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Association Between Helicobacter Pylori Infection and Posner–Schlossman Syndrome

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Association Between Helicobacter Pylori Infection and Posner–Schlossman Syndrome Eye (2010) 24, 64–69 & 2010 Macmillan Publishers Limited All rights reserved 0950-222X/10 $32.00 www.nature.com/eye 1 1 1 1 2 CLINICAL STUDY Association between CY Choi , MS Kim , JM Kim , SH Park , KH Park and C Hong3 Helicobacter pylori infection and Posner–Schlossman syndrome Abstract uncommon unilateral syndrome with recurrent attacks of anterior non-granulomatous uveitis Objective: To investigate possible association and elevated intraocular pressure (IOP). With between Helicobacter pylori infection and acute attack, IOP is typically 40–60 mmHg. After Posner–Schlossman syndrome. an acute attack, IOP and facility of aqueous Methods: In a prospective study, 40 subjects outflow return to normal.1 It has been with Posner–Schlossman syndrome were considered as a benign, self-limited disease examined. As a control group, 73 subjects because short-term use of topical corticosteroids without Posner–Schlossman syndrome were and antiglaucoma medications usually control selected for comparison with the study group. the attacks. But the aetiology of PSS remains 1 All participants underwent serologic analysis Department of still unknown, so there have been numerous Ophthalmology, for the presence of H. pylori infection by postulations for the pathogenesis of PSS Sungkyunkwan University an enzyme-linked immunosorbent assay. including abnormal vascular reactivity, School of Medicine, Positive rate of serum anti-H. pylori IgG Kangbuk Samsung Hospital, autonomic dysregulation, and infections. was compared between Posner–Schlossman Seoul, Korea Herpes simplex virus or cytomegalovirus has syndrome patients and control participants. been suggested as aetiologies for PSS due to 2 Results: The rate of positive titre Department of their presence in the aqueous humour during Ophthalmology, Seoul (415 U/ml) of H. pylori was 80.0% in the the acute attacks.2,3 Genetic factors, such as National University College Posner–Schlossman syndrome group and 56.2% HLA-Bw54, was also considered for the of Medicine, Seoul, Korea in control group, showing significant difference aetiology.4 (Fischer’s exact, P ¼ 0.014). Multivariate analysis 3Dr Hong’s Eye Clinic, Seoul, Helicobacter pylori, a curved spiral Gram- adjusted for various systemic factors revealed Korea negative bacterium that colonies in the gastric that positive titre of anti-H. pylori IgG was a mucosa, is one of the most common infections significant risk factor for Posner–Schlossman Correspondence: JM Kim, in human involving about half of human Department of syndrome with an odds ratio, (4.84, 95.0% CI: population.5 Prevalence of H. pylori infection Ophthalmology, 1.10–21.24, P ¼ 0.037). is known to be differed between developing Sungkyunkwan University Conclusions: H. pylori infection occurred School of Medicine, countries and developed countries, and significantly more often in Posner– Kangbuk Samsung Hospital, according to ethnicity, place of birth, and Schlossman syndrome patients. This study Seoul, socioeconomic factors among people living in Korea. suggests that exposure to H. pylori infection the same country.6 In Korea, 56.0% of 15 916 Tel: þ 82 2 2001 2257; is associated with Posner–Schlossman population-based subjects were positive for Fax: þ 82 2 2001 2262. syndrome in Korea. E-mail: kjoonmo@ anti-H. pylori IgG infection in 2005, and the Eye (2010) 24, 64–69; doi:10.1038/eye.2009.34; dreamwiz.com seroprevalence of asymptomatic healthy published online 20 February 2009 subjects were significantly decreased in Received: 17 September comparison to those in 1998 (59.6 vs 66.9%).7,8 2008 Keywords: Posner–Schlossman syndrome; Knox9 has reported that PSS is associated Accepted in revised form: glaucomatocyclitic crisis; Helicobacter pylori; with systemic disorders including allergic 24 January 2009 anterior uveitis Published online: 20 disorders and peptic ulcer disease. In that study, February 2009 32 PSS patients were evaluated and peptic ulcer was or had been shown in 68% of men and 38% None of the authors have Introduction financial or proprietary of women in contrast to the fact that 10–20% of interest in any of the Posner–Schlossman syndrome (PSS), also men and 5% of women of western cultures have materials mentioned known as glaucomatocyclitic crisis, is an ulcers at sometime in their lives. Furthermore, Association between H. pylori and PSS CY Choi et al 65 the age distribution of the PSS patients was similar to Demographic data including age, gender, and previous that reported for peptic ulcer disease. Knox9 explained history of diabetes mellitus and hypertension were the association between PSS and peptic ulcer by obtained for the study. In group 1, best-corrected visual following mechanism. Inflammation in the wall of an acuity (BCVA) and IOP with a Goldman applanation ulcer produce active cells and circulating antibodies or tonometer of the affected eye at the initial visit were immune complexes that have the capacity to target on or recorded. In group 2, BCVA, IOP of right eye, and the cross-react with ocular tissue which is either H. pylori serologic test value were recorded. If cataract immunologically similar or has become immunologically involved both eyes, BCVA and IOP of less affected eye sensitized. were obtained for the analysis. Peptic ulcer disease known to be related to PSS,9 and For laboratory tests of H. pylori, venous samples close association between H. pylori and gastric ulcer were obtained from each subject. Anti-H. pylori disease warrant an investigation about a link between immunoglobulin G (IgG) was determined quantitatively PSS and H. pylori. The aim of this study is to reveal using an enzyme-linked immunosorbent assay (ELISA; whether H. pylori infection is associated with PSS. Genedia H. pylori ELISA; Green Cross Medical Science Corp, Seoul, South Korea). The manufacturer’s recommended cutoff value was 15 U/ml for H. pylori IgG Materials and methods to determine serologic status as positive or negative. PSS Study subjects were recruited from 1 March 2006 to 31 patients and control participants were tested by the same December 2007 at the Department of Ophthalmology, laboratory. Sungkyunkwan University School medicine, Kangbuk For statistical analysis, Mann–Whitney U-test was used Samsung hospital, Seoul, Korea. An ethics committee for comparison of age, IOP, and BCVA between the two approval was obtained from the Institutional Review groups. Fisher’s exact test was used for comparing Board. Participants were enrolled after the informed gender, existence of diabetes mellitus and hypertension, consent. Two groups were employed to investigate the and positive rate of the serologic test. Odds ratio between association between H. pylori and PSS. positivity of the serologic test and PSS was calculated Group 1 consisted of consecutive 40 PSS patients with univariate and multivariate logistic regression. diagnosed by ophthalmic examinations, including a slit- In multivariate analysis, age, gender, diabetes mellitus, lamp examination, IOP measurement with a Goldman and hypertension were adjusted factors. One sample applanation tonometer, and fundus and optic disc t-test was used for the comparison between the positivity examinations using a 90 D biomicropscopy. All patients of the serologic test in the PSS group and age-matched had recurrent monocular anterior chamber inflammation expected rate of positivity calculated from the at the unilateral affected eye. The inflammation was nationwide survey performed in 2005.8 usually mild, with 1 þ anterior chamber cells and trace flare. Keratic precipatates also accompanied the anterior chamber inflammation in almost all subjects. The IOP Results exceeded 27 mmHg at the initial visit or during the follow-up. Gonioscopy revealed open-angle and no The mean age of PSS patients in the group 1 was peripherial anterior synichiae. All patients underwent 43.8±13.0 years. Twenty-six patients were men and 14 one or more visual field examinations using a Humphrey were women. The mean IOP of involved eye at the initial visual field analyser (Carl zeiss meditec, Dubin, CA, visit was 40.3±12.3 mmHg. There were no significant USA). There was no evidence of visual field defect and differences in the mean age, gender, logMAR of BCVA, optic disc abnormality indicating glaucoma at the initial and diabetes mellitus between groups 1 and 2 (Table 1). visit. The mean IOP was significantly greater in the group 1 In group 2, control participants, consisted of (Po0.001), and group 2 subjects had more hypertension consecutive 254 patients who underwent H. pylori (P ¼ 0.016). The rate of positive titre (415 U/ml) of serologic test during the same study period as group 1. H. pylori was 80.0 and 56.2% in PSS and control groups, All group 2 participants performed eyelid examinations respectively, showing a significant difference (Fischer’s for oculoplastic complaints or cataract assessment at our exact, P ¼ 0.014;Table 1). clinic. Subjects with glaucoma, previous ocular surgery, Table 2 shows risk factors for PSS. In univariate and serious external or retinal disease were excluded analysis, positive titre of anti-H. pylori IgG was a from the group 2. Patients aged 65 years or more were significant risk factor for PSS. After adjustment for age, also excluded because there was no subject older than 65 gender, diabetes mellitus, hypertension, HbsAg, and years of age in the group 1. Seventy-three subjects were anti-Hbs IgG, positive titre of anti-H. pylori IgG was still a enrolled in this study after applying exclusion criteria. significant risk factor for PSS. Eye Association between H. pylori and PSS CY Choi et al 66 Table 1 Clinical charateristics of PSS and non-PSS groups Group 1 (PSS; n ¼ 40) Group 2 (non-PSS; n ¼ 73) P-value Mean age at diagnosis (years) 43.8±13.0 46.1±15.0 0.423a Male (%) 65.0 69.9 0.674b Intraocular pressure (mmHg) 40.3±12.3 13.9±2.7 o0.001a LogMAR of BCVA 0.22±0.44 0.13±0.31 0.255a Diabetes mellitus (%) 6.3 21.2 0.081b Hypertension (%) 6.3 27.3 0.016b HbsAg (%) 4.8 13.7 0.423b Anti-HbsAb (%) 76.2 51.0 0.066b Positive anti-H.
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