0.24 vs. 105 µm, C/D ratio: 0.26). However, the RNFL thickness continued to decrease and the C/D ratio progressively increased in the affected eye over 12 months (60 µm, C/D ratio: 0.67), although the intraocular pressure was controlled at <21 mmHg during that period. Glaucomatous visual field defects were also found. A progressive decrease in the thickness of the RNFL was demonstrated by Stratus optical coherence tomography following an elevation in the acute intraocular pressure in the patient. Prompt treatment and longitudinal monitoring are necessary to prevent and detect glaucomatous damage.

Role of molecular diagnostics in ocular microbiology.

Although microbial culture remains the gold standard for diagnosis of many ocular infections, the technique is limited by low yield, inability to detect certain organisms, and potentially long delays to results. DNA-based molecular diagnostic techniques use detection of specific nucleic acid sequences as evidence for presence of suspected pathogens. The polymerase chain reaction (PCR) is a powerful molecular biology technique that allows for detection of fewer than 10 copies of pathogen genome. Recent technical advances in PCR have permitted quantitation of pathogen load using quantitative PCR (qPCR), and have permitted multiplexing of primer sets. Use of pan-bacterial and pan-fungal primers for ribosomal DNA sequences has allowed diagnosis of bacterial and fungal infections using molecular techniques. In this review, we highlight recent advances in the application of PCR to the diagnosis of anterior segment and posterior segment ocular infectious diseases.

Clinical experience of glaucomatocyclitic crisis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the clinical features of glaucomatocyclitic crisis and to investigate its pathogenesis, diagnosis,treatment and prognosis.METHODS: The clinical data of 15 cases (15 eyes) subjected to glaucomatocyclitic crisis were retrospectively analyzed including clinical manifestation and treatment.RESULTS: Visual field was normal in 13 eyes, and 2eyes had glaucomatous visual field defects. C/D ratio was ≤0.3 in 10 eyes and ≥0.6 in 2 eyes. Through pharmacotherapy the symptoms in 14 eyes disappeared after 2wk. One eye was diagnosed as being complicated by primary open-angle glaucoma and well treated with surgery.CONCLUSION: Glaucomatocyclitic crisis is a kind of ocular syndrome with unknown pathogenesis. It should be differentiated from primary glaucoma and uveitis clinically. Its prognosis is not absolutely benign, and the patients should be followed up regularly.

The Effect of Trabeculectomy with Mitomycin C in Patients with Glaucomatocyclitic Crisis

PURPOSE: In general, glaucomatocyclitic crisis (Posner-Schlossman syndrome) can be controlled during attacks with corticosteroids and antiglaucoma agents, hence filtering surgery is needed in very limited cases. In this study, we investigated the effect of trabeculectomy with the use of Mitomycin C(MMC) as an adjuvant in the patients with this disease. METHODS: Twelve eyes of 12 patients who had been proved having glaucomatocyclitic crisis and received filtering surgery with MMC and could be followed up for more than 6 months were studied by retrospective review. The indication for surgery of the patients with glaucomatocyclitic crisis contains the history of high intraocular pressure over 21mmHg more than 2 times, and uncontrollable intraocular pressure more than 35mmHg with the use of corticosteroids and more than 3 kinds of antiglaucoma agent for more than 3 weeks. The success of surgery was defined when the postoperative intraocular pressure is controlled between 6mmHg and 21mmHg without the use of medication. RESULTS: The mean intraocular pressure was 43.7+/-7.2 mmHg preoperatively and was 12.7+/-6.1 mmHg postoperatively. The mean number of antiglaucoma eye-drops was 3.21+/-0.84 preoperatively and was 0.12+/-0.08 postoperatively. These changes were statistically significant(P<0.01). CONCLUSIONS: We were able to consider filtering surgery with MMC as a treatment of glaucomatocyclitic crisis when the duration of high intraocular pressure lasts for a long time even though using maximal dose of medication.

Relating factors of the visual field damage in glaucomatocyclitic crisis / 国际眼科杂志(Guoji Yanke Zazhi)

To study factors related to visual field damage in Possner- Schlossman Syndrome(PSS) .Methods 145 cases of PSS and 166 cases of promary open angle glaucoma(POAG)were followed up with tonometer and perimeter. Results①Prevalence of visual field damageamong PSS and POAG cases were 35.43% and 93.42% respectively;72.11% of the visual field damage in the PSS group was of early stage,while 78.92% of that in the POAG group was of middle or late stage.②Compared with PSS cases with no visual field damage,the damaged cases were older;their course of the disease was longer;the average IOP between crises was higher;more cases were involved binocularly;more cases demonstrated abnormal diurnal and nocturnal IOP varianle or no crossover phenomenon. ③Systematic examination was given to 26 PSS cases with visual field damage and among them, 11 cases were confirmed to be complicated with POAG. Conclusion①Although the incidence of visual field damage done by PSS is much smaller and the symptoms slighter than those done by POAG,the prognosis of PSS is by no means optimistic. ②Coses at more advanced age, with longer course, with higher IOP between crises, with binocular involvement or without IOP crossover phenomenon are at a higher risk of visual field damage. ③Serious damage can be done by PSS itself.

Effect of apraclonidine hydrochloride on the attack of Posner-Schlossman syndrome

The intraocular pressure (IOP) of glaucomatocyclitic crisis with the attack fell 50.3%, from 37.8 +/- 8.2 mmHg to 18.8 +/- 4.8 mmHg, 4 hours after instillation of 1% apraclonidine. Glaucomatocyclitic crisis showed a more significant hypotensive response to 1% apraclonidine than primary open-angle glaucoma (24.8%, from 43. 1 +/- 8.1 mmHg to 32.4 +/- 7.5 mmHg after 4 hours). The intraocular pressure decrease percentage was similar regardless of the initial level of intraocular pressure. Clinically significant changes in mean systolic and diastolic blood pressures, were not observed, however, a mild decrease in the pulse rate was noted. And the local mydriatic effect on the pupillary diameter was significant. Apraclonidine, 1% might be newly indicated to control the IOP rise of glaucomatocyclitic crisis. Further studies on the possible mechanism of the prostaglandin mediated hypotensive effect of 1% apraclonidine are suggested.