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Background: We aimed to compare choroidal thickness (ChT) and retinal nerve fiber layer (RNFL) thickness in the affected and contralateral eyes of patients with Posner-Schlossman Syndrome (PSS) during acute, remission, and intermittent phases. Methods: This prospective observational study included 18 patients(36 eyes) diagnosed with PSS. These patients underwent a comprehensive ophthalmologic evaluation including slit lamp examination, visual acuity testing, intraocular pressure (IOP) measurement, and funduscopic examination, and assessment of RNFL thickness, macular thickness, and macular ChT. Patient data collected included gender, age, number of keratic precipitates (KPs), and number of episodes. Optical coherence tomography (OCT) was used to measure RNFL thickness, macular thickness, and macular ChT in both eyes during the acute, remission, and intermittent phases. The affected eye was compared with the unaffected eye at each phase. Results: In affected eyes, macular ChT was lower in the acute phase compared to the remission phase at N1500, N1000, N500, and subfoveal locations (allp < 0.05).The central macular recess ChT was also significantly thinner in the acute phase compared to the intermittent and remission phases. Age significantly correlated with ChT in the central recess (p =.024). Macular thickness was thinner during the acute phase in the affected eye (p =.048). The RNFL in the affected eye was thinner in the intermittent phase than in the acute phase at the inferior-temporal (p =.011) and global sectors (p =.044). During the acute phase, RNFL in the affected eye was thinner at the superior-nasal (p =.049), inferior-temporal (p =.003), and global (p =.041) sectors compared to the unaffected eye. In the intermittent phase, the affected eye's RNFL was thinner at the superior-nasal, inferior-temporal, inferior-nasal, and global sectors compared to the unaffected eye (allp < 0.05), while no difference was observed in both eyes at the nasal, superior-temporal, and temporal sectors. The number of episodes and age were significantly associated with RNFL thickness (p <.05). Conclusion: This study demonstrated that in eyes affected by PSS, RNFL, macular ChT, and macular thickness thinned during the acute phase. The number of episodes and age are significant factors in the development of PSS. [ABSTRACT FROM AUTHOR]

Purpose: To identify the types of viral infection in aqueous humor (AqH) among patients diagnosed as Fuchs uveitis syndrome (FUS) or Posner-Schlossman syndrome (PSS) and investigate their relevance to clinical manifestations and visual outcome. Methods: A total of 375 patients and 171 patients were diagnosed as FUS or PSS in our department. AqH and serum samples from 68 FUS patients and 16 PSS patients were obtained during eye surgery. The viral etiologies, clinical features, auxiliary tests and visual prognosis of patients with FUS or PSS who underwent AqH analysis were analysed and compared. Results: Among 68 FUS patients, rubella virus (RV), cytomegalovirus (CMV), herpes simplex virus (HSV) and varicella-zoster virus were identified in 17, 11, 1 and 1 patients, respectively. Seven patients with CMV and 1 with HSV were identified in 16 PSS patients. In both FUS and PSS groups, virus-associated eyes had higher proportion of secondary glaucoma and worse visual prognosis as compared with non-virus-associated eyes (all P < 0.05). In FUS group, specifically, CMV infection manifested as more obvious anterior segment inflammation and lower corneal endothelial cell density (CECD). RV infection showed a higher percentage of vitritis. In PSS group, CMV-associated PSS had a lower retinal nerve fiber layer thickness and CECD, worse visual prognosis as compared with non-virus-associated PSS (all P < 0.05). Conclusion: Our study identified 4 types of viral infection in FUS and 2 types of viral infection in PSS. Virus-associated patients are usually associated with more obvious clinical signs and poor visual prognosis. [ABSTRACT FROM AUTHOR]

This study focused on the prevalence, unique features, and required treatment of steroid-dependent Posner-Schlossman syndrome (SD-PSS), and analyzed the outcome of 2% Ganciclovir and gradual decrement steroid combination therapy in SD-PSS patients. Retrospective comparative and interventional study. SD-PSS was defined as PSS patients with continuous steroid use for over 3 months and relapsed within 2 weeks after steroid withdrawal or tapered dosage. Totally 74 SD-PSS eyes were compared with 78 randomly chosen non-steroid dependent PSS eyes. SD-PSS patients who underwent 2% GCV and gradual decrement steroid therapy with at least two follow-ups (n = 50) were analyzed for the treatment outcome. The prevalence of SD-PSS is 26.87% (97/361) in our PSS patients. SD-PSS patients demonstrated significantly younger onset age, longer disease course, higher intraocular pressure (IOP), and higher degree of iris depigmentation at the first visit. They required significantly more IOP-lowering medication and stronger steroid after the first visit. Our 2% GCV and gradual decrement steroid therapy helped 66% (33/50) SD-PSS patients with steroid withdrawal (median stable time: 13 weeks) and another 32% (16/50) SD-PSS managed to lower the dose or strength of topical steroid. Steroid-induced ocular hypertension happened in 5.26% (19/361) of the PSS patients. Young onset age, high IOP, and high iris depigmentation level during acute stage are indicators of steroid dependency in PSS patients. SD-PSS patients require more medical surveillance. Two percent ganciclovir and gradual decrement steroid combination therapy help with steroid withdrawal and minimize steroid use. [ABSTRACT FROM AUTHOR]

To present the process from acute Posner-Schlossman syndrome (PSS) relapse to remission under 2% ganciclovir (GCV), corticosteroids and anti-glaucoma agents on 323 patients. A retrospective study enrolling 323 PSS patients. Demographics and ophthalmic examination results were generated. Patients were treated with GCV, corticosteroids and anti-glaucoma agents andfollowed up every 2–6 weeks. Patients were divided into the GCV monotherapy (N = 65, 20.12%), GCV and corticosteroids (G+C, N = 106) and GCV, corticosteroid and IOP-lowering drugs (G+C+L, N = 152) group. The G+C+L group had the highest intraocular pressure (IOP, 26.33 ± 10.26 mmHg, P < 0.001) and largest cup-to-disc ratio (0.58 ± 0.19, P < 0.05). After treatment, IOP of three groups dropped to similar level. Ninety-nine (30.65%) patients were corticosteroid-dependent whose daily corticosteroid consumption decreased after using GCV (from 2.23 ± 1.02 to 0.97 ± 0.98 drops/day). 2% GCV solutions worked effectively on PSS relapse with corticosteroids and anti-glaucoma agents. In patients suspected of CMV infection, proper GCV could reduce the chance of corticosteroid dependence. [ABSTRACT FROM AUTHOR]

To evaluate the surgical outcomes in patients with Posner-Schlossman syndrome (PSS) at one year. A prospective interventional study in PSS patients with penetrating canaloplasty. Main outcome measure was success rate (6 mmHg≤ intraocular pressure (IOP) ≤ 21 mmHg) with or without medications. Thirteen eyes in 13 patients with PSS underwent complete catheterization. The mean IOP and medications (Meds) were reduced to 16.1 ± 4.8 mmHg on 0.5 ± 1.0 Meds at 12 months. Complete and qualified success rates were 61.5% and 84.6% at 12 months. The postoperative recurrent rate of PSS was 69.2%, the mean peak IOP during attacks and episodes were decreased to 26.7 ± 8.3 mmHg and 1.7 ± 2.0 times respectively. Transient IOP spike (61.5%) and hyphema (38.5%) were the two most common postoperative complications. Penetrating canaloplasty achieves a high success rate in PSS without serious complications. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical profile, demographics, and management of Posner–Schlossman syndrome (PSS) in patients presenting to a multitier ophthalmology hospital network in India. Methods: This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of PSS in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 130 eyes of 126 (0.004%) patients were diagnosed with PSS. The majority of the patients were male (81.75%) and had unilateral (96.83%) affliction. The most common age group at presentation was during the fourth decade of life, with 46 (36.5%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.005%) presenting from the metropolitan geography (0.008%) and in professionals (0.014%). A significant number of patients (108; 83.08%) had a raised intraocular pressure of >30 mm of Hg. The majority of the eyes had mild or no visual impairment (better than 20/70) in 99 (76.15%) eyes. Keratic precipitates were found in 59 (45.38%) eyes, anterior chamber cells in 43 (33.08%) eyes, and iris atrophy in seven (5.38%) eyes. The majority of eyes (127; 97.69%) had open angles on gonioscopy. The average duration of use of topical steroids was 1.70 ± 0.76 months, and the average duration of use of topical antiglaucoma medications (AGMs) was 1.66 ± 0.81 months, with 35 eyes (26.92%) requiring continued AGMs. Among the surgical interventions, trabeculectomy was performed in nine (6.92%) eyes and cataract surgery in five (3.85%) eyes. Conclusion: PSS more commonly affects males presenting during the fourth decade of life from higher socioeconomic status and is predominantly unilateral. The majority of the eyes have mild or no visual impairment, open angles, and require surgical intervention in a tenth of the eyes. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical profile, demographics, and management of Posner–Schlossman syndrome (PSS) in patients presenting to a multitier ophthalmology hospital network in India. Methods: This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of PSS in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 130 eyes of 126 (0.004%) patients were diagnosed with PSS. The majority of the patients were male (81.75%) and had unilateral (96.83%) affliction. The most common age group at presentation was during the fourth decade of life, with 46 (36.5%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.005%) presenting from the metropolitan geography (0.008%) and in professionals (0.014%). A significant number of patients (108; 83.08%) had a raised intraocular pressure of >30 mm of Hg. The majority of the eyes had mild or no visual impairment (better than 20/70) in 99 (76.15%) eyes. Keratic precipitates were found in 59 (45.38%) eyes, anterior chamber cells in 43 (33.08%) eyes, and iris atrophy in seven (5.38%) eyes. The majority of eyes (127; 97.69%) had open angles on gonioscopy. The average duration of use of topical steroids was 1.70 ± 0.76 months, and the average duration of use of topical antiglaucoma medications (AGMs) was 1.66 ± 0.81 months, with 35 eyes (26.92%) requiring continued AGMs. Among the surgical interventions, trabeculectomy was performed in nine (6.92%) eyes and cataract surgery in five (3.85%) eyes. Conclusion: PSS more commonly affects males presenting during the fourth decade of life from higher socioeconomic status and is predominantly unilateral. The majority of the eyes have mild or no visual impairment, open angles, and require surgical intervention in a tenth of the eyes.

Purpose: To analyse differences in the retinal microvasculature in eyes with cytomegalovirus (CMV)-positive Posner-Schlossman syndrome (PSS) compared to the non-affected eyes using optical coherence tomography angiography (OCTA). Methods: In this monocentric, observational prospective case series, 25 patients with unilateral CMV-positive PSS were included. We compared the vessel area densities (VAD) in the macula, optic disc, and peripapillary region in PSS-affected and non-affected eyes using OCTA. We compared the visual fields (VF) of the affected and healthy eyes of each patient. The mean deviation (MD) of the VF was analysed together with the retinal nerve fibre layer (RNFL) thickness to evaluate the strength of correlation with the VAD parameters. Results: The VAD of the peripapillary superficial vascular complex (SVC) is significantly reduced in CMV-positive PSS-affected eyes (46.1 ± 9.3% versus 50.1 ± 6.3%, p = 0.008, adjusted p = 0.048). The VAD of the deeper macular, papillary, and peripapillary layers showed no differences between the affected and non-affected eyes. The mean deviation and the retinal nerve fibre layer thickness had correlations with the VAD of the macula (r = 0.451, p = 0.001, r = 0.553, p < 0.001), the peripapillary SCV (r = 0.430, p = 0.002, r = 0.723, p < 0.001), and the papillary region (r = 0.512, p < 0.001, r = 0.292, p = 0.039). Patients receiving systemic antiviral therapy (SAT) showed better VAD of the peripapillary choriocapillary layer (p = 0.001, no therapy: 31.4 ± 1.9%, SAT: 35.0 ± 1.6%), and choroidal layer (p = 0.009, no therapy: 34.2 ± 0.3%, SAT: 36.3 ± 1.8%) compared to those with no SAT. Conclusion: A lower peripapillary VAD in the SVC might indicate vascular dysfunction as a sign of glaucomatous damage. SAT might have positive effects on the microcirculation in the deep retinal and choroidal layers. Trial registration: TRN: DRKS00028266, https://www.drks.de/drks_web/. [ABSTRACT FROM AUTHOR]

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.

Abstract Background To assess the anxiety and depression levels in patients with Posner-Schlossman syndrome (PSS) and to determine the potential risk factors. Methods In this cross-sectional study, a total of 195 participants, including 93 PSS patients and 102 healthy controls were recruited. Sociodemographic and clinical information were collected for all participants. Hospital Anxiety and Depression scale (HADS) was administered to evaluate the anxiety and depression levels. Visual function (VF) and quality-of-life (QOL) questionnaires were administered to assess variables potentially associated with anxiety and depression. Results Increased anxiety level was observed in 22 (23.7%) PSS patients as compared to 10 (9.8%) of controls (P = 0.009). While the frequency of depression between the two groups was not significantly different (P = 0.349). The mean anxiety and depression scores were 6.98 ± 4.20 and 6.44 ± 3.66 in PSS patients as compared to 6.67 ± 3.21 (P = 0.564) and 5.96 ± 2.93 (P = 0.311) in controls. Logistic regression analysis showed mental well-being was significantly associated with anxiety (odds ratio [OR] = 0.920, 95% confidence interval [CI] = 0.881–0.962, P

Purpose: This report describes a case of interface fluid syndrome (IFS) secondary to Posner Schlossman Syndrome (PSS) following small incision lenticule extraction (SMILE) surgery. Case presentation: A 19-year-old male was diagnosed with IFS secondary to PSS in his left eye 1 month after undergoing SMILE. Detailed patient history and clinical findings, auxiliary examination results, and short-term follow-up are reported. In this patient, the IFS was caused by elevated intraocular pressure (IOP) due to PSS. Treatment with topical steroids in combination with anti-glaucoma drops led to complete regression of the fluid, and there was no recurrence during a 7-month follow-up period. Conclusion: IFS is a potential complication of SMILE, and anterior segment ocular coherence tomography (AS-OCT) can definitively diagnose the condition. This case demonstrates that the treatment for IFS should be based on the underlying cause, and requires prompt and vigorous management for resolution.

The inclusion criteria of patients in this study were inconsistent especially in distinguishing Fuchs’ uveitis and herpetic uveitis from Posner-Schlossman syndrome, indicating well-defined inclusion criteria were needed. CMV anterior uveitis and Posner-Schlossman syndrome may not be the same disease, CMV may only act as a triggering factor for Posner-Schlossman syndrome, and the clinical manifestations of mild anterior segment inflammation were mainly caused by inflammatory reactions mediated by autoimmune factors. Although the antiviral medication was important in the treatment of Posner-Schlossman syndrome, the role of other treatment methods especially topical steroids should not be ignored. [ABSTRACT FROM AUTHOR]

To evaluate vessel density (VD) and structural features in Posner-Schlossman syndrome (PSS) patients' eyes using optical coherence tomography angiography (OCTA). An observational study was conducted among 23 affected eyes (group A), 23 contralateral unaffected eyes (group B), and 23 control eyes (group C). The macular superficial, macular deep, and optic nerve head (ONH) VD of group A were 45.26 ± 5.80, 46.78 ± 6.96, and 46.10 ± 4.22, respectively. The macular superficial VD, macular deep VD, and retinal thickness of group A were significantly lower than those of group C (all P <.05). The retinal nerve fiber layer thickness of group A decreased in the superior and inferior sections. The macular superficial VD had the highest diagnostic value (area under curve = 0.989) for PSS. OCTA can detect the fundus change in the macular and ONH regions of the PSS's affected eyes. [ABSTRACT FROM AUTHOR]

Background: To assess the anxiety and depression levels in patients with Posner-Schlossman syndrome (PSS) and to determine the potential risk factors. Methods: In this cross-sectional study, a total of 195 participants, including 93 PSS patients and 102 healthy controls were recruited. Sociodemographic and clinical information were collected for all participants. Hospital Anxiety and Depression scale (HADS) was administered to evaluate the anxiety and depression levels. Visual function (VF) and quality-of-life (QOL) questionnaires were administered to assess variables potentially associated with anxiety and depression. Results: Increased anxiety level was observed in 22 (23.7%) PSS patients as compared to 10 (9.8%) of controls (P = 0.009). While the frequency of depression between the two groups was not significantly different (P = 0.349). The mean anxiety and depression scores were 6.98 ± 4.20 and 6.44 ± 3.66 in PSS patients as compared to 6.67 ± 3.21 (P = 0.564) and 5.96 ± 2.93 (P = 0.311) in controls. Logistic regression analysis showed mental well-being was significantly associated with anxiety (odds ratio [OR] = 0.920, 95% confidence interval [CI] = 0.881–0.962, P < 0.001) and depression (OR = 0.959, CI = 0.926–0.994, P = 0.023) in PSS patients. Conclusion: More patients with PSS may experience anxiety as compared to healthy controls. Mental well-being is an independent risk factor for anxiety and depression. It is important for ophthalmologists to be aware of these factors and should pay more attention on mental health when PSS is managed in clinic. [ABSTRACT FROM AUTHOR]

Abstract Background Optical coherence tomography angiography (OCTA) is a novel technology that provides a noninvasive, dye-less method to visualize the blood vessels of the retina. In the present study, we investigate macular microvascular density and the correlation of ocular and demographic factors using OCTA in Posner-Schlossman syndrome (PSS) patients. Methods This is a prospective observational study. All PSS patients and age- and sex-matched healthy subjects underwent complete ophthalmologic examination, and RE, BCVA, IOP, CCT, AL, CMT, GCIPI, RNFL, C/D ratio were recorded. The whole-image vessel density (wiVD) and whole-image perfusion density (wiPD), three-circle (1 mm central ring, 3 mm inner ring, 6 mm outer ring), and four-quadrant segmental VD and PD were calculated. Results Seventeen PSS patients and 17 healthy subjects were enrolled in this study. The mean age was 42.65 ± 11.22 years in PSS patients and 42.71 ± 10.50 years in healthy controls. IOP, CCT, and C/D ratio were higher in PSS-attacked eyes, and BCVA, OPP and RNFL thickness was lower than those in the fellow eyes (p

Purpose: To evaluate and compare the one-year efficacy and influencing factors of different filtration surgeries on Posner–Schlossman syndrome (PSS) patients. Methods: A retrospective study enrolling 91 PSS patients who underwent filtering surgeries and were followed for at least one year. Unilateral PSS was diagnosed as recurrent attacks of mild, unilateral, non-granulomatous anterior uveitis, elevated intraocular pressure (IOP), keratic precipitates (KPs) on the corneal endothelium, open angle, no posterior synechia, and no inflammatory lesions in the posterior segment; the IOP and anterior segment returned to normal between attacks. Medical histories and thorough ocular examination results were collected. Trabeculectomy and ExPRESS were chosen as the first line and AGV was considered for those under high risk of fibrosis. Follow-up data, mainly IOP, best-corrected visual acuity (BCVA), and anterior segment manifestations at the 1st week, 6th month, and 12th month were generated and analyzed. Iris abnormalities were determined by depigmentation or atrophic changes on the anterior segment photograph. Complete surgical success was defined as 5 mmHg < IOP ≤ 21 mmHg without IOP-lowering drug or needle revision; qualified surgical success was defined as 5 mmHg < IOP ≤ 21 mmHg with IOP-lowering drugs or needle revisions. Survival analysis was performed to obtain the success rates. Results: At the 12th month, the complete surgical success rate of trabeculectomy (N = 54), ExPRESS (N = 23), and AGV group (N = 14) was 58.97% (95%CI 46.91–77.09%), 84.21% (95%CI 68.33–100.87%), and 100%; the qualified success rate was 71.79% (95%CI 62.46–88.34%), 89.47% (95%CI 77.07–103.33%), and 100%, respectively. Patients undergoing trabeculectomy experienced the largest decline of BCVA (from 0.58±0.46 to 1.01±0.51, P <.05); the trabeculectomy group endured the highest IOP (20.84±9.92 mmHg) compared to ExPRESS (14.51±2.86 mmHg, P <.05) and AGV group (13.17±3.32 mmHg, P <.05). At the 12th month, in the ExPRESS group, patients with iris abnormalities had higher IOP than the normal ones (15.65±2.05 mmHg, 12.93±3.17 mmHg, P <.05). ExPRESS helped patients with iris abnormalities maintain lower IOP than trabeculectomy (15.65±2.05 mmHg, 22.52±10.67 mmHg, P <.05). Three patients developed hypotony at the 3rd month (1 in ExPRESS and 2 in trabeculectomy group). Conclusion: AGV and ExPRESS performed better than trabeculectomy in PSS patients in terms of IOP and success rate. Iris abnormalities might influence the postoperative IOP and this may be valuable in guiding filtration strategies. Trial registration: Chinese Clinical Trial Registry (No. ChiCTR1800017532, date: 2018/08/02) [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of non-arteritic ischemic optic neuropathy (NAION) secondary to Posner-Schlossman syndrome in a twenty-six-year-old female. Observations: A 26-year-old female presented with painful visual loss of the left eye, elevated intraocular pressure of 38 mmHg, and trace to 1+ anterior chamber cell. Diffuse optic disc edema in the left eye and a small cup-to-disc ratio of the right optic disc were evident. Magnetic resonance imaging was unremarkable. Conclusions and Importance: The patient was diagnosed with NAION secondary to Posner-Schlossman syndrome, an uncommon ocular entity that can significantly affect vision. Posner-Schlossman syndrome can cause a decrease in ocular perfusion pressure involving the optic nerve and can lead to ischemia, swelling, and infarction. NAION should be considered in the differential diagnosis of young patients with sudden development of optic disc swelling and increased intraocular pressure with normal magnetic resonance imaging findings.

Purpose: To investigate iris atrophy in Posner–Schlossman syndrome (PSS). Methods: Sixty-one patients with PSS were included. Using swept-source optical coherence tomography, the thickness of anterior border layer (A), middle stromal layer (M), and the posterior pigmented epithelial layer (P) of iris were measured at 500 μm, 1000 μm, 1500 μm, 2000 μm, and 2500 μm from the pupillary edge in both PSS-affected and fellow eyes. The relationships between iris thickness and corneal endothelium density, cup-to-disc (C/D) ratio, and retinal nerve fiber layer (RNFL) thickness were also estimated in PSS-affected eyes. Results: Iris thickness parameters, including M500, M1000, A1500, A2000, P2000, and P2500, were significantly thinner in PSS-affected eyes than in fellow eyes (all p < 0.05). Moreover, M500 and M1000 were significantly associated with corneal endothelium density (p = 0.047 and 0.018, respectively), and M500 was significantly associated with C/D ratio (p = 0.001) and RNFL thickness (p = 0.037) in PSS-affected eyes. Conclusions: Iris showed significant thinning and atrophy in PSS-affected eyes, and iris stromal thickness close to the pupillary edge could be a novel clinical predictor of the changes in corneal endothelium, C/D ratio, and RNFL thickness in PSS. [ABSTRACT FROM AUTHOR]

Abstract Background We aimed to analyze the clinical characteristics of secondary glaucoma related to cytomegalovirus (CMV)- and varicella zoster virus (VZV)-positive uveitis. Methods In this retrospective study, we enrolled patients with anterior uveitic secondary glaucoma. All the patients underwent aqueous and serum analyses for viral antibody through enzyme-linked immunosorbent assay. Among the 60 included patients, 22 had CMV-negative Posner-Schlossman syndrome (CMV-negative PSS), 25 had CMV-positive PSS, and 13 had VZV-positive anterior uveitis secondary glaucoma (VZV-AUSG). We evaluated the following main indicators: age, disease duration, intraocular pressure (IOP), cup-to-disc ratio, best corrected visual acuity (BCVA), corneal endothelial cell (CEC) count, ocular morphological changes, and medical treatments. Results We found that 53.2% (25/47) patients with PSS were CMV-positive. Patients with CMV-positive PSS had a larger cup-to-disc ratio (p = .043), lower CEC density (p = .017), more severe CEC loss (p

IntroductionThis retrospective study aims to present the characteristics of Posner-Schlossman syndrome (PSS) relapse following inactivated COVID-19 vaccination.MethodsFrom 2020 to 2022, 12 out of 106 PSS patients undergoing relapses after any dose of inactivated COVID-19 vaccines were enrolled. Medical histories, information on the vaccination and systemic adverse events were collected. Patients were treated with corticosteroids, intraocular pressure (IOP)-lowering drugs and systemic immunosuppressive agents (if needed). Daily regimen and release course were noted.ResultsThe recurrence rate after vaccination was 11.32% (12/106, 95% CI: 5.29%–17.35%) among 106 PSS patients we surveyed. All the 12 patients were inoculated with inactivated COVID-19 vaccines developed by Sinopharm, China. The mean time of relapse was 5.27 ± 3.72 days (range: 1–13 days, median: 4 days). Higher IOP and more keratic precipitates (KPs) were seen in the relapse following vaccination (33.55 ± 12.99 mmHg, 91.67% had KPs compared to 25.38 ± 3.80 mmHg, 33.33% had KPs in previous relapse, P = 0.009). The mean release course was 30.71 ± 34.74 days for the relapse following vaccination and 7.33 ± 6.51 days for previous relapses. The attack frequency before and after vaccination was 3.56 ± 2.07 and 9.11 ± 7.34 times per year (P = 0.044). Higher daily doses of corticosteroids, IOP-lowering drugs and ganciclovir were needed to maintain stable course, though the difference did not reach statistical significance.DiscussionMore frequent relapses and harder control of IOP were found in PSS relapse following COVID-19 vaccination. Ophthalmologists need to be aware of the group vulnerability and take precautions, though the pathogenesis is still under investigation.

BackgroundPosner-Schlossman syndrome (PSS) is a relatively rare cause of chronic secondary open-angle glaucoma (OAG), but the exact cause is unknown. This study aimed to determine potential risk factors for OAG secondary to PSS and to provide a basis for early intervention in the development of PSS.MethodsThis was a retrospective case-control study. Nine cases diagnosed with PSS and seven cases diagnosed with OAG secondary to PSS were selected and their aqueous humor assays at the first occurrence of PSS were collected. Clinical characteristics including age, sex, disease duration, eye laterality, baseline visual acuity, maximum IOP, corneal endothelial cell density, visual field, retinal nerve fiber layer thickness, cup-to-disk ratio, keratic precipitates, anterior chamber inflammation, and aqueous humor cytokine assay results were compared between the two groups.ResultsThe cytomegalovirus (CMV) positivity was 55.60% in patients with PSS and 100% in patients with OAG secondary to PSS. Corneal endothelial cell density was lower in patients with CMV-positive PSS (p = 0.0116). Concentrations of basic fibroblast growth factor (bFGF), interleukin (IL)-6, and vascular cell adhesion molecule (VCAM) in patients with PSS and IL-8, IL-6, and VCAM in patients with OAG secondary to PSS were higher than standard reference values; and IL-8 concentration was significantly higher in patients with OAG secondary to PSS (p = 0.0229). There were significant positive correlations between IL-8 and IL-6, IL-6 and VCAM (p = 0.0304, p = 0.0172) and a significant negative correlation between bFGF and vascular endothelial growth factor (VEGF) (p = 0.0497). Simultaneous increase of IL-8 and IL-6 concentration levels could be used as a cytokine indicator to predict secondary OAG in patients with PSS (p = 0.0095).ConclusionSimultaneous increase of IL-8 and IL-6 concentrations may be an important cause of accelerated secondary OAG in patients with PSS, with IL-8 playing a more critical role. IL-8 and IL-6 may be more reliable cytokine markers for predicting secondary OAG in PSS, However, the high possibility of secondary OAG in patients with CMV-positive PSS should not be ignored. Regulation of IL-8 and IL-6 levels may be a new strategy of preventing OAG secondary to PSS.

Posner-Schlossman syndrome (PSS) and viral keratitis have a shared pathogen and are common diseases in China, but there are few case reports on whether these two diseases occur concurrently or alternately. After long-term clinical observations, six patients with alternating episodes of PSS and viral keratitis were confirmed at our hospital in the past 10 years. Of the six patients, three were female and three were male. Four patients had monocular PSS with ipsilateral monocular viral keratitis, one had monocular PSS with bilateral viral keratitis, and one had bilateral PSS with bilateral viral keratitis. Of the six cases, three had epithelial viral keratitis and three had endothelial viral keratitis. In four cases, the interval between the onset of the two diseases ranged from 8 days to 3 years, and two cases showed overlapping manifestations of the two diseases in 3 to 6 days, both with incomplete absorption of keratic precipitates. The six cases had intermittent episodes of both diseases and significant loss of corneal sensation during the onset of viral keratitis, and were effectively treated with antiviral therapy. PSS and viral keratitis may alternate episodically, and clinical attention should be paid to these conditions. The mechanism of the alternate episodes might be associated with viral infection and the use of glucocorticoids. [ABSTRACT FROM AUTHOR]

Background: Optical coherence tomography angiography (OCTA) is a novel technology that provides a noninvasive, dye-less method to visualize the blood vessels of the retina. In the present study, we investigate macular microvascular density and the correlation of ocular and demographic factors using OCTA in Posner-Schlossman syndrome (PSS) patients.Methods: This is a prospective observational study. All PSS patients and age- and sex-matched healthy subjects underwent complete ophthalmologic examination, and RE, BCVA, IOP, CCT, AL, CMT, GCIPI, RNFL, C/D ratio were recorded. The whole-image vessel density (wiVD) and whole-image perfusion density (wiPD), three-circle (1 mm central ring, 3 mm inner ring, 6 mm outer ring), and four-quadrant segmental VD and PD were calculated.Results: Seventeen PSS patients and 17 healthy subjects were enrolled in this study. The mean age was 42.65 ± 11.22 years in PSS patients and 42.71 ± 10.50 years in healthy controls. IOP, CCT, and C/D ratio were higher in PSS-attacked eyes, and BCVA, OPP and RNFL thickness was lower than those in the fellow eyes (p < 0.05). BCVA and OPP were improved in the PSS-attacked eyes in intermittent period (p < 0.05). The wiVD and wiPD were lower in the PSS-affected eyes than in the fellow eyes and in the control eyes in the PSS-attacked period (p < 0.05). All segmental VD and PD was lower in the PSS affected eyes than in the healthy control eyes (p < 0.05). In intermittent period, the wiVD and wiPD were lower in the PSS-affected eyes than in the fellow eyes (p < 0.05). Age, CCT, and SSI were associated with macular wiVD and wiPD in PSS attacked period. Age and CCT were associated with macular wiVD and wiPD in PSS intermittent period.Conclusion: Decreased macular superficial VD and PD was found in patients with Posner-Schlossman syndrome in attacked period and in remission. Macular wiVD and wiPD were associated with age, CCT and SSI in PSS patients. [ABSTRACT FROM AUTHOR]

Purpose: To explore the expression of matrix metalloproteinase-3 (MMP-3) in the aqueous humor of patients with Posner-Schlossman syndrome (PSS), and the association between MMP-3 and PSS., Methods: Peripheral blood and aqueous humor were routinely collected from 29 patients with PSS (PSS group) and 30 patients with age-related-cataract (ARC) (control group). The content of MMP-3 in serum and aqueous humor was measured by immunoturbidimetry. The correlation between MMP-3 and ophthalmic examination results were verified by Spearman's correlation analysis., Results: The MMP-3 level in the aqueous humor of the PSS group was (25.86 ± 13.4)ng/ml, significantly higher than that in the control group (3.9 ± 2.7)ng/ml( p  < 0.001), while there was no significant difference in serum MMP-3 level between the two groups ( p  = 0.125). The endothelial cell density (ECD) in the aqueous humor of the PSS group was (2078 ± 440) cell/mm 2 , intraocular pressure (IOP) in the aqueous humor of the PSS group was (33 ± 12) mmHg. The correlation analysis of aqueous humor MMP-3 and various ophthalmic examination results showed that aqueous humor MMP-3 had a moderate correlation with IOP and the difference in ECD between the affected eye and the fellow eye., Conclusions: MMP-3 level is elevated in the aqueous humor of PSS patients, and it may play an important role in the pathogenesis of PSS.

Introduction: Posner - Schlossman Syndrome (PSS) is a rare disease, more prevalent in men between 20 and 50 years old, characterized by recurrent attacks of anterior uveitis and ocular hypertension. Clinical case: We report the case of a 42-year-old patient with a single eye. He came to the consultation presenting decreased visual acuity, photobobia, halos around the lights, and intense pain in his left eye. The ophthalmological examination revealed inflammatory signs in the anterior segment, elevated intraocular pressure and damage to the optic nerve. Medical treatment was started with corticosteroids and topical antiglaucoma drugs, oral acetazolamide and intravenous mannitol, obtaining no response and it was decided to perform a surgical intervention (Ahmed valve implantation) in the left eye, subsequently achieving a good clinical evolution and resolution of the case. Conclusion: This report highlights that the episodic and recurrent nature of SPS requires strict monitoring.

Background: We aimed to analyze the clinical characteristics of secondary glaucoma related to cytomegalovirus (CMV)- and varicella zoster virus (VZV)-positive uveitis.Methods: In this retrospective study, we enrolled patients with anterior uveitic secondary glaucoma. All the patients underwent aqueous and serum analyses for viral antibody through enzyme-linked immunosorbent assay. Among the 60 included patients, 22 had CMV-negative Posner-Schlossman syndrome (CMV-negative PSS), 25 had CMV-positive PSS, and 13 had VZV-positive anterior uveitis secondary glaucoma (VZV-AUSG). We evaluated the following main indicators: age, disease duration, intraocular pressure (IOP), cup-to-disc ratio, best corrected visual acuity (BCVA), corneal endothelial cell (CEC) count, ocular morphological changes, and medical treatments.Results: We found that 53.2% (25/47) patients with PSS were CMV-positive. Patients with CMV-positive PSS had a larger cup-to-disc ratio (p = .043), lower CEC density (p = .017), more severe CEC loss (p < .001), and more iris depigmentation (p = .006) than CMV-negative PSS patients. Compared with patients with CMV-positive PSS, those with VZV-AUSG were older (p = .003), presented a higher IOP (p = .015), and had poorer BCVA (p < .001). Patients with CMV-positive PSS and VZV-AUSG all accepted ganciclovir treatment, and those with CMV-positive PSS used fewer antiglaucoma agents simultaneously compared with CMV-negative PSS (p = .005) and VZV-AUSG (p < .001). All three groups had a comparable proportion of patients requiring antiglaucoma surgery.Conclusions: We observed some distinctive clinical features in CMV-positive PSS compared with CMV-negative PSS. Further, we found that patients with VZV-AUSG presented with a higher IOP and worse visual acuity, and required more antiglaucoma medication than those with CMV-positive PSS. [ABSTRACT FROM AUTHOR]

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.

Background: The aim of this study is to investigate the long-term prognosis for glaucoma in patients with Posner–Schlossman syndrome (PSS). Methods: In this retrospective case series study, a total of 98 patients with PSS from January 2014 to February 2019 were included in this study. Initial presentations and follow-up data were obtained from medical records. Vision-related quality of life (VR-QoL) was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire. Results: Of the 98 patients included in the study, 66 (67%) presented with glaucoma, and among them, 21 (32%) required glaucoma surgery. The mean follow-up time was 50.1 months (range 1–263 months). Iris involvement was noted in 46 (46.9%) eyes; 26 (26.5%) had sectoral iris changes and 20 (20.4%) showed diffuse iris changes. Eyes with iris involvement had a significantly higher number of acute attacks of uveitis than those without (p = 0.010). The 5-year glaucoma surgery-free interval was 77.8% according to Kaplan–Meier analysis. Significant predictors of glaucoma surgery included iris involvement (hazard ratio [HR] = 5.215; confidence interval [CI] = 1.387–19.610), highest number of anti-glaucoma agents (HR = 5.069; CI = 1.848–13.905), baseline average retinal nerve fiber layer thickness (RNFLT) thickness (HR = 0.949; CI = 0.917–0.982), and disease duration (HR = 0.977; CI = 0.957–0.996). Overall complete surgical success and qualified success at 2 years was 35.3% and 75.5%, respectively. Patients with iris involvement, glaucoma surgery, and thinner average RNFLT had significantly poorer VR-QoL (all, p < 0.05). Conclusions: Patients with PSS and glaucoma required glaucoma surgery in a high rate. Iris involvement increased the probability of surgical treatment and lowered the VR-QoL of PSS patients. [ABSTRACT FROM AUTHOR]

AIM: To compare the clinical characteristics of cytomegalovirus positive and negative patients with Posner-Schlossman syndrome(PSS), and the clinical efficacy and short-term recurrence of 20g/L ganciclovir eye drops in local treatment of patients with CMV positive PSS were evaluated. METHODS: Differences between CMV positive(86 cases, 86 eyes)and CMV negative(60 cases, 60 eyes)PSS patients were compared. General information, ocular parameters and distribution, IFN-γ and IL-4 levels in aqueous humor, clinical efficacy and recurrence within 1a were compared between the conventional group(30 cases, 30 eyes)and the experimental group(56 cases, 56 eyes).RESULTS: Among the 146 PSS patients included, the CMV positive rate was 58.9%. The average intraocular pressure and the difference in the number of corneal endothelial cells between the onset eye and the contralateral eye in CMV positive patients were significantly increased, and the number of corneal endothelial cells in the onset eye was significantly decreased(PPPPCONCLUSION: Patients with CMV positive PSS had higher intraocular pressure and greater damage to corneal endothelial cells than PSS patients with CMV negative. 20g/L ganciclovir eye drops can effectively control intraocular pressure and inflammation by resisting CMV infection, with significant clinical efficacy and not easy to relapse in the short term.

The cause of Posner-Schlossman syndrome (PSS) remains unknown and its frequent recurrence may eventually lead to irreversible damage of the optic nerve. The influence of immune factors in the pathophysiology of PSS is gaining more and more interest. Increasing evidence suggests that gut dysbiosis plays vital roles in a variety of neurodegenerative and immune-related diseases. However, alterations of the gut microbiota in PSS patients have not been well defined yet. In this study, 16S rRNA sequencing was used to explore the difference of gut microbiota between PSS patients and healthy controls, and the correlation between the microbiota profile and clinical features was also analyzed. Our data demonstrated a significant increase of Prevotella and Prevotellaceae , and a significant reduction of Bacteroides and Bacteroidaceae in PSS patients, and KEGG analysis showed dysfunction of gut microbiota between PSS patients and healthy controls. Interestingly, further analysis showed that the alteration of gut microbiota was correlated with the PSS attack frequency of PSS. This study demonstrated the gut microbiota compositional profile of PSS patients and speculated the risk microbiota of PSS, which is expected to provide new insights for the diagnosis and treatment of PSS. • Our study suggested that the gut microbiome in Posner-Schlossman syndrome (PSS) patients is distinct from healthy controls. • Six bacterial taxa include Prevotella and Prevotellaceae were enriched in PSS, and 14 bacterial taxa include Bacteroides and Bacteroidaceae were dominant in healthy controls. • KEGG analysis showed dysfunction of gut microbiota between PSS patients and healthy controls. • The alteration of gut microbiota was correlated with the PSS attack frequency of PSS. [ABSTRACT FROM AUTHOR]

Cytotoxic T-lymphocyte associated protein 4 (CTLA-4) and programmed cell death 1 (PD-1) are well-known key immune checkpoints that play a crucial dampening effect on regulating T-cell homeostasis and self-tolerance. In this study, we aimed to evaluate the association between immune checkpoints (CTLA-4 and PD-1) and Posner-Schlossman syndrome (PSS) in a southern Chinese population. A total of 137 patients with PSS and 139 healthy controls from a southern Chinese population were recruited. Five single nucleotide polymorphisms (SNPs) of CTLA-4 (rs733618, rs4553808, rs5742909, rs231775, and rs3087243) and five SNPs of PD-1 (rs10204525, rs2227981, rs2227982, rs41386349, and rs36084323) were genotyped by SNaPshot technique. Soluble CTLA-4 (sCTLA-4) and soluble PD-1 (sPD-1) were determined by ELISA and antibody array assay, respectively. The frequencies of T allele at rs733618 and A allele at rs231775 of CTLA-4 were significantly higher in PSS patients than in healthy controls (corrected p (Pc) = 0.037; Pc = 0.044, respectively). The haplotype frequencies of CACGG haplotype (rs733618-rs4553808-rs5742909-rs231775-rs3087243) of CTLA-4 and TGAGC haplotype (rs10204525-rs2227981-rs2227982-rs41386349-rs36084323) of PD-1 in the PSS group was significantly lower than those in the control group (Pc = 0.015, p = 0.034, respectively). Circulating plasma levels of sCTLA-4 and sPD-1 in PSS patients were significantly higher than those in controls (all p < 0.001). The present study suggests that CTLA-4 and PD-1 genetic polymorphisms are associated with the susceptibility to PSS in a southern Chinese population. The upregulated circulating plasma protein levels of sCTLA-4 and sPD-1 might provide some hints regarding the dysfunction of immune checkpoints in PSS during the active status.

Cytotoxic T-lymphocyte associated protein 4 (CTLA-4) and programmed cell death 1 (PD-1) are well-known key immune checkpoints that play a crucial dampening effect on regulating T-cell homeostasis and self-tolerance. In this study, we aimed to evaluate the association between immune checkpoints (CTLA-4 and PD-1) and Posner-Schlossman syndrome (PSS) in a southern Chinese population. A total of 137 patients with PSS and 139 healthy controls from a southern Chinese population were recruited. Five single nucleotide polymorphisms (SNPs) of CTLA-4 (rs733618, rs4553808, rs5742909, rs231775, and rs3087243) and five SNPs of PD-1 (rs10204525, rs2227981, rs2227982, rs41386349, and rs36084323) were genotyped by SNaPshot technique. Soluble CTLA-4 (sCTLA-4) and soluble PD-1 (sPD-1) were determined by ELISA and antibody array assay, respectively. The frequencies of T allele at rs733618 and A allele at rs231775 of CTLA-4 were significantly higher in PSS patients than in healthy controls (corrected p (Pc) = 0.037; Pc = 0.044, respectively). The haplotype frequencies of CACGG haplotype (rs733618-rs4553808-rs5742909-rs231775-rs3087243) of CTLA-4 and TGAGC haplotype (rs10204525-rs2227981-rs2227982-rs41386349-rs36084323) of PD-1 in the PSS group was significantly lower than those in the control group (Pc = 0.015, p = 0.034, respectively). Circulating plasma levels of sCTLA-4 and sPD-1 in PSS patients were significantly higher than those in controls (all p < 0.001). The present study suggests that CTLA-4 and PD-1 genetic polymorphisms are associated with the susceptibility to PSS in a southern Chinese population. The upregulated circulating plasma protein levels of sCTLA-4 and sPD-1 might provide some hints regarding the dysfunction of immune checkpoints in PSS during the active status. [ABSTRACT FROM AUTHOR]

Objective: To report the clinical features and treatment outcomes in immunocompetent patients with anterior segment inflammation (ASI) related to human cytomegalovirus (HCMV) depending on their ethnic origin.Material and Methods: Multicenter retrospective study of 38 patients with at least one test, either HCMV-positive PCR or GWc.Results: Features of Posner-Schlossman syndrome were observed in 50% of the eyes, Fuchs heterochromic iridocyclitis in 13% of the eyes, chronic nonspecific anterior uveitis in 21% of the eyes, and corneal endotheliitis in 18% of the eyes. PCR and GWc were positive for HCMV in 50% and 96.2% of the eyes, respectively. Glaucoma was diagnosed in 50% of eyes. Treatment was oral valganciclovir in about half of the patients. Other treatments were intravenous ganciclovir and/or ganciclovir topical ointment and/or intravitreal ganciclovir.Conclusions: No obvious association of specific clinical features with individual ethnicity could be identified. We found a high rate of glaucoma in all ethnic groups. There was a delay in diagnosis and specific treatment of HCMV in most patients. [ABSTRACT FROM AUTHOR]

The Posner–Schlossman syndrome (PSS) is a disease with clinically recurrent unilateral anterior uveitis with markedly elevated intraocular pressure (IOP) and subsequent progression to optic neuropathy. Retrospective studies have reported increased annual incidence of PSS, especially in China. While currently, the clinical management of PSS is still challenging. Metabolomics is considered to be a sensitive approach for the development of novel targeted therapeutics because of its direct elucidation of pathophysiological mechanisms. Therefore, we adopted gas chromatography time-of-flight mass spectrometry (GC-TOF-MS) technology-based non-targeted metabolomics approach to measure comprehensive metabolic profiles of aqueous humor (AH) samples obtained from patients with PSS, with an aim to demonstrate the underlying pathophysiology, identify potential biomarkers specific to PSS, and develop effective treatment strategies. A comparative analysis was used to indicate the distinct metabolites of PSS. Pathway analysis was conducted using MetaboAnalyst 4.0 to explore the metabolic reprogramming pathways involved in PSS. Logistic regression and receiver-operating characteristic (ROC) analyses were employed to evaluate the diagnostic capability of selected metabolites. Comparative analysis revealed a clear separation between PSS and control groups. Fourteen novel differentiating metabolites from AH samples obtained from patients with PSS were highlighted. Pathway analysis identified 11 carbohydrate, amino acid metabolism and energy metabolism pathways as the major disturbed pathways associated with PSS. The abnormal lysine degradation metabolism, valine–leucine–isoleucine biosynthesis, and citrate circle were considered to weigh the most in the development of PSS. The ROC analysis implied that the combination of glycine and homogentisic acid could serve as potential biomarkers for the discrimination of control and PSS groups. In conclusion, these results revealed for the first time the identity of important metabolites and pathways contributing to the development/progression of PSS, enabled the better understanding of the mechanism of PSS, and might lead to the development of metabolic biomarkers and novel therapeutic strategies to restrict the development/progression of PSS.

Objective: The objective of this article is to determine characteristics and outcome of hypertensive anterior uveitis and prevalence of the Herpesviridae family. Study: Retrospective cohort study.Methods: A total of 64 anterior uveitis participants with increased intraocular pressure and Herpesviridae family polymerase chain reaction (PCR) analysis results were included.Results: The prevalence of Herpes family was 53.1% (6.3% for herpes simplex virus, 10.9% for varicella-zoster virus, 34.4% for cytomegalovirus, and 1.6% for Epstein-Barr virus), Posner-Schlossman syndrome 25%, Fuchs uveitis syndrome 7.8%, and idiopathic 14.1%. The recurrence rate was 70.3%. Age in PCR-proven infection group (52.7 ± 15.3) was older than the PCR-negative group (44.4 ± 12.5) (p = 0.021). Glaucoma in PCR-proven infection group (44.1%) was more than in PCR-negative group (16.7%) (p = 0.018). Corneal endothelial cell count in PCR-proven infection group (1879.3 ± 952.3) was lower than in PCR-negative group (2532.9 ± 540.4) (p = 0.004).Conclusion: Viral infection was found in one half of hypertensive anterior uveitis. The complications of PCR-proven infectious case were more severe than PCR-negative case. [ABSTRACT FROM AUTHOR]

Purpose: To compare the choroidal thickness (CT) of the affected eyes with the contralateral eyes in the active period and in the remission period in Posner–Schlossman syndrome (PSS) using EDI-OCT. Patients and methods: This prospective longitudinal study included 15 patients with PSS and 15 age- and sex-matched healthy subjects. All subjects underwent complete ophthalmologic examinations, and EDI-OCT was conducted to measure macular CT (mCT) at the subfoveal locations and at 0.5, 1.0 and 2.0 mm superior, inferior, nasal and temporal to the fovea. The mean measurements at each location were used for analysis. Linear regression analysis was performed to analyse the correlation between the choroidal thickness and IOP, and the correlation between the choroidal thickness and episode time. Results: The mean mCT was significantly thinner in affected eyes than in contralateral eyes in the acute phase (p = 0.010) but were not different in the remission phase (p = 0.404). The mean mCT was significantly increased in the remission phase compared to that in the acute phase in the affected eyes (p = 0.000). The mCT of healthy subjects was significantly thicker than in the affected eyes (p = 0.020) and similar to the fellow eyes of PSS patients (p = 0.357) in the acute phase. Linear regression analyses show negative correlations between the mCT changes and IOP changes in the affected eyes compared to those in the fellow eyes in the acute period (R2 = 0.396, p = 0.033) and between the mCT changes and IOP changes from the acute period to the remission period in the affected eyes (R2 = 0.372, p = 0.027). Linear regression analyses show positive correlations (age- and sex-matched) between the CT changes and episode time from the affected eyes to the fellow eyes in the acute period (R2 = 0.492, p = 0.012). Conclusions: The mCT values of the PSS-affected eyes were significantly thinner than those of the fellow eyes in the acute phase and in the remission phase, and this change was correlated with IOP reduction and episode time. [ABSTRACT FROM AUTHOR]

The Posner–Schlossman syndrome (PSS) is a disease with clinically recurrent unilateral anterior uveitis with markedly elevated intraocular pressure (IOP) and subsequent progression to optic neuropathy. Retrospective studies have reported increased annual incidence of PSS, especially in China. While currently, the clinical management of PSS is still challenging. Metabolomics is considered to be a sensitive approach for the development of novel targeted therapeutics because of its direct elucidation of pathophysiological mechanisms. Therefore, we adopted gas chromatography time-of-flight mass spectrometry (GC-TOF-MS) technology-based non-targeted metabolomics approach to measure comprehensive metabolic profiles of aqueous humor (AH) samples obtained from patients with PSS, with an aim to demonstrate the underlying pathophysiology, identify potential biomarkers specific to PSS, and develop effective treatment strategies. A comparative analysis was used to indicate the distinct metabolites of PSS. Pathway analysis was conducted using MetaboAnalyst 4.0 to explore the metabolic reprogramming pathways involved in PSS. Logistic regression and receiver-operating characteristic (ROC) analyses were employed to evaluate the diagnostic capability of selected metabolites. Comparative analysis revealed a clear separation between PSS and control groups. Fourteen novel differentiating metabolites from AH samples obtained from patients with PSS were highlighted. Pathway analysis identified 11 carbohydrate, amino acid metabolism and energy metabolism pathways as the major disturbed pathways associated with PSS. The abnormal lysine degradation metabolism, valine–leucine–isoleucine biosynthesis, and citrate circle were considered to weigh the most in the development of PSS. The ROC analysis implied that the combination of glycine and homogentisic acid could serve as potential biomarkers for the discrimination of control and PSS groups. In conclusion, these results revealed for the first time the identity of important metabolites and pathways contributing to the development/progression of PSS, enabled the better understanding of the mechanism of PSS, and might lead to the development of metabolic biomarkers and novel therapeutic strategies to restrict the development/progression of PSS. [ABSTRACT FROM AUTHOR]

Background: To compare the detection results consistency of quantitative polymerase chain reaction (qPCR) and digital droplet polymerase chain reaction (ddPCR), and determine the value of ddPCR for viral detection in the aqueous humour. Methods: A total of 130 aqueous humour samples were collected, including 60 patients with Posner‐Schlossman syndrome (PSS) in case group and 70 elderly patients with senile cataract in control group. The target nucleic acid fragments of human cytomegalovirus (HCMV), herpes simplex virus, Epstein‐Barr virus and varicella zoster virus in aqueous humour were analysed by qPCR and ddPCR, respectively, for the diagnosis and curative effect monitoring of pathogen‐induced PSS. Samples with inconsistent results were verified by next‐generation sequencing. Results: There were 27 and 20 HCMV‐positive cases detected in the case group by ddPCR and qPCR, respectively. ddPCR increased the sensitivity for the HCMV virus detection from 400 to 100 copies/mL. No other pathogens were found in this study. The results of ddPCR were consistent with that of next generation sequencing. The mean (SD) of Lg (HCMV copies/mL) detected by ddPCR and qPCR were 1.66 (1.92) and 1.10 (1.61), respectively (P < 0.001). Compared with qPCR, results of ddPCR showed better consistency with validity of clinical treatment. All patients with ddPCR‐positive results had good validity on antiviral therapy, exhibiting anterior chamber inflammation remission, resolution of corneal oedema and good IOP control within 1 month. Conclusions: HCMV was the leading cause of pathogen‐induced PSS in the Chinese population. ddPCR was a promising tool for early detection, accurate diagnosis and therapeutic validity monitoring of pathogen‐induced PSS. The high sensitivity of ddPCR could avoid repeated anterior chamber tap. [ABSTRACT FROM AUTHOR]

Purpose: Describing the utility of Polymerase Chain Reaction for Cytomegalovirus (CMV-PCR) in the diagnosis of suspected viral anterior uveitis (AU).Patients and Methods: We analyzed aqueous humor (AH) CMV-PCR positivity and treatment modifications in 47 eyes of 46 patients with viral uveitis and its correlation with high intraocular pressure (HIOP), uveitis clinical characteristics and time intervals from samples to uveitis diagnosis and to relapse.Results: CMV-PCR positive results occurred in 13 eyes (27.7%) of 12 patients. They were more frequent in HIOP eyes (34.2%, p = 0.047) and with Posner-Schlossman Syndrome (56.2%, p = 0.002). CMV-PCR positivity (p = 0.001) and HIOP (p = 0.038) increased the probability of treatment change. Although CMV-PCR positive results decreased over time (p = 0.002), they were not related to activity or proximity to inflammatory uveitis episode.Conclusion: HIOP AU eyes should be considered for CMV-PCR AH analysis due to possible treatment modifications. [ABSTRACT FROM AUTHOR]

Cytomegalovirus (CMV) anterior uveitis is the most common ocular manifestation of CMV disease in immunocompetent individuals. It is thought to be due to a local reactivation of latent CMV and is usually unilateral. The acute form presents as Posner-Schlossman Syndrome, a recurrent hypertensive anterior uveitis with few granulomatous keratic precipitates. There are geographic differences in the chronic form of CMV anterior uveitis. Asian patients commonly present as Fuchs Uveitis Syndrome with diffuse stellate keratic precipitates, while the European patients present with a chronic hypertensive anterior uveitis with fewer keratic precipitates that are brown in color and located inferiorly. Characteristic features of CMV anterior uveitis include mild anterior chamber inflammation, elevated intraocular pressure, stromal iris atrophy. Synechiae, macular edema and retinitis are typically absent. CMV disease may also be associated with the development of corneal endotheliitis with a reduced endothelial cell count. Long-term complications include glaucomatous optic neuropathy and cataract formation. [ABSTRACT FROM AUTHOR]

As a special type of glaucoma, Posner-Schlossman syndrome (PSS) is characterized by elevated intraocular pressure (IOP) and anterior uveitis. Cytomegalovirus (CMV) anterior chamber infection has now been considered the leading cause of PSS. We used murine CMV (MCMV) intracameral injection to establish a rat model manifested in IOP elevation and mild anterior uveitis, much like PSS; viral localization and gene expression at various time points and inflammatory cell infiltration derived from innate and adaptive immunity were investigated, as well as pathogenetic changes of the trabecular meshwork (TM). The IOP and uveitic manifestations peaked at 24 h post-infection (p.i.) and returned to normal after 96 h; the iridocorneal angle remained open consistently. At 24 h p.i., leucocytes gathered at the chamber angle. Maximum transcription of MCMV immediate early 1 (IE1) was reached at 24 h in the cornea and 48 h in the iris and ciliary body. MCMV localized in aqueous humor outflow facilities and the iris from 24 h to 28 d p.i. and was detected by in situ hybridization, though it did not transcribe after 7 d p.i. TM and iris pigment epithelial cells harboring viral inclusion bodies and autophagosomes were present at 28 d p.i. These findings shed light on how and where innate and adaptive immunity reacted after MCMV was found and transcribed in a highly ordered cascade, as well as pathogenetic changes in TM as a result of virus and uveitis behaviors. • Clinical manifestations similar to PSS are present in the rat model infected with intracameral MCMV. • MCMV localizes in trabecular meshwork, iris and ciliary body and no productive infection was observed after acute infection. • MCMV transcribes in a highly ordered cascade of IE1, E1 and gB in cornea and aqueous humor outflow facilitiesafter entry. • Long-lasting CD8+ T cell responses infiltrate iridocorneal angle and form keratic precipitates after acute phase. • Trabecular cells are impaired morphologically during acute infection and recover cellularity on trabecular beams afterwards. [ABSTRACT FROM AUTHOR]

A 56-year-old man with a rotator cuff injury, scheduled for arthroscopic reconstruction surgery, had a history of recurrent symptoms of eyeball pain and blurred vision for several years. After close examination, he was diagnosed with Posner-Schlossman syndrome. Three weeks before the scheduled surgery, his intraocular pressure (IOP) increased (> 30 mmHg) and he became extremely anxious about the surgery. We monitored his IOP intraoperatively and successfully completed general anesthesia without any sequelae. As Posner-Schlossman syndrome can present with severe complications that may lead to postoperative visual loss, intraoperative monitoring of intraocular monitoring and careful anesthetic management are crucial to protect vision.