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, Epstein-Barr 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:

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