To describe clinical features, laboratory findings, course of disease and response to treatment in four patients diagnosed with Posner-Schlossman syndrome (PSS) who had evidence of cytomegalovirus (CMV) infection in their aqueous humour. Review of four consecutive CMV positive PSS patients seen at the Noor Eye Hospital. CMV was diagnosed by polymerase chain reaction analysis of their aqueous. All four patients were immunocompetent males. Mean age of onset was 44.5 years (range, 32–63 years). Maximum intraocular pressure ranged from 36 to 48 mmHg. Mild to moderate anterior chamber reaction, lack of posterior synechiae and posterior segment involvement were consistent features in all the patients. Three patients had diffuse iris atrophy. One patient with a stromal immune ring at presentation developed features of Fuch’s heterochromic iridocyclitis (FHI) later in his course of disease. Heterochromia was also observed in another patient. All patients had a positive titre of IgG but not IgM against CMV, and none had concomitant CMV antigenemia. One patient who had recalcitrant uveitis and glaucoma and another patient who was suffering from frequent attacks and showed evidence of significant endothelial cell loss received anti-CMV therapy. In our population, PSS may be associated with CMV infection and may develop clinical features similar to FHI. Anti-CMV therapy should be reserved for cases with recalcitrant course or secondary complications.
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This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Conflict of interests
The authors declare that they have no competing interests.
Sinclair J, Sissons P (1996) Latent and persistent infections of monocytes and macrophages. Intervirology 39(5–6):293–301PubMedGoogle Scholar
Yoser SL, Forster DJ, Rao NA (1993) Systemic viral infections and their retinal and choroidal manifestations. Surv Ophthalmol 37:313–352PubMedCrossRefGoogle Scholar
Markomichelakis NN, Canakis C, Zafirakis P, Marakis T, Mallias I, Theodossiadis G (2002) Cytomegalovirus as a cause of anterior uveitis with sectoral iris atrophy. Ophthalmology 109:879–882PubMedCrossRefGoogle Scholar
Van Boxtel L, Van der Lelij A, van der Meer J, Los LI (2007) Cytomegalovirus as a cause of anterior uveitis in immunocompetent patients. Ophthalmology 114:1358–1362PubMedCrossRefGoogle Scholar
Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH (2008) Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol 145(5):834–840PubMedCrossRefGoogle Scholar
Bloch-Michel E, Dussaix E, Cerqueti P, Patarin P (1987) Possible role of cytomegalovirus infection in the etiology of the Posner-Schlossmann syndrome. Int Ophthalmol 11:95–96PubMedCrossRefGoogle Scholar
Teoh SB, Thean L, Koay E (2005) Cytomegalovirus in aetiology of Posner-Schlossman syndrome: evidence from quantitative polymerase chain reaction. Eye 19:1338–1340PubMedCrossRefGoogle Scholar
Chee SP, Jap A (2008) Presumed Fuchs heterochromic iridocyclitis and Posner-Schlossman syndrome: comparison of cytomegalovirus-positive and negative eyes. Am J Ophthalmol 146(6):883–889PubMedCrossRefGoogle Scholar
Koizumi N, Yamasaki K, Kawasaki S et al (2006) Cytomegalovirus in aqueous humor from an eye with corneal endotheliitis. Am J Ophthalmol 141:564–565PubMedCrossRefGoogle Scholar
Chee SP, Bascal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH (2007) Corneal endotheliitis associated with evidence of cytomegalovirus infection. Ophthalmology 114:798–803PubMedCrossRefGoogle Scholar
Standardization of Uveitis Nomenclature (SUN) Working Group (2005) Standardization of uveitis nomenclature for reporting clinical data: results of the First International Workshop. Am J Ophthalmol 140:509–516CrossRefGoogle Scholar
Bagheri L, Mokhtarian H, Sarshar N, Ghahramani M (2012) Seroepidemiology of cytomegalovirus infection during pregnancy in Gonabad, east of Iran: a cross-sectional study. J Res Health Sci 12(1):38–44PubMedGoogle Scholar
Safaie N, Ghotaslou R, Montazer Ghaem H (2010) Seroprevalence of cytomegalovirus in patients with and without coronary artery diseases at Madani Heart Center, Iran. Acta Med Iran 48(6):403–406PubMedGoogle Scholar
Chee SP, Jap A (2011) Immune ring formation associated with cytomegalovirus endotheliitis. Am J Ophthalmol 152(3):449–453PubMedCrossRefGoogle Scholar
Shiraishi A, Hara Y, Takahashi M et al (2007) Demonstration of “owl’s eye” morphology by confocal microscopy in a patient with presumed cytomegalovirus corneal endotheliitis. Am J Ophthalmol 143:715–717PubMedCrossRefGoogle Scholar
Neri P, Azuara-Blanco A, Forrester JV (2004) Incidence of glaucoma in patients with uveitis. J Glaucoma 13(6):461–465PubMedCrossRefGoogle Scholar