Fuchs' Uveitis in Iranian Patients: A Review of 89 Eyes

Fuchs' uveitis syndrome: a 20-year experience in 466 patients

Fuchs Uveitis Syndrome (FUS), also known as Fuchs Heterochromic Iridocyclitis, is a chronic form of uveitis characterized by mild inflammation primarily affecting one eye. This study aimed to investigate the clinical and epidemiological features of FUS in an Iranian population. A retrospective analysis was conducted on 466 patients diagnosed with FUS at an ophthalmology center affiliated with Isfahan University of Medical Sciences between 2003 and 2021. The Kimura et al. criteria were used for FUS diagnosis. Demographic data, clinical characteristics, misdiagnosed cases, concurrent diseases, and associated ocular findings were analyzed. The study included 507 eyes of 466 FUS patients, with a mean age of 34.01 ± 11.25 years. Iris atrophy, keratic precipitates, and vitritis were common clinical findings. Heterochromia was an infrequent feature. Initial misdiagnosis occurred in 13 patients, with pars planitis being the most common incorrect diagnosis. Toxoplasmosis and multiple sclerosis were common concurrent diseases. Pediatric FUS cases were noted, possibly attributed to early-onset manifestations. Differences in clinical characteristics were observed when compared to other populations. This study provides insights into the clinical and epidemiological aspects of FUS in an Iranian population. Variations in clinical features, misdiagnosis patterns, and concurrent diseases were noted. Attention to specific clinical parameters can aid in accurate FUS diagnosis. Understanding these differences contributes to a better understanding of FUS presentation and its relationship with other diseases.

Peripapillary and Macular Choroidal Vascularity Index in Eyes with Fuchs' Uveitis

BACKGROUND

To investigate the choroidal vascularity alterations of macula and peripapillary area in eyes with unilateral Fuchs uveitis (FU).

METHODS

This study included 18 eyes with unilateral FU and 18 healthy fellow eyes. The choroidal vascularity index (CVI) was analyzed, and the results were compared between eyes with FU and healthy fellow eyes (control group).

RESULTS

The mean subfoveal (s)CVI (%) value was significantly lower in the FU group as compared with the control group: 60.92 ± 2.63 vs. 64.01 ± 2.54, respectively (p = .001). The mean pCVI (%) values of superior and inferior quadrant were significantly lower in the Fuchs group as compared with the control group:58.87 ± 4.48 vs. 61.98 ± 3.32, respectively, in superior quadrant (p = .035); and 57.29 ± 6.65 vs. 61.44 ± 4.76, respectively, in inferior quadrant (p = .014).

CONCLUSION

The chronic continuous inflammation in FU causes inflammation-mediated thinning in the vascular area of the subfoveal and peripapillary choroid. The changes in the peripapillary region are remarkable in terms of the further glaucoma risk of these eyes.

Anterior segment structures in dark iris Chinese patients with unilateral Fuchs' uveitis syndrome

Purpose

To compare binocular anterior segment structures in Chinese patients with dark iris and unilateral Fuchs’ uveitis syndrome (FUS).

Methods

This was a cross-sectional study including 34 phakic eyes (17 patients) with unilateral FUS. Anterior segment parameters were measured by rotating Scheimpflug imaging camera, noncontact specular microscopy, and anterior segment optical coherence tomography.

Results

Corneal volume was higher in FUS eyes compared to unaffected eyes (p < 0.05). The iridocorneal angles were larger in FUS eyes compared to contralateral eyes (p < 0.05). Mean endothelial cell density (ECD) was lower, and the coefficient of variation in endothelial cell size and average cell area of endothelial cells (ACA) were higher, in FUS eyes (p < 0.05). Mean densitometry values of the midstromal cornea (zones with a diameter of 0–2, 2–6, or 10–12 mm), posterior (0–2, 2–6, 10–12, or 0–12 mm), or total thickness (0–2 or 2–6 mm) were higher in FUS eyes compared with unaffected eyes (p < 0.05). ECD, percentage of hexagonal cells, and ACA were strongly related to densitometry values of the midstromal and posterior cornea in the FUS eyes (p < 0.05). Smoothness index of iris was lager in affected eyes (p < 0.05).

Conclusion

In Chinese patients with unilateral FUS, loss of endothelial cells, wider iridocorneal angle, thicker cornea, higher corneal densitometry of midstromal and posterior layer, and smoother iris were observed in affected eyes compared to contralateral eyes. These data can help to elucidate anterior segment characteristics of unilateral FUS in this population.

Rubella virus-associated uveitis: The essentiality of aqueous humor virological analysis

AIMS / BACKGROUND

Rubella virus-associated uveitis (RVAU) classically presents with the clinical features of Fuchs uveitis syndrome (FUS). We report a series RVAU, and discuss the relevance of available diagnostic strategies, and how vaccination could potentially prevent disease.

METHODS

We retrospectively included patients with RV-positive aqueous humor (AH) with RT-PCR and/or intraocular RV-IgG production, between January 2014 and December 2019. RV-IgG titers from AH and serum were compared with other virus-specific IgG titers (VZV and/or CMV and/or HSV-1), to determine the derived Goldmann-Witmer coefficient (GWC'). Clinical findings at presentation and during follow-up are reported, as well as the anti-RV vaccination status.

RESULTS

All 13 included patients demonstrated intraocular synthesis of RV-IgG (median GWC': 9.5; 3.2-100). RV-RNA was detected in one patient while PCR results were negative for other HSV1, VZV and CMV. The mean delay in diagnosis was 13 ± 12.6 years, with an initial presentation of FUS in only 3 patients (23%). Only four patients had been vaccinated, but all after the recommended age.

CONCLUSION

As RVAU is a pleiomorphic entity, virological analysis (RV RT-PCR and GWC') of aqueous humor is essential to improve the diagnosis and management of this entity. Improper vaccination against RV appears to be implicated in RVAU.

Automated measurement of iris surface smoothness using anterior segment optical coherence tomography

Fuchs uveitis (FU) is a chronic and often unilateral ocular inflammation and characteristic iris atrophic changes, other than heterochromia, are common in FU and are key to the correct diagnosis in many cases. With the advent of anterior segment optical coherence tomography (AS-OCT), some investigators attempted to quantitatively study these atrophic changes; mostly by introducing various methods to measure iris thickness in AS-OCT images. We aimed to present an automated method in an observational case series to measure the smoothness index (SI) of the iris surface in AS-OCT images. The ratio of the length of the straight line connecting the most peripheral and central points of the anterior iris border (in nasal and temporal sides) to the actual length of this border on AS-OCT images, was defined as SI. In a uveitis referral center, twenty-two eyes of 11 patients with unilateral Fuchs uveitis (FU) (7 female) and 22 eyes of 11 healthy control subjects underwent AS-OCT imaging. Image J and a newly developed MATLAB algorithm were used for manual and automated SI measurements, respectively. Agreement between manual and automated measurements was evaluated with Bland–Altman analysis and interclass correlation coefficient. The inter-eye difference of SI was compared between the FU group and the control group. Automated mean overall SI was 0.868 ± 0.037 and 0.840 ± 0.039 in FU and healthy fellow eyes, respectively (estimated mean difference =  − 0.028, 95% CI [− 0.038, − 0.018], p < 0.001). Bland- Altman plots showed good agreement between two methods in both healthy and FU eyes. The interclass correlation coefficient between the manual and automated measurements in the FU and healthy fellow eyes was 0.958 and 0.964, respectively. The inter-eye difference of overall SI was 0.029 ± 0.015 and 0.012 ± 0.008 in FU group and control group, respectively (p = 0.01). We concluded that the automated algorithm can rapidly and conveniently measure SI with results comparable to the manual method.

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.

Atypical Keratic Precipitates in Fuchs Uveitis

PURPOSE

Here, we report a case of otherwise typical Fuchs uveitis (FU) who presented with atypical keratic precipitates (KPs).

CASE REPORT

A 38 year-old man presented with decreased vision in the right eye. Best corrected visual acuity was 2/10 in the right eye and 10/10 in the left eye. He was known to have advanced glaucoma in the right eye. The presence of KPs, iris smoothness, posterior subcapsular cataract, vitreous cells, as well as imaging characteristics were in complete agreement with the classical picture of FU in this eye. However, KPs varied in size from small to large and had a triangular distribution over the inferior corneal endothelium. A tendency to confluence and pigments were also observed in some KPs. This is in sharp contrast with the description of typical diffuse, small, white, stellate KPs, which has been emphasized as a defining feature of FU in recent publications. To rule out other uveitis entities, a comprehensive laboratory workup was done, as well as a molecular assay on aqueous for common infectious uveitides with the similar clinical picture.

CONCLUSION

Ophthalmologists should be aware that FU can manifest with atypical KPs in a minority of patients to prevent erroneous diagnosis and unnecessary treatments.