Steroid-Dependency in Posner-Schlossman Syndrome: A Suggested Topical 2% Ganciclovir and Gradual Decrement of Topical Steroid Combination Therapy from Shanghai PSS Study

ABSTRACT

Purpose

This study focused on the prevalence, unique features, and required treatment of steroid-dependent Posner-Schlossman syndrome (SD-PSS), and analyzed the outcome of 2% Ganciclovir and gradual decrement steroid combination therapy in SD-PSS patients.

Methods

Retrospective comparative and interventional study. SD-PSS was defined as PSS patients with continuous steroid use for over 3 months and relapsed within 2 weeks after steroid withdrawal or tapered dosage. Totally 74 SD-PSS eyes were compared with 78 randomly chosen non-steroid dependent PSS eyes. SD-PSS patients who underwent 2% GCV and gradual decrement steroid therapy with at least two follow-ups (n = 50) were analyzed for the treatment outcome.

Results

The prevalence of SD-PSS is 26.87% (97/361) in our PSS patients. SD-PSS patients demonstrated significantly younger onset age, longer disease course, higher intraocular pressure (IOP), and higher degree of iris depigmentation at the first visit. They required significantly more IOP-lowering medication and stronger steroid after the first visit. Our 2% GCV and gradual decrement steroid therapy helped 66% (33/50) SD-PSS patients with steroid withdrawal (median stable time: 13 weeks) and another 32% (16/50) SD-PSS managed to lower the dose or strength of topical steroid. Steroid-induced ocular hypertension happened in 5.26% (19/361) of the PSS patients.

Conclusion

Young onset age, high IOP, and high iris depigmentation level during acute stage are indicators of steroid dependency in PSS patients. SD-PSS patients require more medical surveillance. Two percent ganciclovir and gradual decrement steroid combination therapy help with steroid withdrawal and minimize steroid use.

KEYWORDS:

• 2% Ganciclovir
• anterior chamber inflammation
• Posner-Schlossman syndrome
• relapse
• steroid dependency

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contributors

YY and YS contributed to manuscript writing, formal analysis, and conceptualization. RZ contributed to conceptualization, manuscript editing, and supervision. QS and XF participated in the collection and input of data. XK designed and guided the whole study. All authors contributed to the article and approved the submitted version.

Research ethics approval

The study was approved by the ethics committee of Eye & ENT Hospital, Fudan University (2017006-2).

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request.

Additional information

Funding

This study was supported by the Western Medicine Guidance Project of Shanghai Committee of Science and Technology [19411961600], the Experimental Animal Research Project of Shanghai Science and Technology [201409006600], and the Double Excellent Project of EENT Hospital [SYB202003]. The authors were funded by the Surface Project of the National Natural Science Foundation of China [81770922 and 82070957]. The funders had no role in study design, data collection, analysis and interpretation, decision to publish, or preparation of the manuscript.