Su Chien-Chia, Hu Fung-Rong, Wang Tsing-Hong, Huang Jehn-Yu, Yeh Po-Ting, Lin Chang-Ping, Wang I-Jong
Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Ophthalmology, National Taiwan University Hospital College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Ophthalmology, National Taiwan University Hospital College of Medicine, National Taiwan University, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan.
Am J Ophthalmol. 2014 Nov;158(5):1024-1031.e2. doi: 10.1016/j.ajo.2014.08.007. Epub 2014 Aug 12.
To evaluate the clinical characteristics and therapeutic outcomes of cytomegalovirus (CMV)-positive Posner-Schlossman syndrome patients undergoing topical ganciclovir treatment.
Retrospective, comparative, and interventional case series.
One eye of each of 126 consecutive Posner-Schlossman syndrome patients was investigated using aqueous polymerase chain reaction (PCR) between January 2006 and June 2013. The initial presentations and follow-up data of the CMV-positive patients (68 eyes) and CMV-negative patients (58 eyes) were compared.
Severe endothelial cell loss (P < .001) and a higher number of eyes requiring glaucoma filtering surgery (P = .017) were observed in CMV-positive Posner-Schlossman syndrome patients. All CMV-infected eyes treated with continual topical 2% ganciclovir exhibited an undetectable CMV level at the following taps. During follow-up, the average number of antiglaucomatous agents decreased, and a similar frequency of intraocular pressure (IOP) spikes was observed in both groups (P = .358). Patients with CMV-positive eyes with a disease duration over 5 years were likely to require glaucoma surgery (P = .024, log-rank test). All patients receiving surgery exhibited CMV-negative PCR during the IOP attack, but experienced severe peripheral anterior synechiae and pigment clogging. Both groups exhibited a similar endothelial cell decrease (P = .243) and probability of progressive endothelial cell loss (P = .219, log-rank test).
Ganciclovir treatment was effective for clearing the viral load, assisting the IOP control, and preserving the corneal endothelium of CMV-positive Posner-Schlossman syndrome patients. Early diagnosis and proper treatment could decrease the risk of advanced glaucoma and avoid glaucoma surgery in long-lasting cases.
评估接受局部更昔洛韦治疗的巨细胞病毒（CMV）阳性的波斯纳-施洛曼综合征患者的临床特征和治疗效果。
回顾性、比较性和干预性病例系列研究。
在2006年1月至2013年6月期间，对连续126例波斯纳-施洛曼综合征患者的一只眼睛进行房水聚合酶链反应（PCR）检测。比较CMV阳性患者（68只眼）和CMV阴性患者（58只眼）的初始表现和随访数据。
在CMV阳性的波斯纳-施洛曼综合征患者中观察到严重的内皮细胞丢失（P <.001）以及需要进行青光眼滤过手术的眼睛数量更多（P =.017）。所有接受持续局部2%更昔洛韦治疗的CMV感染眼在后续检测中CMV水平均不可检测。在随访期间，抗青光眼药物的平均数量减少，两组眼内压（IOP）峰值出现频率相似（P =.358）。病程超过5年的CMV阳性眼患者可能需要进行青光眼手术（P =.024，对数秩检验）。所有接受手术的患者在眼压发作期间PCR检测显示CMV阴性，但出现了严重的周边前粘连和色素堵塞。两组内皮细胞减少情况相似（P =.243），内皮细胞进行性丢失的概率也相似（P =.219，对数秩检验）。
更昔洛韦治疗对于清除CMV阳性的波斯纳-施洛曼综合征患者的病毒载量、辅助眼压控制以及保护角膜内皮有效。早期诊断和适当治疗可降低晚期青光眼风险，并避免长期病例中的青光眼手术。
