Viral-Linked Glaucoma Associated With Corneal Damage, Retinal Layer Thinning

Cytomegalovirus-positive Posner-Schlossman syndrome may lead to corneal endothelial cell loss and retinal nerve fiber layer thinning.

Cytomegalovirus (CMV)-positive Posner-Schlossman syndrome (PSS) is associated with corneal endothelial cell loss and retinal nerve fiber layer thinning, according to the results of a study published in the American Journal of Ophthalmology.

To evaluate morphological changes in the eyes of patients with CMV-positive PSS, a relatively rare, recurrent unilateral acute hypertensive anterior uveitis, the investigators conducted a retrospective case series.

They reviewed the charts of 52 eyes of 52 consecutive patients (age, 42.0±16.9 years, 34.6% women and 65.4% men) with unilateral PSS who tested positive for CMV between 2007 and 2018. Based on optical coherence tomography (OCT) imaging, the team recorded corneal endothelial cell count, peripapillary retinal nerve fiber layer, and choroidal thickness. They also reported clinical findings and management. The patients’ average follow-up duration was 32.8±28.3 months. Patients had an average peak intraocular pressure (IOP) of 45±11 mm Hg. The affected eyes had significantly reduced corneal endothelial cell count (mean, 2241.7±381.1 cells/mm2 vs 2529.4±351.9 cells/mm2, P =.0004) and global retinal nerve fiber layer (RNFL) thickness (mean, 80.81±21.01 μm vs 97.38±9.75 μm, P =.0001) than the control eyes. Choroidal thickness trended higher (295.69±45.46 μm vs 274.00±67.85 μm, P =.156) in the affected eyes compared with the control eyes. 

Patients were treated most often with oral valganciclovir (76.9%) or received no antiviral therapy (19.2%). After cessation of oral valganciclovir, 57.5% of patients experienced recurrences. Some patients underwent glaucoma surgery, including trabeculectomy with Mitomycin C (15.4%), minimal invasive glaucoma surgery (5.8%), and cyclophotocoagulation (3.8%). 

Limitations of the study included the retrospective design and variation in the diagnostic work-up, follow-up intervals, and follow-up duration. 

“In contrast to former assessments and despite its often-asymptomatic clinical course, our results clearly indicate that PSS is associated with glaucomatous optic atrophy,” report investigators. “In future care for these patients, the highly elevated IOP, the risk of recurrences and the still unclear optimal therapy remain the most relevant challenges.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Lenglinger M, Schick T, Pohlmann D, Pleyer U. Cytomegalovirus positive Posner-Schlossman syndrome: Impact on corneal endothelial cell loss and retinal nerve fiber layer thinning. Am J Ophthalmol. Published online January 4, 2022. doi:10.1016/j.ajo.2021.12.015