Title: A case of Posner-Schlossman syndrome treated by gonioscopy-assisted transluminal trabeculotomy

Abstract

Background: A 28-year-old male presented recurrent Posner-Schlossman syndrome in his left eye, leading to uncontrolled intraocular pressure (IOP) and thus glaucomatous optic neuropathy. Objective: To observe the curative effect of gonioscopy assisted transluminal trabeculotomy (GATT) in the treatment of Posner-Schlossman syndrome. Method: In this paper, GATT was used to make a 360 degrees incision into the inner wall of the Schlemm canal and the trabecular meshwork to reduce the resistance against the outflow of the aqueous humor at the inner wall of the Schlemm canal and the trabecular meshwork to a greater extent, thus lowering the IOP effectively. Result: This case was followed up for 1y postoperatively, during which the IOP was controlled well without using the ocular hypotensive agents, and fluctuated between 12 and 15 mmHg. The complications such as low IOP, shallow anterior chamber and choroidal detachment were not observed postoperatively either, and no transient IOP rise occurred. The patient’s aqueous humor test indicated HSV, cytomegalovirus and rotavirus antibodies were positive, and cytomegalovirus infection was considered to be the most possible cause of PSS. Local use of the ganciclovir eye drops is somewhat useful for controlling the recurrence of PSS and reducing the use of other drugs. Currently, ganciclovir is the clinically preferred anti-cytomegalovirus drug and can be administered in many ways, such as by oral administration, topical eye drop or intravitreal injection. It can inhibit the synthesis of the virus DNA and prevent the replication of the herpesvirus. Therefore, adding the ganciclovir ophthalmic gel postoperatively may reduce the recurrence of PSS. Conclusion: The treatment outcome of this case shows that GATT played a role in significantly lowering the IOP when used to treat this patient with the Posner-Schlossman syndrome.