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
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
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