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

Abstract

Background: 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: A 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.

Results: A 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).

Conclusions: A 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 registration: www.chictr.org.cn, identifier: ChiCTR1900022340, Date: 2019/04/06.

Keywords: Posner-Schlossman Syndrome; antiviral therapy; cytomegalovirus infections; ophthalmic solutions; topical ganciclovir treatment.

Figure 1

Anterior segment photography showing typical Iris depigmentation. Diffuse patchy iris depigmentation could be seen. The photography was captured from the right eye of a male patient aged 51.

Figure 2

Anterior segment photography showing typical fresh keratic precipitates. The three photographs were captured from the right eye of the same female patient aged 26 during follow-up. From A to C, a clear process of KP reduction was reflected according to the timeline. However, the big mutton-fat KP still remained. (A) III-Degree. More than 10 fresh KPs in mutton-fat pattern can be seen on the lower middle endothelium under the slit-lamp. (B) II-Degree. (C) I-Degree. KP, keratic precipitate.

Figure 3

Kaplan-Meier analysis for CMV reactivation and latent group. The curve showed the relationship between cumulative ganciclovir dosage and rate of residual uncontrolled cases. The cumulative 2% ganciclovir drops were acquired by multiplying daily dosage and treatment period. The uncontrolled cases were cases whose IOP or anterior chamber inflammation still cannot be controlled even under the maximum ganciclovir dose predicted. The censored data indicated that actual cumulative doses were unknown in those cases (caused by loss of follow-up or withdrawal; all were predicted statistically). The curve reflected potential tendency in ganciclovir application. CMV, cytomegalovirus.