Abstract
Purpose To analyze how keratic precipitate (KP) morphology changes during Posner–Schlossman syndrome (PSS) prognosis and raise medication suggestions on 2% ganciclovir eye drops. Materials and Methods Clinical retrospective cohort study in the Eye & ENT Hospital of Fudan University, Shanghai, China. The attacked eyes of 98 eligible subjects diagnosed unilateral PSS were enrolled between 2016 and 2019. All patients were treated with intraocular pressure-lowering drugs and anti-inflammatory steroids. 2% ganciclovir eye drops were given to cytomegalovirus (CMV) immunoglobulin G (IgG) correction ratio positive patients. Frequent follow-ups and examinations were performed. KP morphology was focused and categorized into coin-shaped, mutton-fat, and pigmented. Medical histories were noted. Multidimensional analysis was given. Results Totally 47 patients in 98 achieved all-KP disappearance. Mean treatment time was (5.13 ± 3.66) weeks. Total KP disappearance was negatively correlated with mutton-fat and pigmented KPs at the first visit (P=0.020, P=0.007) and treatment time was also longer (P=0.018, P=0.014). Mean cumulative steroids dosage for 47 subjects was (159.66 ± 161.84) drops. CMV IgG correction ratio positive patients had smaller corneal endothelial cell density (P < 0.005) and larger cup-to-disc ratio (P=0.017) than negative subjects. Cumulative steroid treatment time was longer in the CMV-positive group, and overall dosage was also larger. However, due to 2% ganciclovir eye drops, daily steroid dosage was lower in the CMV-positive group. Conclusions The disappearance of mutton-fat and pigmented KPs needed longer treatment time. Paired aqueous humor and serum CMV IgG tests were recommended in PSS patients with coin-shaped KPs. 2% ganciclovir eye drops improved prognosis; and steroids dosage reduced significantly.
Highlights
Posner–Schlossman syndrome (PSS) is a special form of anterior uveitis with glaucoma mainly seen in young adults between 20 and 50 years old, characterized by nongranulomatous uveitis with marked increase in intraocular pressure (IOP) [1, 2]
Patients must be clearly diagnosed PSS, which was classified as follows: (1) recurrent attacks of mild, unilateral, nongranulomatous anterior uveitis accompanied by markedly elevated IOP, small white keratic precipitate (KP) on the endothelial surface of the central cornea, open angle, no posterior synechia, and no inflammatory lesions in the posterior segment of the eye; and (2) the IOP and anterior chamber inflammation returned normal between attacks
We found different KP patterns changed differently during PSS prognosis, and disappearance of specific KPs was correlated with the treatment period
Summary
Posner–Schlossman syndrome (PSS) is a special form of anterior uveitis with glaucoma mainly seen in young adults between 20 and 50 years old, characterized by nongranulomatous uveitis with marked increase in intraocular pressure (IOP) [1, 2]. Mild ciliary flush, corneal edema, iris changes, and a few gray-white medium-to-large granulomatous keratic precipitates (KPs) on the central or peripheral cornea are present with minimal flare [1,2,3,4]. Being an intuitive index under a slitlamp biomicroscope, dynamic KP morphology may reflect PSS progression and medication efficacy. Aqueous humor and serum CMV antibody examination and antivirus therapy have not been a routine in clinical practice. Several case reports have found CMV examinations effective, but intravenous and oral ganciclovir therapy had limitations in application or side effects [13,14,15,16]. CMV infection, PSS prognosis, and KP morphology changes reflect pathogenesis, progression, and manifestation, respectively. Deepening the current understanding of PSS and raising effective medication suggestions are of high value in clinical practice
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