Clinical Features and Risk Factors of Glaucomatous Change in Posner-Schlossman Syndrome

Eun Jung Lee; Young Kyo Kwun; Dong Hoon Shin; Chang Won Kee

doi:10.3341/jkos.2015.56.6.938

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Lee, Kwun, Shin, and Kee: Clinical Features and Risk Factors of Glaucomatous Change in Posner-Schlossman Syndrome

Original Article

J Korean Ophthalmol Soc 2015;56(6):938-943.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.6.938

Clinical Features and Risk Factors of Glaucomatous Change in Posner-Schlossman Syndrome

Eun Jung Lee, MD, Young Kyo Kwun, MD, Dong Hoon Shin, MD, Chang Won Kee, MD, PhD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Chang Won Kee, MD, PhD Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea, Tel: 82-2-3410-3564, Fax: 82-2-3410-0029 E-mail: ckee@skku.edu

Received 25 July 20141 December 2015 Accepted 20 April 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the clinical features and determine the factors that affect glaucomatous change of patients with Posner-Schlossman syndrome (PSS).

Methods

A retrospective analysis of 51 eyes of 51 patients diagnosed with PSS was performed. We analyzed the factors including age of first attack, highest intraocular pressure (IOP), duration of the disease, number of the attacks and interval between attacks among the patients who developed glaucoma and those who did not and compared the 2 groups.

Results

The age of first attack was 34.73 ± 10.77 years, and highest IOP was 47.75 ± 9.43 mm Hg. Duration of the disease was 62.06 ± 69.84 months, number of the attacks was 6.20 ± 7.73 times, and interval between attacks was 12.65 ± 8.95 months. Of 51 eyes of 51 patients, 12 eyes (23.5%) of 12 patients showed significant glaucomatous change. In the glaucoma group, highest IOP was 52.81 ± 7.87 mm Hg, number of attacks was 11.91 ± 10.63 times, and interval between attacks was 8.07 ± 3.97 months. In the non-glaucomatous group highest IOP was 46.19 ± 9.14 mm Hg, number of attacks was 4.59 ± 5.94 times, and interval between attacks was 14.59 ± 9.79 months, respectively. Highest IOP was significantly greater, number of attacks was higher, and interval was shorter with statistical significance in the glaucoma group (p = 0.025, p = 0.001, p = 0.028).

Conclusions

A significant number of patients with PSS tend to show glaucomatous change over time. Patients with high IOP during attacks and those having frequent attacks with short intervals should be closely monitored and evaluation for glaucomatous damage is recommended.

Keywords: Glaucoma, Posner-Schlossman syndrome, Risk factors

References

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Figure 1.

Distribution of age at the first attack in patients with Posner-Schlossman syndrome. In patients with no glaucomatous change, the age at first attack is distributed mostly from twenties to thirties and in patients with glaucomatous change, the age at first attack showed tendency toward a slightly older age. No glaucoma＝ patients without glaucoma development; Glaucoma＝ patients with glaucoma development.

Table 1.

Patients clinical characteristics

Clinical characteristics	Total (n＝51)	No glaucomatous change (n＝39)	Glaucomatous change (n＝12)	p-value
Age of first attack (years, range)	34.73 ± 10.77 (13-57)	33.26 ± 11.21 (13-57)	39.5 ± 7.76 (29-52)	0.050^*
Sex (male/female)	37/14	27/12	10/2	0.34^†
Highest IOP (mm Hg, range)	47.75 ± 9.43 (31-70)	46.19 ± 9.14 (31-63)	52.81 ± 7.87 (42-70)	0.025^*
Duration (month, range)	62.06 ± 69.84 (1-312)	59.24 ± 70.51 (1-312)	74.00 ± 69.64 (4-198)	0.480^*
Number of attack (times, range)	6.20 ± 7.73 (1-35)	4.59 ± 5.94 (1-30)	11.91 ± 10.63 (3-35)	0.001^*
Interval between attacks (month, range)	12.65 ± 8.95 (1.33-38.70)	14.59 ± 9.79 (3.0-38.7)	8.07 ± 3.97 (1.33-13.67)	0.028^*
Baseline MD (dB, range)	-2.57 ± 4.87 (-20.66-2.08)	-0.61 ± 1.20 (-4.21-2.08)	-7.21 ± 6.94 (-20.66~-0.84)	0.000^*
CCT (μ m, range)	547.0 ± 39.85 (482-635)	553.00 ± 36.02 (492-635)	535.50 ± 47.73 (482-623)	0.350^*

Values are presented as mean ± SD (range).

IOP＝ intraocular pressure; MD＝ mean deviation; CCT＝ central corneal thickness.

^* Mann-Whitney U-test

^† Pearson Chi-squared test.

Table 2.

Logistic regression analysis with the dependent variable being the presence of a glaucomatous change

Factors	Univariate analysis		Multivariable analysis^*		Multivariable analysis^*
Factors	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Age of first attack (years)	1.057 (0.990-1.129)	0.097	1.177 (1.020-1.358)^†	0.025	0.112 (0.989-1.250)	0.076
Highest IOP (mm Hg)	1.102 (1.011-1.202)^†	0.028	1.206 (1.017-1.431)^†	0.031	1.146 (0.990-1.327)	0.067
Number of attack (times)	1.113 (1.017-1.207)^†	0.020	1.321 (1.037-1.683)^†	0.024	-	-
Interval between attacks (month)	0.862 (0.738-1.006)	0.060	-	-	0.816 (0.648-1.028)	0.084

OR＝ odds ratio; CI＝ confidence interval; IOP＝ intraocular pressure.

^* Adjusted for all variables with p<0.10 in the univariate model

^† The OR and 95% CI with p<0.05.

Table 3.

Characteristics of patients with Posner-Schlossman syndrome who developed glaucoma

Patient	Sex	Age at first attack (years)	Duration of the disease (month)	Highest IOP (mm Hg)	Total number of attacks (times)	Interval between attacks (month)	Baseline MD (dB)	Last MD (dB)	CCT (μ m)	Glaucoma surgery
1	M	29	-^*	55	8	-	-10.69	-20.65	543	No
2	F	38	111	47	15	7.93	-5.67	-4.09	489	No
3	M	32	174	60	29	6.21	-0.96	-20.24	-	No
4	M	42	40	50	4	13.33	-2.72	-2.49	-	No
5	M	46	52	54	6	10.40	-6.95	-13.61	578	No
6	M	44	22	52	6	4.40	-2.81	-6.39	-	No
7	M	30	198	70	11	9.78	-0.84	-5.65	-	No
8	M	51	41	42	4	13.67	-11.37	-15.25	623	No
9	M	40	145	47	35	3.88	-0.99	-	535	Yes
10	F	33	-^†	58	9	-	-8.17	-10.33	498	Yes
11	M	37	22	43	3	11.00	-20.42	-21.24	-	Yes
12	M	52	12	46	10	1.33	-20.66	-17.71	482	Yes

IOP＝ intraocular pressure; MD＝ mean deviation; CCT＝ central corneal thickness.

^* Duration of the disease could not be evaluated because the patient showed advanced glaucomatous change at first visit without detailed history

^† Duration of the disease could not be evaluated because the patient showed glaucomatous change in too short interval without detailed and reliable history.

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