Analysis of risk factors associated with secondary open-angle glaucoma in Posner-Schlossman syndrome: A retrospective case-control study

Abstract

BackgroundPosner-Schlossman syndrome (PSS) is a relatively rare cause of chronic secondary open-angle glaucoma (OAG), but the exact cause is unknown. This study aimed to determine potential risk factors for OAG secondary to PSS and to provide a basis for early intervention in the development of PSS.MethodsThis was a retrospective case-control study. Nine cases diagnosed with PSS and seven cases diagnosed with OAG secondary to PSS were selected and their aqueous humor assays at the first occurrence of PSS were collected. Clinical characteristics including age, sex, disease duration, eye laterality, baseline visual acuity, maximum IOP, corneal endothelial cell density, visual field, retinal nerve fiber layer thickness, cup-to-disk ratio, keratic precipitates, anterior chamber inflammation, and aqueous humor cytokine assay results were compared between the two groups.ResultsThe cytomegalovirus (CMV) positivity was 55.60% in patients with PSS and 100% in patients with OAG secondary to PSS. Corneal endothelial cell density was lower in patients with CMV-positive PSS (p = 0.0116). Concentrations of basic fibroblast growth factor (bFGF), interleukin (IL)-6, and vascular cell adhesion molecule (VCAM) in patients with PSS and IL-8, IL-6, and VCAM in patients with OAG secondary to PSS were higher than standard reference values; and IL-8 concentration was significantly higher in patients with OAG secondary to PSS (p = 0.0229). There were significant positive correlations between IL-8 and IL-6, IL-6 and VCAM (p = 0.0304, p = 0.0172) and a significant negative correlation between bFGF and vascular endothelial growth factor (VEGF) (p = 0.0497). Simultaneous increase of IL-8 and IL-6 concentration levels could be used as a cytokine indicator to predict secondary OAG in patients with PSS (p = 0.0095).ConclusionSimultaneous increase of IL-8 and IL-6 concentrations may be an important cause of accelerated secondary OAG in patients with PSS, with IL-8 playing a more critical role. IL-8 and IL-6 may be more reliable cytokine markers for predicting secondary OAG in PSS, However, the high possibility of secondary OAG in patients with CMV-positive PSS should not be ignored. Regulation of IL-8 and IL-6 levels may be a new strategy of preventing OAG secondary to PSS.

A case of Posner-Schlossman syndrome treated by gonioscopy-assisted transluminal trabeculotomy

“…Comparison of cytomegaloviruspositive and cytomegalovirus-negative PSS patients showed that the former had significant loss of corneal endothelial cells and the density was significantly lower than the latter, which may be associated with cytomegalovirus attacking the trabecular meshwork endothelial cells and corneal endothelial cells, resulting in increased IOP and corneal endothelial cell loss. The high possibility of rotavirus open angle glaucoma (OAG) in cytomegalovirus-positive PSS patients in the future should not be ignored, and regulation of IL-8 and IL-6 levels may be a new intervention to prevent OAG secondary to PSS [4] . Murata et al [5] treated 14 cases of PSS with trabeculectomy, and the surgical success (IOP <20 mm Hg) rate was up to 85.7%.…”