Abstract
Posner-Schlossman-Syndrome (PSS) is clinically characterized by acute, recurrent, mild, unilateral uveitis anterior accompanied by elevated intraocular pressure (IOP). Fuchs´ Uveitis (FU) is a chronic, low-grade-inflammatory disorder, involving anterior uvea and vitreous. The clinical findings show remarkable similarities as well as differences. In our study, we determine the composition of immune mediators in aqueous humor of patients with PSS and FU and evaluate if immune mediators play a crucial role in specific viral intraocular inflammation and IOP rises. Aqueous humor samples from 81 uveitis patients (= eyes) presenting with either PSS or FU were collected at one time point. Local intraocular antibody synthesis to rubella virus was confirmed in 65 patients, whereas 16 were tested positively for human cytomegalovirus. Thirteen patients with PSS and 10 patients with FU were treated with glaucoma medications. Additionally, 11 cataract patients acted as control group. Immune mediator concentrations were measured by Bio-Plex Pro assay. We observed in both PSS (IFN-γ: 174.9 pg/mL; TNF-α: 25.1 pg/mL) and FU (IFN-γ: 25.4 pg/mL; TNF-α: 27.2 pg/mL) groups a significantly increased level of T-helper 1 immune mediators compared to controls (IFN-γ, TNF-α: 0 pg/mL) [median]. Notably, PSS patients (IL-1RA: 73.4 pg/mL; IL-8: 199.4 pg/mL; IL-10: 33.4 pg/mL; IP-10: 126350 pg/mL) showed a stronger and more active ocular inflammatory response, than FU patients (IL-1RA: 4.3 pg/mL; IL-8: 72.4 pg/mL; IL-10: 1.6 pg/mL; IP-10: 57400 pg/mL). Furthermore, a negative correlation between mediators and IOP was seen in the PSS group, potentially caused by acetazolamide-treatment. Our findings show that immune mediators play a crucial role in specific viral intraocular inflammation and influence IOP levels. Remarkable similarities but also significant differences of immune mediator concentrations are apparent in PSS compared to FU. High concentrations of IL-1RA, IL-8, IL-10, and IP-10 correlate with active inflammation in PSS, while FU may trigger chronic inflammation. Our data also substantiated a very similar composition of cytokines in those patients from the PSS group suffering from ocular hypertension and thus offers a potential explanation model for a negative correlation between mediators and IOP.
Highlights
Posner-Schlossman-Syndrome (PSS) typically presents with acute, recurrent, unilateral attacks of markedly raised intraocular pressure (IOP) associated with the presence of cells in the anterior chamber and sparse keratic precipitates
Antibodies against CMV were detected in aqueous humor of all 16 PSS patients, and rubella virus (RV) antibodies were found in all 65 Fuchs Uveitis (FU) patients with the corresponding clinical findings (Fig 1)
herpes simplex virus (HSV) and varicella zoster virus (VZV) antibodies were not detected in any patient
Summary
Posner-Schlossman-Syndrome (PSS) typically presents with acute, recurrent, unilateral attacks of markedly raised intraocular pressure (IOP) associated with the presence of cells in the anterior chamber and sparse keratic precipitates. Fuchs’ uveitis (FU) is characterized by similar findings, including a mild unilateral inflammation of the anterior chamber with stellate keratic precipitates. It follows the course of a chronic, low-grade anterior uveitis. Heterochromia and iris atrophy may be present, and early cataract formation is common [2]. Because of these similar clinical features, PSS may be inadvertently misdiagnosed as FU
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