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Sheng Q, Sun Y, Zhai R, Fan X, Ying Y, Kong X. 2% Ganciclovir Controlled Posner-Schlossman Syndrome Relapse and Reduced the Chance of Corticosteroid Dependence: A Large Cohort in East China. Ocul Immunol Inflamm 2024; 32:505-512. [PMID: 37437131 DOI: 10.1080/09273948.2023.2228404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Qilian Sheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
| | - Yanan Sun
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
| | - Ruyi Zhai
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
| | - Xintong Fan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
| | - Yue Ying
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
| | - Xiangmei Kong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia, Fudan University
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, (Eye & ENT Hospital of Fudan University), Shanghai, China
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Ying Y, Sun Y, Sheng Q, Zhai R, Fan X, Kong X. Steroid-Dependency in Posner-Schlossman Syndrome: A Suggested Topical 2% Ganciclovir and Gradual Decrement of Topical Steroid Combination Therapy from Shanghai PSS Study. Ocul Immunol Inflamm 2024; 32:513-519. [PMID: 37703505 DOI: 10.1080/09273948.2023.2251576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/18/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Yue Ying
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Yanan Sun
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Qilian Sheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Ruyi Zhai
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Xintong Fan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Xiangmei Kong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Eye & ENT Hospital of Fudan University, Shanghai, China
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3
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Dheyab AM, Albloushi AF, Al-Zuabi A, AlTariqi SM, Tobaigy MF, Alfawaz A, Abu El-Asrar A. Long-term Efficacy of Oral Valganciclovir in Presumed Cytomegalovirus Unilateral Hypertensive Anterior Uveitis. Ocul Immunol Inflamm 2024:1-8. [PMID: 38776468 DOI: 10.1080/09273948.2024.2356057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To describe long-term efficacy and safety of oral valganciclovir in the treatment of presumed cytomegalovirus (CMV) unilateral hypertensive anterior uveitis. METHODS Retrospective review of 40 patients (40 eyes). RESULTS All patients presented with high intraocular pressure (mean 39.35 ± 7.58 mmHg), associated with signs of mild anterior uveitis. Oral valganciclovir resulted in control of the intraocular pressures and inflammation in 35 eyes. At the dose of ≥450 mg twice daily, no relapses were documented. The follow-up period ranged from 12 to 108 months (24.45 ± 14.56). At the final follow-up, the intraocular pressure was reduced to 14.92 ± 2.43 mmHg (<0.001). Drug-related complications in the form of leukopenia and azoospermia were reported in one patient. CONCLUSIONS Oral valganciclovir effectively and safely controls intraocular pressure and inflammation in presumed CMV anterior uveitis. A long-term treatment course seems necessary.
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Affiliation(s)
- Abdulsalam M Dheyab
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman F Albloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Asma Al-Zuabi
- Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sulaiman M AlTariqi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohannad F Tobaigy
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alfawaz
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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4
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Tranos P, Markomichelakis N, Koronis S, Sidiropoulos G, Tranou M, Rasoglou A, Stavrakas P. CMV-Related Anterior Uveitis in a Mediterranean European Population: Clinical Features, Prognosis, and Long-Term Treatment Outcomes. Ocul Immunol Inflamm 2024:1-6. [PMID: 38621024 DOI: 10.1080/09273948.2024.2329315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/02/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To describe the spectrum of clinical features of cytomegalovirus-related anterior uveitis (CMV-AU) along with potential comorbidities, to calculate complication rates, and to determine risk factors and biomarkers affecting prognosis in a cohort of a Southern European Mediterranean population. MATERIALS AND METHODS It is a retrospective, multicenter case series of consecutive patients with persisting hypertensive AU, unresponsive to topical steroids therapy, and CMV-positive essays from two uveitis referral centers were collected and analyzed. RESULTS Fifty-seven eyes of 53 patients with polymerase chain reaction-verified CMV-AU over a period of 8 years were included with a mean age of 48 ± 18. Four presentation patterns were identified: 26.3% as Posner-Schlossman-like, 31.6% as chronic AU, 19.3% as presumed herpetic uveitis, 12.3% as Fuchs uveitis syndrome-like, and 10.5% without specific initial classification. About 15.8% received oral valganciclovir, 22.8% received topical valganciclovir, and 61.4% received both, for a mean duration of treatment of 44 months. AU recurrences were observed in 23 eyes with a mean of 1.5 (±1.5) recurrences per year. The only finding significantly associated with recurrence was the presence of posterior synechiae (PS) (p = 0.034). Fewer keratic precipitates (KPs) were indicative for the need of longer treatment, and endotheliitis was strongly associated with the need for filtration surgery. CONCLUSION In this immunocompetent southern European population, four distinct clinical presentation patterns were further confirmed, and possible biomarkers such as PS, KPs, and endotheliitis were newly reported to influence treatment outcomes. Large-scale studies could provide a more effective customized treatment protocol.
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Affiliation(s)
- Paris Tranos
- Uveitis & Surgical Retina Service, Ophthalmica Eye Institute, Thessaloniki, Greece
| | | | - Spyridon Koronis
- Uveitis & Surgical Retina Service, Ophthalmica Eye Institute, Thessaloniki, Greece
| | | | - Marianna Tranou
- Uveitis & Surgical Retina Service, Ophthalmica Eye Institute, Thessaloniki, Greece
| | - Achilleas Rasoglou
- Uveitis & Surgical Retina Service, Ophthalmica Eye Institute, Thessaloniki, Greece
| | - Panagiotis Stavrakas
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, Greece
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5
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Sheng Q, Sun Y, Zhai R, Fan X, Ying Y, Liu Z, Kong X. Murine cytomegalovirus localization and uveitic cell infiltration might both contribute to trabecular meshwork impairment in Posner-Schlossman syndrome: Evidence from an open-angle rat model. Exp Eye Res 2023; 231:109477. [PMID: 37137438 DOI: 10.1016/j.exer.2023.109477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/22/2023] [Accepted: 04/16/2023] [Indexed: 05/05/2023]
Abstract
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.
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Affiliation(s)
- Qilian Sheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; National Health Commission Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Rd., 200031, Shanghai, China
| | - Yanan Sun
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; National Health Commission Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Rd., 200031, Shanghai, China
| | - Ruyi Zhai
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; National Health Commission Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Rd., 200031, Shanghai, China
| | - Xintong Fan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; National Health Commission Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Rd., 200031, Shanghai, China
| | - Yue Ying
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; National Health Commission Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Rd., 200031, Shanghai, China
| | - Zhijun Liu
- Department of Medical Microbiology, Weifang Medical University, Weifang, 261053, China.
| | - Xiangmei Kong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; National Health Commission Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Rd., 200031, Shanghai, China.
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6
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Ye Z, Yang Y, Ke W, Li Y, Wang K, Chen M. Overview and update on cytomegalovirus-associated anterior uveitis and glaucoma. Front Public Health 2023; 11:1117412. [PMID: 36935679 PMCID: PMC10014866 DOI: 10.3389/fpubh.2023.1117412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/08/2023] [Indexed: 03/06/2023] Open
Abstract
Cytomegalovirus anterior uveitis is the most common ocular inflammatory disease caused by cytomegalovirus infection. It mainly occurs in middle-aged males with competent immunologic function, and the incidence is higher in Asia. The clinical manifestations vary from Posner-Schlossman syndrome and corneal endotheliitis to Fuchs uveitis syndrome, and are often accompanied by intraocular hypertension. Secondary glaucoma is a potentially blinding ocular complication with a pathogenesis that includes complicated immunological factors, intraocular inflammation, different types of angle abnormalities, and the administration of steroids, which may result in physical discomfort and visual impairment. Diagnostic tests, such as the polymerase chain reaction, optical coherence tomography, ocular microscopy, and confocal microscopy, might help in identifying anterior uveitis caused by other viruses. Combinations of antiviral medications and anti-inflammatory agents are effective treatments. If pharmacological therapy cannot reduce intraocular pressure or slow the progression of glaucomatous optic neuropathy, surgical intervention is required as a last resort.
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Affiliation(s)
- Zifan Ye
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Yumei Yang
- Shangyu People's Hospital of Shaoxing, Shaoxing, China
| | - Weishaer Ke
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Yuhang Li
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Kaijun Wang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
- Kaijun Wang
| | - Min Chen
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
- *Correspondence: Min Chen
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HSP70 and TNF Loci Polymorphism Associated with the Posner-Schlossman Syndrome in a Southern Chinese Population. J Immunol Res 2022; 2022:5242948. [DOI: 10.1155/2022/5242948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022] Open
Abstract
Previous studies have shown that HLA gene polymorphisms are associated with the pathogenesis of the Posner-Schlossman syndrome (PSS). This study was aimed at evaluating the associations between HLA-III gene polymorphisms and PSS in a southern Chinese Han population. A total of 150 PSS patients and 183 healthy controls were included in this study. Twenty-one single nucleotide polymorphisms (SNPs) of HLA-III genes (including HSP70-1, HSP70-2, HSP70-hom, TNF-α, TNF-β, C2, and CFB) were genotyped using the SNaPshot technique. Our study showed that the frequencies of G allele at rs909253, A allele at rs1041981, and G allele at rs2844484 of TNF-β in the patient group were significantly higher than those in healthy controls (Corrected
,
;
,
;
,
, respectively). The frequency of T allele at rs12190359 of HSP70-1 was significantly lower in PSS patients than those in healthy controls (
and
). The frequencies of the CCT haplotype of HSP70-1 gene (rs1008438-rs562047-rs12190359) and the ACCCTTT haplotype of HSP70 gene (rs2227956-rs1043618-rs1008438-rs562047-rs12190359-rs2763979-rs6457452) were significantly lower in PSS patients than those in healthy controls (
,
;
,
, respectively). In conclusion, the G allele at rs909253, A allele at rs1041981, and G allele at rs2844484 of TNF-β gene might be risk factors for PSS, while the T allele at rs12190359 of HSP70-1 gene and specific haplotypes of the HSP70-1 and HSP70 genes might be protective factors for PSS.
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Sheng Q, Zhai R, Fan X, Kong X. 2% Ganciclovir Eye Drops Control Posner-Schlossman Syndrome Relapses With/Without Cytomegalovirus Intraocular Reactivation. Front Med (Lausanne) 2022; 9:848820. [PMID: 35355609 PMCID: PMC8959537 DOI: 10.3389/fmed.2022.848820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Qilian Sheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Ruyi Zhai
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xintong Fan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiangmei Kong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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9
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Fan X, Li Z, Zhai R, Sheng Q, Kong X. Clinical characteristics of virus-related uveitic secondary glaucoma: focus on cytomegalovirus and varicella zoster virus. BMC Ophthalmol 2022; 22:130. [PMID: 35317777 PMCID: PMC8938591 DOI: 10.1186/s12886-022-02348-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
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 < .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.
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Affiliation(s)
- Xintong Fan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Zhizhe Li
- Department of Ophthalmology, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Ruyi Zhai
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Qilian Sheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Xiangmei Kong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
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10
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Construction of a mouse model of Posner-Schlossman syndrome by anterior chamber infection with cytomegalovirus. Exp Eye Res 2022; 218:109009. [PMID: 35276185 DOI: 10.1016/j.exer.2022.109009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 11/21/2022]
Abstract
Accumulated clinical evidence has shown that Posner-Schlossman syndrome (PSS) is most likely the result of recurrent human cytomegalovirus (HCMV) infection in the anterior chamber (AC). Establishing an animal model is necessary to investigate the pathogenesis of PSS. In this study, we constructed a mouse model of (PSS) by injecting murine cytomegalovirus (MCMV) into the AC of BALB/c mice. Twenty-five BALB/c mice were divided into 5 groups. Smith strain MCMV expressing enhanced green fluorescent protein (EGFP) was passaged with mouse embryonic fibroblast (MEF). Right eyes in the 4 experiment groups received AC injection of 1 μL of virus solution with concentrations of 103,104,105,106 pfu/mL respectively, and the control group received only PBS. PSS-like signs (mutton-fat keratic precipitates (KP), pupil dilation, IOP elevation and corneal edema) were recorded 0-28 days post-injection (DPI). Sections of eyeballs from another 9 mice harvested on 0,10 and 28 DPI were examined to locate KP and the fluorescence signal of the virus. Reversible PSS-like signs except KP were observed in 20% and 60% mice of 104 and 105 groups while no PSS-like signs in the control and 103 group; 80% in the 106 group with partially unreversible signs till 28DPI. Much More fluorescent signals of virus in the iris and KP were found on 10DPI than 28 DPI, while no fluorescent signals and KP on 0DPI. The extent of PSS-like signs (pupil dilation, IOP elevation and corneal edema) was virus concentration-dependent (Spearman correlation coefficient, r = 0.830, = 0.475, = 0.662, p < 0.0001, <0.05, <0.001, respectively, n = 25). Success rate of PSS model (mice with PSS-like signs) was also virus concentration-dependent (Chi-square trend test, χ2 = 6.828, df = 1, p < 0.01, n = 25). Our results indicate that AC injection of 1 μL MEF passaged MCMV (Smith strain) of 104-106 pfu/mL in BALB/c mice can be used to construct a mouse model of PSS. MCMV can infect iris tissue and replicate in it and then establish latency. This might account for the recurrent and self-limited nature of PSS.
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Abstract
Glaucoma is an intraocular pressure-related ophthalmic disease with multiple causes that results in an optic neuropathy and vision loss. Intraocular pressure elevation is among its strongest risk factors. While glaucoma is mostly primary in etiology, secondary glaucoma is not infrequent. Recognizing its cause is imperative, since treatment is often different depending on the pathophysiologic mechanism. Numerous clinically relevant ophthalmic infections can result in robust inflammatory responses that may result in pressure elevation or intraocular anatomic configurations that predispose to pressure elevation. Knowing the mechanisms by which these infections can lead to glaucoma is critical in treating, and we consolidate what is currently known in regards to how infectious diseases lead to glaucoma.
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12
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Babu K, Konana VK, Ganesh SK, Patnaik G, Chan NSW, Chee SP, Sobolewska B, Zierhut M. Viral anterior uveitis. Indian J Ophthalmol 2021; 68:1764-1773. [PMID: 32823392 PMCID: PMC7690545 DOI: 10.4103/ijo.ijo_928_20] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Viral anterior uveitis (VAU) needs to be suspected in anterior uveitis (AU) associated with elevated intraocular pressure, corneal involvement, and iris atrophic changes. Common etiologies of VAU include herpes simplex, varicella-zoster, cytomegalovirus, and rubella virus. Clinical presentations can vary from granulomatous AU with corneal involvement, Posner-Schlossman syndrome, Fuchs uveitis syndrome, and endothelitis. Due to overlapping clinical manifestations between the different viruses, diagnostic tests like polymerase chain reaction and Goldmann-Witmer coefficient analysis on the aqueous humor may help in identifying etiology to plan and monitor treatment.
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Affiliation(s)
- Kalpana Babu
- Department of Uveitis and Ocular inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India
| | - Vinaya Kumar Konana
- Department of Uveitis and Ocular inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India
| | - Sudha K Ganesh
- Department of Uveitis and Ocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Gazal Patnaik
- Department of Uveitis and Ocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Nicole S W Chan
- Department of Ophthalmology, National University Hospital, Singapore
| | - Soon-Phaik Chee
- Singapore National Eye Centre; Singapore Eye Research Institute; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore; Duke-NUS Graduate Medical School Singapore, Singapore
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Papasavvas I, Jeannin B, Herbort CP. When HIV Immunodeficiency and Heterochromia Confuse the Issue: Recurrent Zoster Uveitis Mistaken for Fuchs' Uveitis. J Ophthalmic Vis Res 2021; 16:295-299. [PMID: 34055267 PMCID: PMC8126730 DOI: 10.18502/jovr.v16i2.9094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose We report a case with iris heterochromia misdiagnosed as Fuchs' uveitis which finally turned out to be a unilateral zoster uveitis in an HIV-positive patient. Case Report A 45-year old patient was seen for a recurrent right anterior uveitis treated with prednisolone 1% drops BID. The iris of the right eye was hypochromic and atrophic and several small granulomatous keratic precipitates (KPs) were present. After discontinuation of corticosteroid drops, severe uveitis developed with mutton-fat KPs, and laser flare photometry (LFP) increased from 20 to 50.3 ph/ms. He had presented with right zoster ophthalmicus two years earlier and HIV-serology revealed to be positive. Conclusion Iris heterochromia is not a good disease-defining criterion for Fuch's uveitis even when typical KPs are present and can lead to misdiagnosis. More reliable criteria including stellate KPs, low LFP values, absence of synechiae, vitreitis, and disc hyperfluorescence, all absent in this case, should be sought to confirm or exclude the diagnosis.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
| | - Bruno Jeannin
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
| | - Carle Pierre Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
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14
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Yang MM, Sun HY, Meng T, Qiu SH, Zeng QQ, Ng TK, Jiang L, Deng TM, Zeng AN, Wang J, Luo XL. CFH I62V as a Putative Genetic Marker for Posner-Schlossman Syndrome. Front Immunol 2021; 12:608723. [PMID: 33643312 PMCID: PMC7904693 DOI: 10.3389/fimmu.2021.608723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/22/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: Posner-Schlossman syndrome (PSS), also known as glaucomatocyclitic crisis, is an ocular condition characterized by recurrent attacks of anterior uveitis and raised intraocular pressure. Previous studies by our team and others have identified the genetic association of complement pathway genes with uveitis and glaucoma. This study aimed to investigate the complement genes in PSS patients with the view of elucidating the genetic background of the disease. Methods: A total of 331 subjects (56 PSS patients and 275 controls) were recruited for this study. We selected 27 variants in six complement pathway genes (SERPING1, C2, CFB, CFH, C3, and C5) and detected them using TaqMan single nucleotide polymorphism (SNP) Genotyping Assays. Univariate SNP association analysis, haplotype-based association analysis, gene-gene interaction analysis among complement genes, and genotype-phenotype correlation analysis were performed. Results: Among the 27 variants of six complement pathway genes, the functional variant I62V (rs800292) at the CFH gene was found to be significantly associated with PSS; there was a significant increase in the frequency of A allele and AA homozygosity in PSS patients than in controls (P = 1.79 × 10−4; odds ratio (OR) 2.18, 95% CI: 1.44–3.29; P = 4.65 × 10−4; OR 3.66, 95% CI: 1.70–7.85, respectively). The additive effect of CFH-rs800292 and SERPING1-rs3824988 was identified with an OR of 12.50 (95% CI: 2.16–72.28). Genotype-phenotype analysis indicated that the rs800292 AA genotype was associated with a higher intraocular pressure and higher frequency of recurrence. Unlike a high proportion of human leukocyte antigen (HLA)-B27 positivity in anterior uveitis, only 3 in 56 (5.36%) PSS patients were HLA-B27 positive. In addition, one haplotype block (GC) in the SERPING1 gene showed a nominal association with PSS with an increased risk of 2.04 (P = 0.01; 95% CI: 1.18–3.53), but the P-value could not withstand the Bonferroni correction (Pcorr > 0.05). Conclusion: This study revealed a genetic association of a CFH variant with PSS as well as its clinical parameters, implying that the alternative complement pathway might play an important role in the pathogenesis of PSS. Further studies to enrich the understanding of the genetic background of PSS and the role of the complement system in ocular inflammation are warranted.
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Affiliation(s)
- Ming Ming Yang
- Department of Ophthalmology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University & The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Hong Yan Sun
- Department of Ophthalmology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University & The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Ting Meng
- Department of Ophthalmology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University & The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Shan Hu Qiu
- Department of Endocrinology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University & The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Qi Qiao Zeng
- Department of Ophthalmology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University & The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Jiang
- Department of Ophthalmology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University & The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Ting Ming Deng
- Department of Ophthalmology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University & The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Ai Neng Zeng
- Department of Ophthalmology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University & The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Jun Wang
- Department of Endocrinology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University & The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xiao Ling Luo
- Department of Ophthalmology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University & The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
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15
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Igarashi N, Honjo M, Kaburaki T, Aihara M. Effects of ROCK Inhibitors on Apoptosis of Corneal Endothelial Cells in CMV-Positive Posner-Schlossman Syndrome Patients. Invest Ophthalmol Vis Sci 2021; 61:5. [PMID: 32749463 PMCID: PMC7441372 DOI: 10.1167/iovs.61.10.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose To examine the role of aqueous tumor necrosis factor α (TNF-α)–RhoA–Rho kinase (ROCK) signaling in cytomegalovirus (CMV)-induced apoptosis and the barrier function of cultured human corneal endothelial cells (hCECs) in CMV-positive Posner–Schlossman syndrome (CMV+/PSS) patients. Methods Aqueous levels of TNF-α, IL-8, IL-10, and several other cytokines in 19 CMV+/PSS patients and 20 healthy control subjects were quantitated using a multiplex assay. The expression of active RhoA in hCECs post-CMV infection was determined using western blotting (WB). The expression levels of TNF-α and nuclear factor kappa B (NF-κB) in CMV-infected hCECs were examined by immunocytochemistry (ICC) and WB with and without ROCK inhibitors. The apoptotic rate and barrier integrity in CMV-infected hCECs were also examined. Results The expression levels of TNF-α, monocyte chemoattractant protein-1 (MCP-1), IL-8, and IL-10 were upregulated in the aqueous humor of CMV+/PSS patients, and among these upregulated cytokines aqueous TNF-α was negatively correlated with the number of corneal endothelial cells. In CMV-infected hCECs, upregulation of TNF-α and NF-κB was determined by WB and ICC. In hCECs, CMV infection induced apoptosis and significantly impaired cell–cell contacts, effects that were attenuated by treatment with a ROCK inhibitor. Conclusions Aqueous TNF-α was upregulated in CMV+/PSS patients, which may have triggered corneal endothelial cell loss. Modulation of TNF-α, including its downstream Rho–ROCK signaling, could serve as a novel treatment modality for corneal endothelial cell loss in CMV+/PSS patients.
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Murata K, Ishida K, Ozawa K, Sawada A, Mochizuki K, Yamamoto T. The characteristics of Posner-Schlossman syndrome: A comparison in the surgical outcome between cytomegalovirus-positive and cytomegalovirus-negative patients. Medicine (Baltimore) 2019; 98:e18123. [PMID: 31770242 PMCID: PMC6890343 DOI: 10.1097/md.0000000000018123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This retrospective observational study aims to report the clinical characteristics and surgical results in eyes with Posner-Schlossman syndrome (PSS), and compare these outcomes between cytomegalovirus (CMV)-positive and -negative eyes.We reviewed the medical records of 21 consecutive immunocompetent patients clinically diagnosed with PSS between the years 2010 and 2018. Aqueous humor was collected from all the affected eyes to detect if CMV was present, and polymerase chain reaction (PCR) was performed using the herpesvirus family primers.The average period between the initial PSS attack and aqueous humor sampling at our institute was 9.3 years. Out of the 21 patients, 62% were CMV-positive. Regardless of CMV status, the mean intraocular pressure (IOP), mean deviation (MD), and central corneal endothelium cell (CEC) density, at the initial examination at our institute were already significantly worse in the affected eyes than in the unaffected eyes (all P values < .05). The average visual acuity (VA) was only significantly worse in the CMV-positive group (P = .02). Out of all the patients, those that were CMV-positive had undergone more glaucoma surgeries (P = .056). Fourteen patients underwent either a trabeculectomy (TRAB) or a trabeculotomy (LOT), and their IOP significantly reduced following surgery (P < .001). In 85.7% of those that had surgery, their IOP was successfully lowered to less than 20 mm Hg.Long-lasting PSS causes a decrease in VA, MD, and the CEC density. A prompt diagnosis is required, and an appropriate treatment plan should be formulated. In those patients with PSS that develop uncontrolled glaucoma, both TRAB and LOT may be effective in controlling IOP.
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Affiliation(s)
- Kazuhiro Murata
- Department of Ophthalmology, Gifu University Graduate School of Medicine
| | - Kyoko Ishida
- Department of Ophthalmology, Toho University Ohashi Medical Center, Japan
| | - Kenji Ozawa
- Department of Ophthalmology, Gifu University Graduate School of Medicine
| | - Akira Sawada
- Department of Ophthalmology, Gifu University Graduate School of Medicine
| | - Kiyofumi Mochizuki
- Department of Ophthalmology, Gifu University Graduate School of Medicine
| | - Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine
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Association of TLR2 Gene Polymorphisms with Presumed Viral-Induced Anterior Uveitis in male Han Chinese. Exp Eye Res 2019; 187:107777. [DOI: 10.1016/j.exer.2019.107777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/22/2019] [Accepted: 08/23/2019] [Indexed: 01/27/2023]
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18
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Diagnosis and Management of CMV Endotheliitis. CURRENT OPHTHALMOLOGY REPORTS 2019. [DOI: 10.1007/s40135-019-00205-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Keorochana N, Treesit I, Funarunart P. Characteristics and Clinical Outcomes of Hypertensive Anterior Uveitis. Ocul Immunol Inflamm 2019; 28:538-548. [PMID: 31020885 DOI: 10.1080/09273948.2019.1587471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Narumon Keorochana
- Ocular inflammatory and Uveitis division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao college of Medicine , Bangkok, Thailand
| | - Isaraporn Treesit
- Glaucoma division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao college of Medicine , Bangkok, Thailand
| | - Panrapee Funarunart
- Glaucoma division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao college of Medicine , Bangkok, Thailand
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Chan NS, Chee S. Demystifying viral anterior uveitis: A review. Clin Exp Ophthalmol 2018; 47:320-333. [DOI: 10.1111/ceo.13417] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/07/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | - Soon‐Phaik Chee
- Singapore National Eye Centre Singapore Singapore
- Singapore Eye Research Institute Singapore Singapore
- Department of Ophthalmology, Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
- Duke‐NUS Medical School Singapore Singapore
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21
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Aqueous tap and rapid diagnosis of cytomegalovirus anterior uveitis: the Reggio Emilia experience. Graefes Arch Clin Exp Ophthalmol 2018; 257:181-186. [DOI: 10.1007/s00417-018-4180-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 12/19/2022] Open
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22
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Relvas LJM, Antoun J, de Groot-Mijnes JD, Motulsky E, Ten Dam-Van Loon NH, Makhoul D, Willermain F, Caspers L. Diagnosis of Cytomegalovirus Anterior Uveitis in Two European Referral Centers. Ocul Immunol Inflamm 2018; 26:116-121. [DOI: 10.1080/09273948.2017.1411952] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Lia Judice M. Relvas
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Ophthalmology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joelle Antoun
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Elie Motulsky
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Dorine Makhoul
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Ophthalmology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - François Willermain
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Ophthalmology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Laure Caspers
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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23
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Chan NSW, Chee SP, Caspers L, Bodaghi B. Clinical Features of CMV-Associated Anterior Uveitis. Ocul Immunol Inflamm 2017; 26:107-115. [PMID: 29172842 DOI: 10.1080/09273948.2017.1394471] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Nicole Shu-Wen Chan
- a Ocular Inflammation and Immunology Service , Singapore National Eye Centre , Singapore
| | - Soon-Phaik Chee
- a Ocular Inflammation and Immunology Service , Singapore National Eye Centre , Singapore.,b Ocular Inflammation and Immunology Research Group , Singapore Eye Research Institute , Singapore.,c Department of Ophthalmology, Yong Loo Lin School of Medicine , National University of Singapore , Singapore.,d Ophthalmology & Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School , Singapore
| | - Laure Caspers
- e Department of Ophthalmology , CHU St Pierre and Université Libre de Bruxelles , Brussels , Belgium
| | - Bahram Bodaghi
- f DHU ViewRestore , University of Pierre and Marie Curie, Sorbonne Universités , Paris , France
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Abstract
Anterior uveitis is a potentially sight-threatening disease, which affects either one or both eyes. Although the etiology is not fully understood, important associations with systemic diseases and infections have been established. A thorough clinical investigation with the slit lamp may reveal important findings leading to diagnosis and therapy. Additional diagnostic procedures are usually required only with the occurrence of relapses. Most anterior uveitis cases with an underlying autoimmune etiology respond very well to topical steroids and mydriasis while systemic treatment is rarely needed. In contrast, infectious causes typically require systemic medication. Anterior uveitis has a good prognosis if treated adequately despite some complications like cataract, macular edema, or increase of intraocular pressure, which cannot be prevented in all cases.
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25
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Antoun J, Willermain F, Makhoul D, Motulsky E, Caspers L, Relvas LJ. Topical Ganciclovir in Cytomegalovirus Anterior Uveitis. J Ocul Pharmacol Ther 2017; 33:313-318. [PMID: 28426277 DOI: 10.1089/jop.2016.0138] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To study the effects of topical ganciclovir 0.15% gel on cytomegalovirus (CMV) anterior uveitis in a tertiary uveitis referral center in Brussels, Belgium. METHODS A retrospective study of patients with a clinical diagnosis of CMV anterior uveitis/endotheliitis demonstrated by a positive polymerase chain reaction and/or Goldmann-Witmer coefficient (GWc). RESULTS We report a series of 15 patients presenting clinical characteristics of CMV anterior uveitis. Patients had a pretreatment follow-up of 13.00 ± 12.78 months and a posttreatment follow-up of 42.64 ± 31.23 months. The 14 non-Asian patients (93.3%) had clinical characteristics of Posner-Schlossman syndrome, and the only Asian patient (6.7%) had keratic precipitates like Fuchs heterochromic iridocyclitis. At presentation, uveitis was unilateral in all patients, visual acuity (VA) was 0.91 ± 0.25, and all patients had an increased intraocular pressure (IOP), with a mean IOP of 41.40 ± 10.35 mmHg. At the end of the follow-up, 5 patients (33.3%) had glaucoma, 2 needed glaucoma surgery (13.3%). The mean final VA was 0.93 ± 0.11; 13 patients (86.5%) reached a final VA of 0.7 to 1. Patients had a significantly lower number of recurrences/year posttreatment (0.76 ± 0.57) than in the pretreatment period (3.76 ± 2.44) (P = 0.001). The mean time to recurrence increased from 4.03 months before treatment to 12.58 months after treatment (P = 0.003). CONCLUSION Our results suggest that patients treated with 0.15% topical ganciclovir have a decreased frequency of CMV anterior uveitis recurrences, most preserve a relatively good central vision over time. However, glaucoma is a frequent and severe complication.
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Affiliation(s)
- Joelle Antoun
- 1 Department of Ophthalmology, Saint Pierre Hospital , Université Libre de Bruxelles, Brussels, Belgium
| | - François Willermain
- 1 Department of Ophthalmology, Saint Pierre Hospital , Université Libre de Bruxelles, Brussels, Belgium .,2 Department of Ophthalmology, Brugmann Hospital , Université Libre de Bruxelles, Brussels, Belgium
| | - Dorine Makhoul
- 1 Department of Ophthalmology, Saint Pierre Hospital , Université Libre de Bruxelles, Brussels, Belgium .,2 Department of Ophthalmology, Brugmann Hospital , Université Libre de Bruxelles, Brussels, Belgium
| | - Elie Motulsky
- 1 Department of Ophthalmology, Saint Pierre Hospital , Université Libre de Bruxelles, Brussels, Belgium .,2 Department of Ophthalmology, Brugmann Hospital , Université Libre de Bruxelles, Brussels, Belgium
| | - Laure Caspers
- 1 Department of Ophthalmology, Saint Pierre Hospital , Université Libre de Bruxelles, Brussels, Belgium
| | - Lia Judice Relvas
- 1 Department of Ophthalmology, Saint Pierre Hospital , Université Libre de Bruxelles, Brussels, Belgium .,2 Department of Ophthalmology, Brugmann Hospital , Université Libre de Bruxelles, Brussels, Belgium
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Megaw R, Agarwal PK. Posner-Schlossman syndrome. Surv Ophthalmol 2016; 62:277-285. [PMID: 28012873 DOI: 10.1016/j.survophthal.2016.12.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
Posner-Schlossman syndrome, or glaucomatocyclitic crisis, is a unilateral ocular condition characterized by recurrent attacks of nongranulomatous anterior uveitis and raised intraocular pressure that can result in chronic secondary glaucoma. This relatively rare disease is most likely the result of recurrent cytomegalovirus infection and affects predominantly middle-aged males. Diagnosis is largely clinical, with aqueous and blood sampling aiding the identification of any underlying infectious cause. Successful disease management is often achieved by topical treatment, although systemic therapy and even surgical intervention may be required. We discuss our current understanding of Posner-Schlossman syndrome, from its pathophysiology through to recommended treatment options.
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Affiliation(s)
- Roly Megaw
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom.
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Thurau S, Pleyer U. Differenzialdiagnose der anterioren intraokularen Entzündung. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0320-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current Approach in the Diagnosis and Management of Uveitic Glaucoma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:742792. [PMID: 26558280 PMCID: PMC4628996 DOI: 10.1155/2015/742792] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 05/18/2015] [Accepted: 05/25/2015] [Indexed: 12/15/2022]
Abstract
Uveitic glaucoma (UG) typically is associated with very high intraocular pressure (IOP) and more intense optic nerve damage than other glaucoma types. This secondary glaucoma requires an early diagnosis and adequate management of both uveitis and glaucoma. It is mandatory to identify the mechanisms of IOP elevation that in many eyes have multiple combined mechanisms. Management of these patients commonly requires an interdisciplinary approach that includes a glaucoma specialist and rheumatologist to control the inflammation and IOP. Glaucoma surgery is required early in these patients due to the high IOP usually present and is less successful than in primary open-angle glaucoma. Recurrent uveitic episodes, multiple mechanism, and the complications associated with uveitis make surgical management of UG challenging. In this review, the management and treatment of UG are updated to clarify the pathogenesis and prevent optic nerve damage.
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Abstract
AIM To analyze current understanding of the factors that contribute to raised intraocular pressure (IOP) in patients with uveitis. METHODS A pubmed literature review was carried out using words including "uveitic glaucoma", "IOP AND uveitis", "ocular hypertension AND uveitis", "inflammation AND glaucoma", "aqueous dynamics" AND "glaucoma/uveitis". RESULTS Of the two studies looking at the aqueous dynamics in experimentally induced uveitis, both found aqueous flow decreased acutely, and one found that uveoscleral outflow increased. This is likely to reflect the types of uveitis that present acutely with hypotony. A study examining patients with Fuch's heterochromic cyclitis found no difference in aqueous flow or uveoscleral outflow. No studies have examined aqueous dynamics in types of uveitis that present with acutely raised IOP. Levels of prostaglandins rise in acute uveitis, which has been shown to increase uveoscleral and trabecular outflow, without affecting aqueous flow. Studies have demonstrated that raised levels of trabecular protein reduce trabecular outflow. Steroid treatment, inflammatory cells, free radicals and enzymes are also likely to contribute to the development of raised pressure. When considering the impact of the pathogenesis of raised pressure in uveitis on its treatment, prostaglandins may provide good intraocular pressure control, but there are concerns regarding their theoretical ability to worsen the inflammatory response in uveitis. Studies have not conclusively proven this to be the case. Surgical success rates vary, but trabeculectomy plus an antimetabolite, deep sclerectomy plus an antimetabolite, and Ahmed valve surgery have been used. CONCLUSIONS Uveitic glaucoma is caused by a number of different diseases, some of which present with acute hypotony, others with acutely raised IOP, and others which demonstrate an increase in IOP over time. Further studies should be carried out to examine the differing pathogenesis in these types of diseases, and to establish the best treatment options.
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Affiliation(s)
- Alexander Jan Baneke
- a Department of Ophthalmology , St Thomas' Hospital, Guy's and St Thomas' NHS Trust , London , UK
| | - K Sheng Lim
- a Department of Ophthalmology , St Thomas' Hospital, Guy's and St Thomas' NHS Trust , London , UK
| | - Miles Stanford
- a Department of Ophthalmology , St Thomas' Hospital, Guy's and St Thomas' NHS Trust , London , UK
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