Transcript Folie 1

Posner-Schlossman Syndrome
Bianka Sobolewska, MD
Centre of Ophthalmology
University of Tuebingen,
Germany
Ocular and General History
 27 year old men
 3-2010: OS recurrent anterior uveitis with
elevated intraocular pressure (IOP)
 2007: knee pain
August 2010: First Presentation
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VA: OD 20/20, OS 20/32
IOP: OD 20 mmHg, OS 34 mmHg
OD: regular
OS: non-granulomatous KPs,
slightly larger pupil than in OD, cells 0.5+
 Fundus:
 regular
August 2010: First Presentation
 Diagnostic tests:
 anterior chamber fluid analysis (PCR) for CMV, EpsteinBarr virus, herpes simplex virus, varicella zoster virus
 all other tests negative: serology for syphilis, borreliosis and
Bartonella, QuantiFeron test, ANA, ANCA, chest CT
 Therapy:
 topical antiglaucomatosa, rimexolone eye drops t.i.d., and
ganciclovir ophthalmic gel t.i.d.
 systemic valganciclovir : 3 weeks: 900 mg b.i.d. followed
by 450 mg b.i.d.
September 2010 to March 2011
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VA: OS 20/20
IOP: OS between 16 mmHg and 18 mmHg
No KPs, no cells
Therapy:
 reduction of topical therapy
 systemic valganciclovir 450 mg b.i.d
Follow-up
 08-2012:
 No recurrence
 Termination of therapy
 01-2013:
 No recurrence
Final Diagnosis
 Possner-Schlossman Syndrome (PSS)
 Differential diagnosis
 Herpetic anterior uveitis (HSV, VZV)
 Fuchs` uveitis
 Good response to oral valganciclovir
Problems
 Rare disease
 Often misdiagnosed
 Negative AC tap (PCR) does not exclude PSS
 Unclear treatment regimen when AC tap is
negative
Conclusion
 Clinical signs can mimic other uveitis disorders
 When AC tap is negative but the clinical signs are
still suggestive for PSS, repeated AC tap may be
considered
 Oral valganciclovir with additional topical
ganciclovir was effective
 Side effects possible, but seem to be far less
dominant as from HIV patients reported