Clinical profile, demographic distribution, and management of Posner–Schlossman syndrome

Dear Editor, We read with interest the article by Warjri et al.[1] and congratulate the authors for providing large real-world data with important information about Posner–Schlossman syndrome (PSS), which is one of the rare causes of open-angle glaucoma. The authors have provided details regarding clinical profiles, demographics, and management of PSS in a large cohort of PSS patients presenting to a multitier hospital in India. We would like to comment on the demographic profile and medical management part described by the authors for PSS patients. The authors documented significantly higher prevalence in urban populations, higher socioeconomic status, and in professionals, but the authors did not mention the possible reason for this association. Based on the information provided, in the medical history part, 17.7% of PSS patients had been given antiviral treatment, but the authors did not specify the criteria used to start antiviral treatment or the positivity rates of viral markers in aqueous humor (AC tap) for these 17.7% of patients. Viral infections have been identified as a proven etiological factor in PSS, the most common being cytomegalovirus (CMV), varicella zoster virus (VZV), and herpes simplex virus (HSV),[2] and clinically CMV-positive and negative patients present with similar clinical features.[3] Previous studies have shown satisfactory outcomes with antiviral treatment in PSS patients.[4] Therefore, understanding the indication for starting antivirals and the positivity rates of viral markers in AC tap could provide valuable insights into the medical management of PSS. Establishing standardized guidelines for initiating antiviral therapy in PSS patients could enhance the consistency and effectiveness of medical management strategies. In addition, determining the positivity rates of viral markers in AC tap could help clinicians better understand the prevalence and significance of viral infections in PSS, leading to more informed treatment decisions and potentially improved patient outcomes. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.