Prevalence and clinical manifestations of cytomegalovirus infection in patients with Posner-Schlossman syndrome: A systematic review and meta-analysis

Posner-Schlossman syndrome (PSS) is thought to be associated with cytomegalovirus (CMV) infection; however, the prevalence of CMV infection and its characteristics in PSS patients varies across studies. Therefore, global estimates of CMV prevalence in PSS are needed to provide clearer insights for informing epidemiological surveillance and guiding treatment strategies. Embase, MEDLINE, Scopus, and Web of Science were searched for population-based, clinic-based, and secondary health care database studies that reported prevalence or incidence of CMV in patient with PSS published between database inception and October 31, 2024. Meta-analysis was conducted by using a random-effects model. The primary outcome was prevalence of CMV infection in patient with PSS. Secondary outcomes were characteristics of CMV infection in patient with PSS, such as corneal endothelial cell density and filtering surgery rate. Twenty-one studies, enrolling 1265 patients with PSS, were included. The pooled prevalence of CMV infection in patients with PSS was 44.5 % (95 % CI: 36.2 %–53.1 %; I²= 73.9 %). The affected eye in patients with CMV infection had significantly lower endothelial density (mean difference, −389.8 cell/mm²; 95 % CI: −553.8 to −225.9 cell/mm²; p < 0.001; I ² = 53.8 %) and a higher risk of requiring filtration surgery than that in patients without CMV infection (pooled OR: 8.9, 95 % CI: 3.0–26.4; p < 0.001; I ² = 0 %). We highlight the prevalence and clinical outcomes of CMV infection in patients with PSS. The causal relationship between CMV infection and PSS requires exploration to inform effective diagnosis and treatment strategies.