Long-term oral therapy with valganciclovir in patients with Posner-Schlossman syndrome

Inflammatory Disorders
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Abstract

Background

To assess the short-term and long-term efficacy of oral therapy with valganciclovir in patients with Posner-Schlossman Syndrome (PSS).

Methods

This is a retrospective observational study on 11 patients with PSS treated with valganciclovir. The PSS was diagnosed clinically on the basis of recurrent episodes of anterior uveitis associated with attacks of elevated intraocular pressure (IOP). All patients who did not respond to aciclovir, or whose cytomegalovirus (CMV) DNA polymerase chain reaction (PCR) analysis of the aqueous humour was positive, were treated with valganciclovir (Valcyte®). Initially, the drug was given 900 mg twice daily for 3 weeks, followed by 450 mg twice daily for a mean period of 20 months (range 10–46 months).

Results

Eleven patients with mean age of 44 years were included in this study. Four of 11 patients were working in a sanitary profession. Before initiation of valgancicloivir therapy, the highest IOP was 68 mmHg (mean 45 mmHg ±9 mmHg). In the first week of treatment, the IOP decreased significantly (mean 16 mmHg ±10 mmHg) and maintained stability during the entire treatment period. In seven of 11 (63.6 %) patients, valganciclovir led to resolution of inflammatory activity and stable IOP. In six patients, the therapy could be discontinued after a mean of 14 months. However, two patients had a recurrence after discontinuation of valganciclovir treatment. No side effects of therapy were observed.

Conclusions

Long-term oral therapy with valganciclovir seems to lower the recurrence rate in patients with clinically diagnosed PSS.

Keywords

Posner-Schlossman syndrome Cytomegalovirus Valganciclovir 
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Notes

Acknowledgments

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Authors’ contribution

Each author 1) contributed to the conception and design, acquisition of data, analysis and interpretation of data; 2) drafted the article and revised it critically for important intellectual content and final approval of the version to be published.

Conflict of interest

None of the authors has a financial or property interest in any material or method mentioned in this manuscript.

References

  1. 1.
    Posner A, Schlossman A (1948) Syndrome of unilateral attacks of glaucoma with cyclitic symptoms. Arch Ophthalmol 39:517–535CrossRefGoogle Scholar
  2. 2.
    de Schryer I, Rozenberg F, Cassoux N, Michelson S, Kestelyn P, Lehoang P, Davis JL, Bodaghi B (2006) Diagnosis and treatment of cytomegalovirus iridocyclitis without retinal necrosis. Br J Ophthalmol 90:852–855CrossRefGoogle Scholar
  3. 3.
    Bloch-Michel E, Dussaix E, Cerqueti P, Patarin D (1987) Possible role of cytomegalovirus infection in the etiology of the Posner-Schlossman syndrome. Int Ophthalmol 11:95–96PubMedCrossRefGoogle Scholar
  4. 4.
    Teoh SB, Thean L, Koay E (2005) Cytomegalovirus in etiology of Posner-Schlossman syndrome: evidence from quantitative polymerase chain reaction. Eye 19:1338–1340PubMedCrossRefGoogle Scholar
  5. 5.
    Chee SP, Jap A (2010) Cytomegalovirus anterior uveitis: outcome of treatment. Br J Ophthalmol 94:1648–1652PubMedCrossRefGoogle Scholar
  6. 6.
    Jabs DA, Nussenblatt RB, Rosenbaum JT (2005) Standarization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 140:509–516PubMedCrossRefGoogle Scholar
  7. 7.
    Chee SP, Jap A (2008) Presumed Fuchs heterochromic iridocyclitis and Posner-Schlossman syndrome: comparison of cytomegalovirus positive and negative eyes. Am J Ophthalmol 146:883–889PubMedCrossRefGoogle Scholar
  8. 8.
    Foster PJ, Ralf B, Quigley HA, Johnson GJ (2002) The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol 86:238–242PubMedCrossRefGoogle Scholar
  9. 9.
    Markomichelakis NN, Canakis N (2002) Cytomegalovirus as a cause of anterior uveitis with sectorial iris atrophy. Ophthalmology 109:879–882PubMedCrossRefGoogle Scholar
  10. 10.
    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 145:834–840PubMedCrossRefGoogle Scholar
  11. 11.
    Hwang YS, Link KK, Lee JS, Chang SH, Chen KJ, Lai CC, Huang JC, Kuo JH, Hsiao CH (2010) Intravitreal loading injection of ganciclovir with or without adjunctive oral valganciclovir for cytomegalovirus anterior uveitis. Graefes Arch Clin Exp Ophthalmol 248:263–269PubMedCrossRefGoogle Scholar
  12. 12.
    Macha A, Mitra AK (2002) Ocular disposition of ganciclovir and its monoester prodrugs following intravitreal administration using microdialysis. Drug Metab Dispos 30:670–675PubMedCrossRefGoogle Scholar
  13. 13.
    Morlet N, Young S, Naidoo D, Graham G, Coroneo MT (1996) High dose intravitreal ganciclovir injection provides a prolonged therapeutic intraocular concentration. Br J Ophthalmol 80:214–216PubMedCrossRefGoogle Scholar
  14. 14.
    Castela N, Vermerie N, Chast F, Sauvageon-Martre H, Denis J, Godard V, Goldschmidt P, Pouliquen Y (1994) Ganciclovir ophthalmic gel in herpes simplex virus keratitis: intraocular penetration and efficacy. J Ocul Pharmacol 10:439–451PubMedCrossRefGoogle Scholar
  15. 15.
    Kondo K, Kanehima H, Mocarski ES (1994) Human cytomegalovirus latent infection of granulocyte-mycrophage progenitors. Proc Natl Acad Sci U S A 91:11879–11883PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Bruggeman CA (1993) Cytomegalovirus and latency: an overview. Virchows Arch B Cell Pathol Incl Mol Pathol 64:325–333PubMedCrossRefGoogle Scholar
  17. 17.
    Hendrix RMG, Wagenaar M, Slobbe RL, Bruggeman CA (1997) Widespread presence of cytomegalovirus DNA in tissues of healthy trauma victims. J Clin Pathol 50:59–63PubMedCrossRefGoogle Scholar
  18. 18.
    Taylor-Wiedeman J, Hayhurst GP, Sissons JG, Sinclair JH (1993) Polymorphonuclear cells are not sites of persistence of human cytomegalovirus in healthy individuals. J Gen Virol 74:265–268PubMedCrossRefGoogle Scholar
  19. 19.
    Stanier P, Taylor DL, Kitchen AD, Wales N, Tryhorn Y, Tyms AS (1989) Persistence of cytomegalovirus in mononuclear cells in peripheral blood from blood donors. BMJ 299:897–898PubMedCrossRefGoogle Scholar
  20. 20.
    Bowden RA (1991) Cytomegalovirus infections in transplant patients: methods of prevention of primary cytomegalovirus. Transplant Proc 23:136–138PubMedGoogle Scholar
  21. 21.
    Jap A, Sivakumar M, Chee SP (2001) Is Posner Schlossman syndrome benign? Ophthalmology 108:913–918PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • B. Sobolewska
    • 1
    • 2
  • C. Deuter
    • 1
  • D. Doycheva
    • 1
  • M. Zierhut
    • 1
  1. 1.Center for OphthalmologyEberhard-Karls University TuebingenTuebingenGermany
  2. 2.Center for OphthalmologyUniversity Eye Hospital, Eberhard-Karls UniversityTuebingenGermany

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