Clinical outcomes in cytomegalovirus-positive posner-schlossman syndrome patients treated with topical ganciclovir therapy

Author(s): Su CC(1), Hu FR(2), Wang TH(2), Huang JY(2), Yeh PT(2), Lin CP(2), Wang IJ(3)

1 Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Ophthalmology, National Taiwan University Hospital College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
2 Department of Ophthalmology, National Taiwan University Hospital College of Medicine, National Taiwan University, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan.
3 Department of Ophthalmology, National Taiwan University Hospital College of Medicine, National Taiwan University, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. Electronic address: ijong@ms8.hinet.net.

PURPOSE: To evaluate the clinical characteristics and therapeutic outcomes of cytomegalovirus (CMV)-positive Posner-Schlossman syndrome patients undergoing topical ganciclovir treatment.

DESIGN: Retrospective, comparative, and interventional case series.

METHODS: One eye of each of 126 consecutive Posner-Schlossman syndrome patients was investigated using aqueous polymerase chain reaction (PCR) between January 2006 and June 2013. The initial presentations and follow-up data of the CMV-positive patients (68 eyes) and CMV-negative patients (58 eyes) were compared.

RESULTS: Severe endothelial cell loss (P < .001) and a higher number of eyes requiring glaucoma filtering surgery (P = .017) were observed in CMV-positive Posner-Schlossman syndrome patients. All CMV-infected eyes treated with continual topical 2% ganciclovir exhibited an undetectable CMV level at the following taps. During follow-up, the average number of antiglaucomatous agents decreased, and a similar frequency of intraocular pressure (IOP) spikes was observed in both groups (P = .358). Patients with CMV-positive eyes with a disease duration over 5 years were likely to require glaucoma surgery (P = .024, log-rank test). All patients receiving surgery exhibited CMV-negative PCR during the IOP attack, but experienced severe peripheral anterior synechiae and pigment clogging. Both groups exhibited a similar endothelial cell decrease (P = .243) and probability of progressive endothelial cell loss (P = .219, log-rank test).

CONCLUSION: Ganciclovir treatment was effective for clearing the viral load, assisting the IOP control, and preserving the corneal endothelium of CMV-positive Posner-Schlossman syndrome patients. Early diagnosis and proper treatment could decrease the risk of advanced glaucoma and avoid glaucoma surgery in long-lasting cases.

Copyright © 2014 Elsevier Inc. All rights reserved.

Am J Ophthalmol. 2014 Nov;158(5):1024-1031.e2. doi: 10.1016/j.ajo.2014.08.007. Epub 2014 Aug 12

PMID: 25124264
http://www.ncbi.nlm.nih.gov/pubmed/25124264

Clinical Paper of the Month manager: Andreas Boehm