Response comment on “Clinical profile, demographic distribution, and management of Posner-Schlossman syndrome: An electronic medical record-driven data analytics from an eye care network in India”

Dear Editor, We would like to thank the authors for their insightful comments and commentary[1] on our article, “Clinical profile, demographic distribution, and management of Posner-Schlossman syndrome: An electronic medical record-driven data analytics from an eye care network in India.”[2] For their initial comment on the socioeconomic status distribution of our patients with Posner-Schlossman syndrome (PSS), while analyzing the reasons for this difference in the disease prevalence based on socioeconomic strata was beyond the scope of the study due to data not being available, we surmise that it is quite possible that the eye health seeking behavior of these populations is earlier and higher as compared to the lower socioeconomic population. As the symptoms of PSS can often be mild and vision may/may not be affected, patients who have barriers to attending an eye clinic either due to financial or other reasons are more likely from the lower socioeconomic population. Similar differences in other diseases have been found in earlier studies.[3] The decision to start antivirals in our patients was taken based on the presence of the following clinical findings: “mild, unilateral, nongranulomatous anterior uveitis accompanied by markedly elevated intraocular pressure (IOP), small white keratic precipitates (KPs) on the endothelial surface of the central cornea, open-angle, no posterior synechia, and no inflammatory lesions in the posterior segment,” similar to the criteria reported in previous studies.[4] A recent study has shown that treatment with antivirals is recommended for relapses in PSS either with or without cytomegalovirus reactivation.[5] In this study, anterior chamber tap was not done in all cases and not done in relapses. This has been mentioned in the limitations along with the fact that the follow-up period was not long enough to judge the long-term effects of the antivirals.[5] We agree with the authors that there is still a lack of high-quality evidence regarding the role of antiviral treatment in PSS, especially its long-term role and role in reducing recurrences. Long-term trials are still the need of the hour to address all these queries.