The aim of this study was to observe the clinical features of Posner-Schlossman syndrome (PSS) and to explore the role of aqueous humor detection in the early diagnosis of PSS.

41 patients (41 eyes) with PSS, and 30 patients (30 eyes) with senile cataract who were diagnosed in the Department of Ophthalmology, Beijing Chaoyang Hospital affiliated to Capital Medical University from May 2019 to July 2021 were enrolled retrospectively. Among them, there were 38 males (38 eyes) and 33 females (33 eyes) with an average age of (54.4±10.3) years-old (ranged from 15 to 86 years-old). Patients with PSS were as PSS groups, and patients with senile cataract were as control group. The intraocular pressure (IOP) of patients was examined using indirect ophthalmoscope; cup to disk ratio was examined using optical coherence tomography; the mutton-fat keratic precipitates (KP), Tyndall sign, cells of the aqueous humor were examined using slit lamp microscope. The aqueous humor of all patients were collected; those virus load, virus anti-immunoglobulin G (IgG) and cytokine level were examined, including cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), vascular endothelial growth factor (VEGF), vascular cell adhesion molecule (VCAM), basic fibroblast growth factor (bFGF). The age of patients, aqueous humor HSV, VZV, CMV, EBV, IL-6, IL-8, IL-10, VEGF, VCAM and bFGF were tested for normal distribution. Measurement data conforming to normal distribution was expressed as ±s and compared by independent samples t-test; measurement data with skewed distribution was expressed as median and upper and lower quartiles and compared by Mann-Whitney rank-sum test. The positive rate of aqueous humor pathogens was described by the number of cases and percentages and compared by the Mcnemar paired chi-square test.

In the PSS group, there were 33 patients to observe mutton-fat KP using biomicro-scopy, 32 patients to observe Tyndal′s sign using biomicroscopy, 29 patients to observe cells in aqueous humors using biomicroscopy, 33 patients with IOP measurements, 32 patients with cup-to-disk ratio using optical coherence tomography. Among of them, there were 24 patients with mutton-fat KP (+ ), accounting for 72.7%, 12 cases with Tyndall′s sign (+ ), accounting for 37.5%, 5 cases with cells (+ ), accounting for 17.2%, 15 cases with an increased IOP (>21 mmHg)(1 mmHg=0.133 kPa), accounting for 45.5%, 7 cases with an increased cup-to-disk ratio (≥0.6), accounting for 21.9%. The number of patients in PSS group with virus nucleic acid testing in HSV, VZV, CMV, EBV was 22 cases, 22 cases, 38 cases, and 25 cases, respectively. Among of them, there were 9 cases with CMV(+ ), accouting for 23.7%; others were negative. The number of patients in PSS group with virus nucleic acid IgG testing in HSV, VZV, CMV, EBV was 23 cases, 21 cases, 31 cases, and 20 cases. Among of them, there were 2 cases with HSV-IgG (+ ), 1 case with VZV-IgG (+ ), 16 cases with CMV-IgG (+ ), accouting for 8.7%, 4.8%, 51.6%; others were negative. In the control group, the nucleic acid and their IgG of all virus in the aqueous humor were negative. In the PSS group, there were 29 cases detected simultaneously with CMV nucleic acid viral load and CMV-IgG. It was showed that the positive detection rate of CMV nucleic acid viral load was 24.1%, while the positive detection rate of CMV-IgG in aqueous humor was 48.3%, which was higher than the former. The Mcnemar paired chi-square test showed that there was no statistical difference between groups (P>0.05). The levels of aqueous humor IL-6, IL-8, IL-10, VEGF, VCAM and bFGF of patients with PSS were 22.5(5.1, 212.7) pg/ml, 18.1(8.4, 54.1)pg/ml, 3.6(0.5, 9.0)pg/ml, 20.2(14.7, 28. 0)pg/ml, 1212.4(369.9, 3617.9)pg/ml and 5.9(0.0, 7.3)pg/ml, respectively. Those indice of patients in the control group were 9.9(3.7, 34.9)pg/ml, 9.6(2.0, 24.2)pg/ml, 1.6(1.0, 5.2)pg/ml, 20.5(11.2, 24.5)pg/ml, 116.4(83.8, 178.5)pg/ml and 7.1(1 .0, 15.6)pg/ml, respectively. The Mann-Whitney rank sum test showed that there were significant differences in IL-8, VCAM and bFGF between two groups (Z=-2.57, -4.77, -2.07; P<0.05). There was no significant difference in IL-6, IL-10 and VEGF between the two groups (Z=-1.56, -1.18, -0.25; P>0.05).

The main clinical mani-festations of patients with PSS were mutton-fat KP and elevated IOP. The positive CMV nucleic acid load, positive CMV-IgG, and increased levels of IL-8 and VCAM in the aqueous humor were sensitive in the diagnosis of PSS, which has a clinical value for the auxiliary diagnosis of PPS.