1 / 18

Posner-Schlossman Syndrome

Posner-Schlossman Syndrome. Bianka Sobolewska, MD Manfred Zierhut, MD Centre of Ophthalmology University of Tuebingen , Germany. Ocular History. 49 year old healthy white women 1999: OD recurrent anterior uveitis IOP up to 60 mmHg no response to oral aciclovir.

karenq
Download Presentation

Posner-Schlossman Syndrome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Posner-Schlossman Syndrome Bianka Sobolewska, MD Manfred Zierhut, MD Centre of Ophthalmology University of Tuebingen, Germany

  2. OcularHistory • 49 yearoldhealthywhitewomen • 1999: OD • recurrentanterioruveitis • IOP upto 60 mmHg • noresponseto oral aciclovir

  3. April 2010: First Presentation • VA: OD 20/63, OS 20/20 • IOP: OD 38 mmHg, OS 17 mmHg • OD: non-granulomatouscentral KPs, irispigmentdefect, anteriorchambercells 1+, posteriorsubcapsularcataract, theiridocorneal angle open with pigment • OS: regular • Fundus: • OD/OS: regular with physiologicexcavationoftheoptic nerve

  4. non-granulomatouscentral KPs April 2010: First Presentation

  5. First Presentation - Diagnostics • negative anteriorchamber fluid analysis(PCR) for • CMV • Epstein-Barr virus • herpessimplexvirus • varicellazostervirus • all othertests negative: serologyforsyphilis, borreliosisand Bartonella, Quantiferontest, ANA, ANCA, chest CT

  6. Diagnosis • CMV- indducedanterioruveitis • based on: • Clinical findings with classical Posner-Schlossman Syndrome behaviourofintraocularpressure • Missingresponsetoacyclovir

  7. Treatment • topicalantiglaucomatosa • prednisoloneeyedrops (3x/day) • systemicvalganciclovir • 3 weeks: 900 mg b.i.d. • followedby 450 mg b.i.d.

  8. Follow up – After 1-6 MonthsMai-October 2010 • norecurrencesincethestartofvalganciclovirtherapy • VA: OD 20/1000 • IOP: OD 16-17 mmHg • onlytwoold KPs, nocells, posteriorsubcapsularcataract • therapy: • reductionoftopicaltherapy • systemicvalganciclovir 450 mg b.i.d • clearcornealphacoemulsification 11/2010

  9. Follow up – After 7 MonthsOctober 2011 • OD: 20/20 • norecurrence • terminationofvalganciclovirtherapy

  10. Follow up – After 11 MonthsMarch 2012 • recurrence with IOP of 40 mmHg, • anteriorchambercells 1+ • therapy • valganciclovir (450 mg 2x/day • topicalrimexolone (4x/day) • topicalganciclovir (5x/day) • acetacolamide (2x125 mg/day)

  11. Follow-up – After 1-2 YearsApril 2012 – April 2013 • IOP 14-17 mmHg • norecurrence • reductionoftopicaltherapy • terminationof oral therapy in 04-2013

  12. Follow-up – After 28 MonthsAugust 2013 • recurrence with IOP of 60 mmHg • acetacolamide 2x250 mg/day • starttherapy with leflunomide 20mg/d • topicaltherapy with • antiglaucomatosa, • prednisolone 3x/day • ganciclovir 3x/day

  13. Follow-up – After 29 MonthsSeptember 2013 • twicerecurrenceswith IOP of 60 mmHg • stopofleflunomide (headache, nausea) • topicaltherapywith • antiglaucomatosa • prednisolone 3x/day • ganciclovir 3x/day

  14. Follow-up – After 30- 42 MonthsOctober 2013-October 2014 • norecurrences • reductionoftopicaltherapy

  15. Final Ocular Investigation – After 42 MonthsOctober 2014 • VA: 0.7 • anteriorchambernocells • opticdisc: physiologicalexcavation • notopicaltreatmentbesidesarteficialtears

  16. Final Diagnosis • Possner-Schlossman Syndrome (PSS) • Differential diagnosis • Herpeticanterioruveitis (HSV, VZV) • Fuchs` uveitis

  17. Problems • rare disease • oftenmisdiagnosed • negative AC tap (PCR) does not exclude PSS • uncleartreatmentregimenwhen AC tapis negative • recurrences after terminationofsystemicvalganciclovirtherapyoftenreported

  18. Conclusion – CMV anterior Uveitis • Clinical signscanmimicother viral uveitisdisorders • When AC tapis negative but theclinicalsignsare suggestive for PSS, systemicacyclovirineffective: systemicvalganciclovirisrecommended • In caseofrecurrences, oral valganciclovirtherapywith additional topicalganciclovircanberepeated • In long-lasting undiagnosed PSS treatedonly with aciclovir, theresponsetovalgancilovirseems limited

More Related