Posner-Schlossman syndrome associated with cytomegalovirus infection: a case series from a non-endemic area

To describe clinical features, laboratory findings, course of disease and response to treatment in four patients diagnosed with Posner-Schlossman syndrome (PSS) who had evidence of cytomegalovirus (CMV) infection in their aqueous humour. Review of four consecutive CMV positive PSS patients seen at the Noor Eye Hospital. CMV was diagnosed by polymerase chain reaction analysis of their aqueous. All four patients were immunocompetent males. Mean age of onset was 44.5 years (range, 32-63 years). Maximum intraocular pressure ranged from 36 to 48 mmHg. Mild to moderate anterior chamber reaction, lack of posterior synechiae and posterior segment involvement were consistent features in all the patients. Three patients had diffuse iris atrophy. One patient with a stromal immune ring at presentation developed features of Fuch's heterochromic iridocyclitis (FHI) later in his course of disease. Heterochromia was also observed in another patient. All patients had a positive titre of IgG but not IgM against CMV, and none had concomitant CMV antigenemia. One patient who had recalcitrant uveitis and glaucoma and another patient who was suffering from frequent attacks and showed evidence of significant endothelial cell loss received anti-CMV therapy. In our population, PSS may be associated with CMV infection and may develop clinical features similar to FHI. Anti-CMV therapy should be reserved for cases with recalcitrant course or secondary complications.