• Written By: Scott K. Schultz, MD
    Cornea/External Disease, Glaucoma, Uveitis

    This retrospective study found that topical gancyclovir can preserve the corneal endothelium and assist in IOP control in cytomegalovirus (CMV)-positive Posner Schlossman syndrome (PSS) patients.

    This study is important as it points out that 2% topical gancyclovir drops are effective at treating CMV-positive PSS patients and reduce the need for topical glaucoma medications, reduce uveitic recurrences and help maintain the endothelium if administered continuously. These patients can be difficult to diagnose and are very challenging for practitioners.

    The authors reviewed the charts of 126 consecutive Posner-Schlossman syndrome patients examined via aqueous polymerase chain reaction (PCR) between January 2006 and June 2013, comparing CMV-positive with CMV-negative patients.

    The CMV-positive group showed more severe endothelial cell loss (45% vs. 18%) and had a significantly higher proportion of eyes requiring glaucoma filtering surgery (13% vs. 2%.). 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 used decreased, and both groups showed a similar frequency of IOP spikes. Patients with CMV-positive eyes with a disease duration of more than five years were more likely to require glaucoma surgery. All patients receiving surgery exhibited CMV-negative PCR during the IOP attack but experienced severe peripheral anterior synechiae and pigment clogging.

    One significant limitation of this treatment in general is the general ophthalmologist's difficulty in making the true diagnosis, as most are unable to perform anterior chamber taps and obtain PCR for CMV. In addition, it is not standard of care to perform anterior chamber taps for all uveitic glaucoma patients in which CMV PSS is a clinical possibility. Also, this study is limited by its retrospective nature, and prospective trials could be carried out to further investigate 2% topical gancyclovir.