Fuchs’ heterochromic cyclitis: a post-infectious manifestation of ocular toxoplasmosis?

Cytokine Changes in the Aqueous Humor in Rubella-Related Fuchs Heterochromic Iridocyclitis

This retrospective study is aimed at determining the correlation between cytokine levels and virus status in the aqueous humor of 38 patients with Fuchs heterochromic iridocyclitis (FHI) with/without a viral presence between May 2017 and January 2020. The levels of cytokines were analyzed in the groups with and without virus-related FHI. Among the patients, 50% had rubella virus, 5.26% had cytomegalovirus, and 2.63% had herpes simplex virus infections. The expression of interleukin-6 (IL-6) and IL-8 was significantly higher, and that of basic fibroblast growth factor (bFGF) was significantly lower in the virus-positive group than in the virus-negative group (P = 0.015, P = 0.001, and P = 0.001, respectively). Although there was no significant difference in the mean expression of vascular cell adhesion protein 1 (VCAM-1), IL-10, and vascular endothelial growth factor (VEGF), that of VCAM-1 and IL-10 was higher (M = 1338 and M = 1390, respectively; M = 6.225 and 10.600, respectively) and that of VEGF was lower (M = 134.5 and M = 38.70, respectively) in the virus-positive group than in the virus-negative group. Similar findings were observed for the expressions of IL-6, IL-8, and bFGF in the rubella-positive and rubella-negative groups. Viral presence was highly related to FHI, especially that of the rubella virus. High levels of inflammatory cytokines and low levels of neovascularization-related factors are involved in rubella-related FHI. These study findings could be helpful in the diagnosis and treatment of FHI.

Fuchs' Uveitis: Is It Different from What We Know?

BACKGROUND

To describe ocular findings in Turkish patients with Fuchs' uveitis (FU).

METHODS

The medical records of FU were retrospectively reviewed.

RESULTS

The study included 281 eyes of 258 patients with FU. There were diffusely spread keratic precipitates (KPs)[(medium sized in 253 (90.0%) eyes, stellate-medium in 28 (10%) eyes)], Koeppe nodules (KN) in 64 (22.8%) eyes and cataract in 129 (45.9%) eyes. There was vitreous infiltration of varying grades in all eyes (100%) with grade 1 haze in 96 (34.2%) eyes, grade 2 haze in 69 (24.6%) eyes, and grade 3 haze in 63 (22.4%) eyes. Stellate-medium KPs were significantly more likely in eyes with KN than in eyes without KN (28.1 vs. 4.6%, p <.001) and in eyes with +3 vitreous haze than in those without +3 vitreous haze (28.6 vs. 4.6%, p <.001).

CONCLUSION

Vitreous involvement is the most frequent posterior segment finding. Posterior involvement is a feature that should not be ignored.Stellate-medium KPs and KN may be an indicator of increased and chronic inflammation.

A literature review on Fuchs uveitis syndrome: An update

Fuchs uveitis syndrome is a chronic, typically unilateral, ocular condition characterized by an asymptomatic mild inflammatory syndrome that can result in cataract and secondary glaucoma. Diagnosis is largely clinical because the etiology remains obscure. Fuchs uveitis syndrome is most likely the result of different insults or pathogenic mechanisms, including infections, autoimmune diseases, hereditary and sympathetic dysfunction. According to the infectious theory, the infection of herpes simplex virus, ocular toxoplasmosis, cytomegalovirus, rubella virus, and other viruses have been implicated in the pathogenesis of the disease. There is no indication for corticosteroid therapy in Fuchs patients, and treatment should be mostly reserved to cataract and glaucoma. Phacoemulsification with intraocular lens implantation is a safe procedure with good visual outcomes in patients with Fuchs uveitis syndrome. Glaucoma is often unresponsive to treatment and should actively be monitored both preoperatively and postoperatively in these patients. We discuss the current understanding of Fuchs uveitis syndrome from its clinical presentations through recommended management and provide a comprehensive description and the updated knowledge of its pathophysiology.

[Anterior uveitis]

Anterior uveitis is the most common form of uveitis. There are several known and many possible etiologies for anterior uveitis. After examining the posterior segment and ruling out masquerade syndromes, the main step of etiologic diagnosis is clinical characterization. It is essential to establish unilateral versus bilateral involvement and presence or absence of granulomatous features. Subsequently, a work-up may be obtained which then helps to confirm diagnostic hypotheses based on the detailed history and clinical examination. The priority is to rule out an infection, although less frequent, before starting steroid therapy, adapted to the severity of the clinical picture. Finally, biologics have greatly changed the management and prevention of some forms of anterior uveitis, in particular uveitis associated with HLA-B27 and juvenile idiopathic arthritis-associated anterior uveitis.

Anterior uveitis

Anterior Uveitis is the most common form of uveitis. There are several known and many possible etiologies for anterior uveitis. After examining the posterior segment and ruling out masquerade syndromes, the main step of etiologic diagnosis is clinical characterization. It is essential to establish the presence or absence of unilateral versus bilateral and granulomatous features. Subsequently, a directed work-up may be obtained which then helps to confirm diagnostic hypotheses based on the detailed history and clinical examination. The priority is to rule out an infection. Treatments are adapted according to etiology and disease severity. Finally, biologics have greatly changed the management and prevention of some forms of anterior uveitis, in particular uveitis associated with HLA-B27 and juvenile idiopathic arthritis-associated anterior uveitis.

[Differential diagnosis of anterior uveitis]

Anterior uveitis is a potentially sight-threatening disease, which affects either one or both eyes. Although the etiology is not fully understood, important associations with systemic diseases and infections have been established. A thorough clinical investigation with the slit lamp may reveal important findings leading to diagnosis and therapy. Additional diagnostic procedures are usually required only with the occurrence of relapses. Most anterior uveitis cases with an underlying autoimmune etiology respond very well to topical steroids and mydriasis while systemic treatment is rarely needed. In contrast, infectious causes typically require systemic medication. Anterior uveitis has a good prognosis if treated adequately despite some complications like cataract, macular edema, or increase of intraocular pressure, which cannot be prevented in all cases.

Seroprevalence of Bartonella Species in Patients with Ocular Inflammation

Bartonella species, vector-borne etiologic agents of many systemic or self-limited infections, are responsible for a widening spectrum of diseases in humans, including inflammatory conditions of the eye. The aim of this study was to determine whether there is any relationship between uveitis and the evidence of Bartonella spp. infection in the serum, ocular fluid, and cataract mass in patients with intraocular inflammation. Polymerase chain reaction (PCR)-based tests and DNA sequencing were performed on surgery-extracted specimens of intraocular fluid and lens mass of 33 patients. Sera from 51 patients and 101 control subjects were tested for the presence of specific antibodies against Bartonella spp. Neither IgM-class antibodies against Bartonella spp. nor Bartonella spp. DNA were detected. A specific IgG-class antibody was found in 33.3% of the patients with uveitis. The rate of positive Bartonella serology was higher among the uveitis patients than that in control subjects. This high rate may in part result from unrecognized indirect mechanisms rather than the immediate presence and multiplication of Bartonella spp. in the eyeball. Nonetheless we believe that screening for Bartonella spp. should become part of the diagnostic workup in uveitis.