1. Posner-Schlossman Syndrome
Bianka Sobolewska, MD
Centre of Ophthalmology
University of Tuebingen,
Germany

2. Ocular and General History
27 year old men
3-2010: OS recurrent anterior uveitis with elevated intraocular pressure (IOP)
2007: knee pain

3. 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

6. 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.

7. 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

9. Follow-up :
No recurrence
Termination of therapy :

10. Final Diagnosis Possner-Schlossman Syndrome (PSS)
Differential diagnosis
Herpetic anterior uveitis (HSV, VZV)
Fuchs` uveitis
Good response to oral valganciclovir

11. Problems Rare disease Often misdiagnosed
Negative AC tap (PCR) does not exclude PSS
Unclear treatment regimen when AC tap is negative

12. 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