2% Ganciclovir Eye Drops Control Posner-Schlossman Syndrome Relapses With/Without Cytomegalovirus Intraocular Reactivation.

Qilian Sheng,Xiangmei Kong,Xintong Fan,Ruyi Zhai

doi:10.3389/fmed.2022.848820

Abstract

BackgroundTo observe and compare the efficacy of 2% ganciclovir eye drops in the treatment of Posner-Schlossman Syndrome relapses with/without cytomegalovirus intraocular reactivation.MethodsA prospective cohort study enrolling 101 patients diagnosed unilateral Posner-Schlossman Syndrome in Eye & ENT hospital, Fudan University, Shanghai, China. Thorough ophthalmic examinations were given. Aqueous humor sample was collected from the attacked eye of each patient and all pathogen immunoglobulins tests were performed. All patients were treated with appropriate corticosteroids and intraocular pressure-lowering drugs. 2% ganciclovir eye drops were given to patients whose cytomegalovirus antibody aqueous humor/serum correction ratio >0. Patients were followed up for 2 months. Ocular manifestations and cumulative drug dose were recorded.ResultsA cytomegalovirus ratio >0.40 was considered cytomegalovirus reactivation. The reactivation group (N = 46) had significantly higher percent of iris depigmentation (78.26%, P < 0.05) and endothelial cell loss rate (19.46%, P < 0.001) than the latent group (N = 55, 58.18% and 10.86%, respectively). The cumulative treatment time and 2% ganciclovir doses were 6.50 ± 4.67 weeks and 181.70 ± 130.95 drops for the reactivation group; 5.95 ± 4.11 weeks and 161.89 ± 110.66 drops for the latent group (P > 0.05). The median cumulative 2% ganciclovir estimated for inflammation control were 252.00 ± 50.71 and 224.00 ± 32.45 drops for the reactivation and latent group. The residual rate of uncontrolled cases was 0.19 ± 0.15 and 0.00, respectively (P < 0.05).ConclusionsA treatment course of 8–9 weeks' 2% ganciclovir is recommended to relapses both with and without cytomegalovirus intraocular reactivation. Preventive ganciclovir application may benefit patients with historical cytomegalovirus infections.Clinical Trial Registrationwww.chictr.org.cn, identifier: ChiCTR1900022340, Date: 2019/04/06.

Highlights

Posner-Schlossman Syndrome (PSS), known as glaucomatocyclitic crisis, is characterized by recurrent unilateral attacks of anterior non-granulomatous uveitis and elevated intraocular pressure (IOP) [1, 2]
All patients were treated with appropriate corticosteroids and intraocular pressure-lowering drugs. 2% ganciclovir eye drops were given to patients whose cytomegalovirus antibody aqueous humor/serum correction ratio >0
The median cumulative 2% ganciclovir estimated for inflammation control were 252.00 ± 50.71 and 224.00 ± 32.45 drops for the reactivation and latent group

Summary

Introduction

Posner-Schlossman Syndrome (PSS), known as glaucomatocyclitic crisis, is characterized by recurrent unilateral attacks of anterior non-granulomatous uveitis and elevated intraocular pressure (IOP) [1, 2]. Though the etiology of PSS has not been fully elucidated, a bulk of literature supports the cytomegalovirus (CMV) as the leading cause of anterior chamber infection [4–6]. CMV replication is restricted in the anterior segment, presented as chronic anterior uveitis or recurrent episodic iritis with raised IOP, much resembling PSS [7, 8]. The replication of latent CMV poses a continuous threat to anterior segment [9, 10]. To further investigate the manifestations and pathogenesis, a comparative observation of PSS relapses with/without CMV reactivation is conducted in our center. To observe and compare the efficacy of 2% ganciclovir eye drops in the treatment of Posner-Schlossman Syndrome relapses with/without cytomegalovirus intraocular reactivation

Methods

Results

Discussion

Conclusion