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Manfred Zierhut, Christoph M. Deuter, Deshka Doycheva, Bianka Sobolewska; Long-term oral Therapy with Ganciclovir in Patients with Posner-Schlossman Syndrome. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6204.
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To assess the long-term efficacy of oral therapy with ganciclovir in patients with Posner-Schlossman syndrome (PSS).
This is a retrospective observational study on eleven patients with PSS, who were treated at our institution from April 2007 to November 2011. The PSS was diagnosed clinically on the basis of following ophthalmological findings: recurrent episodes of anterior uveitis associated with attacks of elevated intraocular pressure (IOP). A complete history and full ocular examination, including best-corrected visual acuity and IOP were performed. Chest x-ray, angiotensin converting enzyme (ACE), syphilis, Borrelia and Bartonella serology were done in all patients to exclude other causes of uveitis. The complete ocular examination was repeated in the first week, in the first and third month and thereafter at four-month intervals, with more frequent visits if necessary. All patients who did not respond to acyclovir therapy (6 of 11 patients) or whose CMV PCR analysis of the aqueous humour was positive (6 of 11 patients) were treated with oral ganciclovir. Initially, the drug was prescribed at a dose of 900mg twice daily for three weeks, followed by 450 mg twice daily for a minimum period of three months. Full blood count, liver and renal function tests were monitored every four weeks during the entire course of oral ganciclovir treatment. Conservative and surgical treatment of glaucoma was performed as required.
Eleven patients (7 male, 4 female) were included in this study. The mean age was 44 years (range 27-60 years). Five of eleven patients are working in a social or medical profession. The mean duration of treatment was thirteen months (range 3-33 months). Before initiation of oral gancicloivir therapy the highest IOP was 60 mmHg (mean 45 mmHg±8 mmHg). In the first week of treatment, the IOP decreased significantly (mean 16 mmHg±10 mmHg, the highest IOP 33 mmHg) and maintained stable during the entire follow-up period (mean 16 mmHg±6 mmHg, the highest IOP 26 mmHg). Three of ten patients (30%) required an operative intervention to reduce the IOP. In 91% of patients (10 of 11), oral ganciclovir could be tapered due to resolution of inflammatory activity. Only in one patient (9%), oral ganciclovir could not be tapered due to relapses of uveitis. No side effects of long-term ganciclovir therapy were observed.
Long-term oral therapy with ganciclovir is effective in patients with clinically diagnosed Posner-Schlossman syndrome who did not respond to acyclovir therapy. Out study shows that PSS might be associated with social and medical occupation.
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