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Yang P, Zhang W, Chen Z, Zhang H, Su G, Cao Q, Zhu Y, Zhong Z, Zhou C, Wang Y, Kijlstra A. Development of revised diagnostic criteria for Fuchs' uveitis syndrome in a Chinese population. Br J Ophthalmol 2022; 106:1678-1683. [PMID: 34108225 PMCID: PMC9685691 DOI: 10.1136/bjophthalmol-2021-319343] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS Fuchs' uveitis syndrome (FUS) is one of the frequently misdiagnosed uveitis entities, which is partly due to the absence of internationally recognised diagnostic criteria. This study was performed to develop and evaluate a set of revised diagnostic criteria for FUS. METHODS The clinical data of Chinese patients with FUS and patients with non-FUS were collected and analysed from a tertiary referral centre between April 2008 and December 2020. A total of 593 patients with FUS and 625 patients with non-FUS from northern China were enrolled for the development of diagnostic criteria for FUS. Three hundred and seventy-seven patients with FUS and 503 patients with non-FUS from southern China were used to validate the criteria. Clinical symptoms and ocular signs were collected from all patients with FUS and patients with non-FUS. Multivariate two-step cluster analysis, logistic regression and decision tree algorithms in combination with the clinical judgement of uveitis experts were used to revise diagnostic criteria for FUS. RESULTS Three essential findings including diffuse iris depigmentation, absence of posterior synechiae, mild inflammation in the anterior chamber at presentation and five associated findings including mostly unilateral involvement, cataract, vitreous opacities, absence of acute symptoms and characteristic iris nodules were used in the development of FUS diagnostic criteria. All essential findings were required for the diagnosis of FUS, and the diagnosis was further strengthened by the presence of associated findings. CONCLUSION Revised diagnostic criteria for FUS were developed and validated by analysing data from Chinese patients and showed a high sensitivity (96.55%) and specificity (97.42%).
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Affiliation(s)
- Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Wanyun Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Zhijun Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Han Zhang
- Harbin Institute of Technology, Harbin, Heilongjiang, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Qingfeng Cao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Ying Zhu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Chunjiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Yao Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, The Netherlands
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Özdamar Erol Y, Güngör A, Şekeryapan Gediz B. Peripapillary and Macular Choroidal Vascularity Index in Eyes with Fuchs' Uveitis. Ocul Immunol Inflamm 2022; 30:1853-1858. [PMID: 34410884 DOI: 10.1080/09273948.2021.1964031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Yasemin Özdamar Erol
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Anıl Güngör
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Berrak Şekeryapan Gediz
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
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Yoneda Y, Usui Y, Tanaka R, Hase K, Namba K, Kamoi K, Takase H, Takeuchi M, Matsumiya W, Kusuhara S, Takeda A, Yawata N, Yanai R, Hiyama T, Harada Y, Hashida N, Maruyama K, Nakai K, Taguchi R, Kaburaki T, Mizuki N, Goto H, Fujino Y, Takeuchi M. Factors associated with low prevalence of Fuchs' uveitis syndrome in Japan. Front Med (Lausanne) 2022; 9:999804. [PMID: 36250082 PMCID: PMC9561393 DOI: 10.3389/fmed.2022.999804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
AimTo investigate the causes of low prevalence of Fuchs' uveitis syndrome (FUS) in Japan.MethodsMedical records of 160 patients diagnosed with FUS at 14 uveitis specialty facilities in Japan were reviewed retrospectively.ResultsIn 160 FUS patients, mean follow-up period before referral to our uveitis facilities was 31.6 ± 50.9 months. The most common reason for referral was idiopathic uveitis (61.9%), followed by cataract (25.0%), high intraocular pressure (IOP) including glaucoma (16.3%), and FUS (14.4%). Unilateral involvement was 96.9%. The most frequent ocular finding of FUS was anterior inflammation (91.9%), followed by stellate-shaped keratic precipitates (88.1%), cataract/pseudophakia (88.1%), diffuse iris atrophy (84.4%), vitreous opacity (62.5%), heterochromia (53.1%) and high IOP including glaucoma (36.3%). As treatments of these ocular findings, cataract surgery was performed in 52.5%, glaucoma surgery in 10.6%, and vitrectomy in 13.8%. Mean logMAR VA was 0.28 ± 0.59 at the initial visit, and decreased significantly to 0.04 ± 0.32 at the last visit. Proportions of FUS patients with BCVA <0.1 and 0.1 to <0.5 decreased, while that of ≥0.5 increased at the last visit compared with the initial visit.ConclusionsOcular findings of FUS in Japanese FUS patients were consistent with the characteristic features. The low prevalence of FUS in Japan may be a result of being overlooked and misdiagnosed as mild idiopathic uveitis, cataract, and/or glaucoma.
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Affiliation(s)
- Yu Yoneda
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Rie Tanaka
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Keitaro Hase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Takase
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Wataru Matsumiya
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsunobu Takeda
- Department of Ophthalmology, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Nobuyo Yawata
- Department of Ophthalmology, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Ryoji Yanai
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Noriyasu Hashida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kei Nakai
- Department of Ophthalmology, Yodogawa Christian Hospital, Osaka, Japan
| | - Ryo Taguchi
- Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, Omiya, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, Omiya, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Yujiro Fujino
- Department of Ophthalmology, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
- *Correspondence: Masaru Takeuchi
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Yermalitski A, Rübsam A, Pohlmann D, Metzner S, Pleyer U. Rubella Virus- and Cytomegalovirus-Associated Anterior Uveitis: Clinical Findings and How They Relate to the Current Fuchs Uveitis Syndrome Classification. FRONTIERS IN OPHTHALMOLOGY 2022; 2:906598. [PMID: 38983570 PMCID: PMC11182156 DOI: 10.3389/fopht.2022.906598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/25/2022] [Indexed: 07/11/2024]
Abstract
Rubella virus (RV) and cytomegalovirus (CMV) have both been implicated in anterior uveitis (AU). Clinical phenotypes can vary widely among both etiologies, including Fuchs uveitis syndrome (FUS) as a very distinct phenotype that has been associated with both RV and CMV. The Standardization of Uveitis Nomenclature (SUN) Working Group recently updated the classification criteria for FUS as unilateral AU, including either heterochromia or diffuse iris atrophy combined with stellate keratic precipitates as key findings. The aim of this study was to determine whether our patients adhere to the classification criteria of FUS as previously reported and whether RV- or CMV-associated uveitis can be differentiated by clinical findings. Therefore, this study investigated the clinical characteristics of patients with AU and intraocular presence of either RV or CMV determined by the Goldmann-Witmer coefficient (GWC). Our study included 100 patients (107 eyes) with AU and positive GWC for RV (86) and CMV (21). Clinical findings of RV-positive eyes were as follows: keratic precipitates (91.9%) with a predominantly diffuse distribution (81.4%), unilateral cataract (80.2%), pseudophakia (73.5%), and vitreous cells (59.7%), whereas heterochromia was present in only 39.5% of eyes and iris atrophy in 12.9% of eyes. In CMV-positive eyes, conversely, a higher incidence of ocular hypertension with markedly increased intraocular pressures above 30 mmHg (66.7%), keratic precipitates (81.0%), which were most commonly distributed in the center of the cornea (63.6%), an unaffected lens (55.0%), absent iris atrophy (100%), and absent posterior synechiae (90.5%) could be detected. This indicates a clinical presentation that was mainly compatible with Posner-Schlossman syndrome. In our cohort of RV-positive FUS patients, we saw a different cluster of clinical findings compared to the classification criteria suggested by the SUN Working Group. The main criteria, such as unilaterality, were mostly fulfilled. When applying all classification criteria, only 8.4% of 107 eyes and 10.5% of all 86 RV-positive eyes would qualify for the diagnosis of FUS. In addition, in our cohort of predominantly Caucasian patients, the clinical findings in patients with proven CMV infection differed from the clinical presentation typically associated with FUS.
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Affiliation(s)
- Anton Yermalitski
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Ophthalmology, Berlin, Germany
| | - Anne Rübsam
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Ophthalmology, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dominika Pohlmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Ophthalmology, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvia Metzner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Ophthalmology, Berlin, Germany
| | - Uwe Pleyer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Ophthalmology, Berlin, Germany
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5
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Optic coherence tomography angiography findings in fuchs heterochromic iridocyclitis. Int Ophthalmol 2022; 42:2519-2524. [PMID: 35624335 DOI: 10.1007/s10792-022-02299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate macular capillary perfusion in patients with fuchs heterochromic iridocyclitis (FHI) by using optical coherence tomography angiography (OCTA). MATERIAL AND METHOD A total of 19 eyes of 19 patients with unilateral FHI underwent detailed eye examination. OCTA (RTVue-XR Avanti) images were obtained from both eyes. OCTA parameters, including foveal avascular zone, superficial capillary plexus and deep capillary plexus vessel densities, were compared between the involved and fellow control eyes. RESULTS The median age of the patients (11 females, 8 males) was 42.0 ± 9.63 (range 24-57) years. DCP and SCP densities at the parafoveal and perifoveal area were significantly lower in the FHI eyes compared to the control eyes (44.80 ± 5.24% vs. 54.70 ± 3.76% and 43.30 ± 5.10% vs. 53.70 ± 2.73%, respectively; p < 0.05). The median FAZ was 0.29 ± 0.12 (0.11-0.42) mm2 in the FHI eyes and 0.26 ± 0.09 (0.10-0.40) mm2 in the control eyes. This difference did not reach statistical significance (p = 0.199). CONCLUSION Macular capillary perfusion was significantly reduced in both SCP and DCP in the eyes with FHI. FHI, which is known to affect the choroid layer, could also compromise macular capillary perfusion of the retina.
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[Secondary open-angle glaucoma: uveitic secondary glaucoma, steroid-induced glaucoma, posttraumatic and postoperative glaucoma, tumor-related glaucoma and glaucoma due to elevated episcleral venous pressure]. Ophthalmologe 2022; 119:533-546. [PMID: 35471612 DOI: 10.1007/s00347-022-01630-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
Secondary open-angle glaucomas are a heterogeneous group of diseases in which a variety of pathophysiological mechanisms result in an elevation of intraocular pressure (IOP). In contrast to primary open-angle glaucoma in many cases besides IOP reduction a causal treatment is possible. This article is the second part of a review of the more frequently encountered forms of secondary open-angle glaucoma. Uveitic glaucoma, steroid-induced glaucoma, posttraumatic and postoperative glaucoma, glaucoma due to intraocular tumors and caused by elevated episcleral venous pressure are covered. The underlying pathophysiological mechanisms, characteristic clinical findings and treatment options are discussed.
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Mao Y, Lin S, Zhu C, Liu X, Wu H, Ou S. Cytokine Changes in the Aqueous Humor in Rubella-Related Fuchs Heterochromic Iridocyclitis. DISEASE MARKERS 2022; 2022:8906752. [PMID: 35178133 PMCID: PMC8843966 DOI: 10.1155/2022/8906752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Yi Mao
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
| | - Sijie Lin
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
| | - Chengfang Zhu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
| | - Xiaodong Liu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
| | - Huping Wu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
| | - Shangkun Ou
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361002, China
- Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen 361002, China
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Zhang W, Chen Z, Zhang H, Su G, Chang R, Chen L, Zhu Y, Cao Q, Zhou C, Wang Y, Yang P. Detection of Fuchs' Uveitis Syndrome From Slit-Lamp Images Using Deep Convolutional Neural Networks in a Chinese Population. Front Cell Dev Biol 2021; 9:684522. [PMID: 34222252 PMCID: PMC8250145 DOI: 10.3389/fcell.2021.684522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022] Open
Abstract
Fuchs' uveitis syndrome (FUS) is one of the most under- or misdiagnosed uveitis entities. Many undiagnosed FUS patients are unnecessarily overtreated with anti-inflammatory drugs, which may lead to serious complications. To offer assistance for ophthalmologists in the screening and diagnosis of FUS, we developed seven deep convolutional neural networks (DCNNs) to detect FUS using slit-lamp images. We also proposed a new optimized model with a mixed "attention" module to improve test accuracy. In the same independent set, we compared the performance between these DCNNs and ophthalmologists in detecting FUS. Seven different network models, including Xception, Resnet50, SE-Resnet50, ResNext50, SE-ResNext50, ST-ResNext50, and SET-ResNext50, were used to predict FUS automatically with the area under the receiver operating characteristic curves (AUCs) that ranged from 0.951 to 0.977. Our proposed SET-ResNext50 model (accuracy = 0.930; Precision = 0.918; Recall = 0.923; F1 measure = 0.920) with an AUC of 0.977 consistently outperformed the other networks and outperformed general ophthalmologists by a large margin. Heat-map visualizations of the SET-ResNext50 were provided to identify the target areas in the slit-lamp images. In conclusion, we confirmed that a trained classification method based on DCNNs achieved high effectiveness in distinguishing FUS from other forms of anterior uveitis. The performance of the DCNNs was better than that of general ophthalmologists and could be of value in the diagnosis of FUS.
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Affiliation(s)
- Wanyun Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Zhijun Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Han Zhang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Rui Chang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Lin Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Ying Zhu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Qingfeng Cao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Chunjiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Yao Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
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Babu K, Konana VK, Ganesh SK, Patnaik G, Chan NSW, Chee SP, Sobolewska B, Zierhut M. Viral anterior uveitis. Indian J Ophthalmol 2021; 68:1764-1773. [PMID: 32823392 PMCID: PMC7690545 DOI: 10.4103/ijo.ijo_928_20] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Viral anterior uveitis (VAU) needs to be suspected in anterior uveitis (AU) associated with elevated intraocular pressure, corneal involvement, and iris atrophic changes. Common etiologies of VAU include herpes simplex, varicella-zoster, cytomegalovirus, and rubella virus. Clinical presentations can vary from granulomatous AU with corneal involvement, Posner-Schlossman syndrome, Fuchs uveitis syndrome, and endothelitis. Due to overlapping clinical manifestations between the different viruses, diagnostic tests like polymerase chain reaction and Goldmann-Witmer coefficient analysis on the aqueous humor may help in identifying etiology to plan and monitor treatment.
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Affiliation(s)
- Kalpana Babu
- Department of Uveitis and Ocular inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India
| | - Vinaya Kumar Konana
- Department of Uveitis and Ocular inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India
| | - Sudha K Ganesh
- Department of Uveitis and Ocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Gazal Patnaik
- Department of Uveitis and Ocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Nicole S W Chan
- Department of Ophthalmology, National University Hospital, Singapore
| | - Soon-Phaik Chee
- Singapore National Eye Centre; Singapore Eye Research Institute; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore; Duke-NUS Graduate Medical School Singapore, Singapore
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In vivo analysis of choroidal vascularity index changes in eyes with Fuchs uveitis syndrome. Photodiagnosis Photodyn Ther 2021; 34:102332. [PMID: 33962055 DOI: 10.1016/j.pdpdt.2021.102332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study aimed to investigate changes in the choroidal vascularity index (CVI) in eyes with Fuchs uveitis syndrome (FUS) and determine the effect of heterochromia on choroidal vascularity using binarisation of enhanced-depth imaging (EDI)-optical coherence tomography (OCT) images. METHODS The study included the affected eyes (FEs) and unaffected fellow eyes (NFEs) of 24 patients with unilateral FUS and the eyes of 30 healthy controls (HCs). The subfoveal total choroidal area (TCA) and the luminal area (LA) were determined by binarised EDI-OCT images using Image J software (National Institutes of Health, Bethesda, MD). The CVI value was calculated by dividing the LA value by the TCA value. RESULTS The CVI values were significantly lower in FEs (58.8 ± 3.7 %) compared to NFEs (62.3 ± 3.9 %, p = 0.002) and HCs (61.1 ± 3.7 %, p = 0.008). The mean LA was significantly narrower in FEs than in NFEs (p = 0.047) and HCs (p = 0.001). Additionally, the mean CVI values were significantly lower in eyes with heterochromia compared to those without heterochromia (p = 0.024) in the affected eyes of patients with FUS. CONCLUSION This study shows that there are significant quantitative structural changes, especially in the luminal part of the subfoveal choroid, in eyes with FUS. The choroid seems to be more affected in the presence of heterochromia. These findings might support posterior involvement and the chronicity of the disease.
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Balikoglu Yilmaz M, Doganay Kumcu N, Daldal H, Saritepe Imre S, Aydin E, Ozgul S, Kose T. May ganglion cell complex analysis be a marker for glaucoma susceptibility in unilateral Fuchs' uveitis syndrome? Graefes Arch Clin Exp Ophthalmol 2021; 259:1975-1983. [PMID: 33929589 DOI: 10.1007/s00417-021-05182-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To compare retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer thickness (GCIPLT) in the affected eyes to fellow unaffected eyes of patients with unilateral Fuchs' uveitis syndrome (FUS) and analyze their change over time. METHODS Twenty seven unilateral FUS patients who did not have concomitant systemic or ocular disease were retrospectively enrolled. Central macular thickness (CMT), RNFL thickness, and GCIPLT measurements were evaluated. Data was analyzed using the non-parametric Brunner-Langer model (LD-F2 design) and Wilcoxon signed-rank test. RESULTS The mean age of the patients was 40.2 ± 10.2 years. The median disease duration was 11 (2-62) months. The median best-corrected visual acuity (BCVA) of the affected eyes and the fellow eyes was 0.22 (0.00-2.50) vs. 0.00 (0.0-0.10) logMAR at the initial visit and 0.05 (0.00-2.50) vs. 0.00 (0.0-0.30) logMAR at the final visit. The change in BCVA was found significant in the affected eyes, but not in the fellow eyes (p < 0.001 and p = 0.287, respectively). The median CMT in the affected eyes at the final visit was not statistically different from the value at the initial visit (255 (157-306) vs. 245 (140-310) µm, p = 0.256). The change in RNFL thickness over time in the affected eyes was similar to the fellow unaffected eyes of the patients with unilateral FUS at all quadrants, with non-significant time and group effects (p > 0.05). However, median GCIPLT in all quadrants (except superonasal) in the affected eyes was statistically lower than the fellow eyes at the initial and final visits (p < 0.05). The most affected quadrant of the ganglion cell complex was inferonasal in the involved eyes (79 (42-97) vs. 75 (43-87) µm) at initial and final visits (p = 0.033 for time effect and p < 0.001 for group effect, respectively). CONCLUSION Median CMT and RNFL thickness did not change during follow-up in the affected eyes of patients with unilateral FUS. Median GCIPLT in the affected eyes declined over time in all quadrants. Ganglion cell loss was also most prominent in the inferonasal quadrant in the affected eyes. FUS patients should be followed up long-term in terms of ganglion cell loss, especially in the inferonasal quadrant.
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Affiliation(s)
- Melike Balikoglu Yilmaz
- Ophthalmology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Basın Sitesi Mah, Hasan Tahsin Cad No: 143, 35150, Karabaglar, Izmir, Turkey.
| | | | - Hatice Daldal
- Ophthalmology, Training and Research Hospital, Usak University, Usak, Turkey
| | - Seher Saritepe Imre
- Ophthalmology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Basın Sitesi Mah, Hasan Tahsin Cad No: 143, 35150, Karabaglar, Izmir, Turkey
| | - Erdinc Aydin
- Ophthalmology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Basın Sitesi Mah, Hasan Tahsin Cad No: 143, 35150, Karabaglar, Izmir, Turkey
| | - Semiha Ozgul
- Department of Biostatistics and Medical Informatics, Ege University, Izmir, Turkey
| | - Timur Kose
- Department of Biostatistics and Medical Informatics, Ege University, Izmir, Turkey
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Zarei M, Mahmoudi T, Riazi-Esfahani H, Mousavi B, Ebrahimiadib N, Yaseri M, Khalili Pour E, Arabalibeik H. Automated measurement of iris surface smoothness using anterior segment optical coherence tomography. Sci Rep 2021; 11:8505. [PMID: 33875715 PMCID: PMC8055699 DOI: 10.1038/s41598-021-87954-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Mohammad Zarei
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, 1336616351, Iran
| | - Tahereh Mahmoudi
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences and Research Center for Science and Technology in Medicine, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, 1336616351, Iran
| | - Behnam Mousavi
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences and Research Center for Science and Technology in Medicine, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, 1336616351, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, 1336616351, Iran.
| | - Hossein Arabalibeik
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences and Research Center for Science and Technology in Medicine, Tehran, Iran
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Simsek M, Cakar Ozdal P, Cankurtaran M, Ozdemir HB, Elgin U. Analysis of Corneal Densitometry and Endothelial Cell Function in Fuchs Uveitis Syndrome. Eye Contact Lens 2021; 47:196-202. [PMID: 32483051 DOI: 10.1097/icl.0000000000000717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate corneal densitometry and endothelial cell properties in patients with unilateral Fuchs uveitis syndrome (FUS), and to compare results with unaffected contralateral eyes and healthy control subjects. METHODS A total of 90 participants were included in this prospective cross-sectional study. Forty-five affected eyes of patients with FUS were regarded as group 1 (FUSa), 45 fellow eyes were regarded as group 2 (FUSf), and 45 healthy-control eyes were regarded as group 3. Corneal densitometry was measured with densitometry software of Scheimpflug Corneal Topography (Pentacam HR, Oculus GmbH, Wetzlar, Germany), whereas endothelial cell measurement was evaluated with specular microscopy (Tomey, EM4000, GmbH, Germany). RESULTS The mean corneal densitometry values were higher in the midstromal (zones; 2-6, 6-10 mm), posterior (all zones), and total thickness (zones; 2-6, 6-10 mm) layers in the FUSa compared with FUSf and control eyes (P<0.05 for all comparisons). The mean values of average cell area and cell size characteristics (minimum, maximum, SD, and coefficient of variation) were higher; endothelial cell density and percentage of hexagonal cells were lower in the FUSa than in the other two groups (P<0.05 for all comparisons). There was a significantly strong correlation between specular microscopy parameters and posterior corneal densitometry values in the FUSa group. CONCLUSIONS Impairment of endothelial cell function in affected eyes of patients with FUS resulted in increased values of corneal densitometry, especially posterior layer.
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Affiliation(s)
- Mert Simsek
- Department of Ophthalmology (M.S., P.C.O., M.C., U.E.), University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey ; and Department of Ophthalmology (H.B.O.), Gazi University School of Medicine, Ankara, Turkey
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Huang Y, Ye Z, Li Z. Siderotic glaucoma without detectable intraocular foreign body in a pseudophakic eye: a case report. BMC Ophthalmol 2020; 20:417. [PMID: 33076842 PMCID: PMC7574297 DOI: 10.1186/s12886-020-01691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/12/2020] [Indexed: 12/02/2022] Open
Abstract
Background Ocular siderosis is induced by a retained intraocular foreign body (IOFB) containing iron and can present as siderotic glaucoma. We report a rare case of histopathologically proven siderotic glaucoma in a middle-aged blacksmith with a preceding history of ocular trauma but no radiologically detectable IOFB. Case presentation A 42-year-old blacksmith presented with an elevation of intraocular pressure (IOP) in left eye showing iris heterochromia and brownish deposits throughout the trabecular meshwork (TM). Preoperative ophthalmic examination did not reveal any retained IOFBs. Electroretinography showed the classic changes of retinal degeneration in ocular siderosis. Histopathologic staining of the TM verified the presence of iron deposits. Conclusion This case underlines the importance of the close monitoring of patients with a history of ocular trauma and highlights the necessity of electroretinography, histopathologic study, and detailed ophthalmic examination in the diagnosis of siderotic glaucoma, even if there is no definite radiologically detectable IOFB.
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Affiliation(s)
- Yang Huang
- Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, No.28 Fuxing Road Haidian District, Beijing, China
| | - Zi Ye
- Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, No.28 Fuxing Road Haidian District, Beijing, China
| | - Zhaohui Li
- Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, No.28 Fuxing Road Haidian District, Beijing, China.
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Zarei M, KhaliliPour E, Ebrahimiadib N, Riazi-Esfahani H. Quantitative Analysis of the Iris Surface Smoothness by Anterior Segment Optical Coherence Tomography in Fuchs Uveitis. Ocul Immunol Inflamm 2020; 30:697-702. [PMID: 32966151 DOI: 10.1080/09273948.2020.1823424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To demonstrate the value of "smoothness index (SI)" as a novel tool for quantitative analysis of iris surface findings in unilateral Fuchs' uveitis (FU). METHODS Both phakic eyes from patients with unilateral FU as well as healthy control subjects underwent anterior segment optical coherence tomography (AS-OCT). The ImageJ software was used for calculating the SI. RESULTS Forty eyes from 20 patients with unilateral FU and 40 eyes from 20 healthy subjects were enrolled. In FU eyes, mean overall SI (0.876 ± 0.030) was significantly higher than fellow control eyes (0.841 ± 0.041) (p = .001). Mean inter-eye difference for overall SI in the FU patients (0.037 ± 0.030) was significantly larger than the healthy control subjects (0.018 ± 0.014) (p = .033). CONCLUSION Iris "smoothness index" can be used to quantitatively assess iris surface smoothness and may facilitate the diagnosis of subtle iris atrophic changes in eyes affected by FU especially in the absence of heterochromia.
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Affiliation(s)
- Mohammad Zarei
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias KhaliliPour
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
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.
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Affiliation(s)
- Yasemin Özdamar Erol
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Merve İnanç
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Pınar Özdal
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
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Aksoy FE, Altan C, Basarir B, Garip D, Pasaoglu I, Perente I, Yigit U, Taskapili M. Analysis of retinal microvasculature in Fuchs' uveitis syndrome. Retinal microvasculature in Fuchs' uveitis. J Fr Ophtalmol 2020; 43:324-329. [PMID: 32008841 DOI: 10.1016/j.jfo.2019.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/10/2019] [Accepted: 10/18/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective of this study is to quantitatively analyse the foveal microvasculature in eyes with Fuchs' Uveitic Syndrome (FUS), or Fuchs' Heterochromic Iridocyclitis (FHI), by Optical coherence tomography angiography (OCTA). METHODS Thirty patients with FUS and 30 healthy volunteer patients (control group) were enrolled in the study. Vascular density (VD) in the superior and deep capillary plexuses (SCP, DCP) were reported and compared between eyes with FUS (FU), fellow eyes (FE) and the control group. RESULTS Foveal VD and parafoveal VDs in all quadrants of the SCP were significantly lower in the FU group than the FE group and normal eyes (P<0.05). Foveal VDs in the DCP were similar between the three groups (P>0.05); however, parafoveal VDs in all quadrants of the DCP were significantly lower in the FU group than in the FE and control eyes (P<0.05). Foveal and parafoveal VDs in both the SCP and DCP were similar between fellow eyes and the control group. CONCLUSION Fuchs' Uveitic Syndrome (Fuchs' Heterochromic Iridocyclitis) affects not only the anterior uvea and vitreous but also the retinal microvasculature. Analysis by OCT-A may enable us to understand the extent of this disease.
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Affiliation(s)
- F E Aksoy
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - C Altan
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - B Basarir
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - D Garip
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - I Pasaoglu
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - I Perente
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - U Yigit
- Bakirkoy Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - M Taskapili
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Tekin K, Ozdamar Erol Y, Inanc M, Sargon MF, Cakar Ozdal P, Berker N. Ultrastructural Analysis of the Anterior Lens Epithelium in Cataracts Associated with Uveitis. Ophthalmic Res 2019; 63:213-221. [PMID: 31838467 DOI: 10.1159/000504497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/31/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the transmission electron microscopic findings of lens epithelial cells (LECs) in patients with different subtypes of uveitis and to compare the findings with those in age-matched controls. METHODS In this prospective case-control study, the anterior lens capsules were taken from 47 eyes of 47 patients with uveitis of different subtypes (17 with Fuchs uveitis syndrome [FUS], 13 with -Behçet's uveitis, 10 with idiopathic uveitis, and 7 with herpetic keratouveitis) and from 15 eyes of 15 control patients. RESULTS In the FUS group, the LECs had homogeneous thickening and irregularity, with some small vacuoles and widespread, oval-shaped pigment clusters in some areas. In the Behçet uveitis group, there was evident thinning in the lens epithelium. The subepithelial tissue under the epithelium was thickened, and edematous areas were detected. In the idiopathic uveitis group, the LECs were thinner with small vacuoles, and the cubic structure of the LECs was transformed into a squamous one. Moreover, the LECs included some small vacuoles, similar to those in the FUS group. In the herpetic keratouveitis group, two prominent cell types were observed: (1) completely normal LECs and (2) degenerated-type LECs with pyknotic nuclei, condensation of chromatin, swelling in the cytoplasm, membrane ruptures, and intra-cytoplasmic inclusion bodies. In the control group, the LECs and all of their elements occurred in normal ultrastructural patterns, with the exception of a few small intraepithelial vacuoles, which were fewer in number and smaller than those in the FUS and idiopathic uveitis groups. CONCLUSION The electron microscopic analysis of LECs of patients with different subtypes of uveitis revealed significant ultrastructural alterations, which may be related to the summation of oxidative stress and intraocular inflammation.
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Affiliation(s)
- Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van, Turkey,
| | - Yasemin Ozdamar Erol
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Merve Inanc
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | | | - Pinar Cakar Ozdal
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Nilufer Berker
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Touhami S, Vanier A, Rosati A, Bojanova M, Benromdhane B, Lehoang P, Rozenberg F, Bodaghi B. Predictive Factors of Intraocular Pressure Level Evolution Over Time and Glaucoma Severity in Fuchs' Heterochromic Iridocyclitis. Invest Ophthalmol Vis Sci 2019; 60:2399-2405. [PMID: 31157832 DOI: 10.1167/iovs.18-24597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the clinical and virologic-associated and predictive factors of intraocular pressure (IOP) evolution over time and its severity in Fuchs' heterochromic iridocyclitis (FHC). Methods Consecutive patients with both clinical FHC and intraocular synthesis of rubella virus (RV)-specific antibodies were included in this study. Specific ocular production of RV antibodies was confirmed using the quotient of serum/aqueous humor ratio of RV IgGs (Crv) and control antiviral IgGs (Cctl), using quantitative serology methods. Epidemiologic, clinical, biological, and virologic data at referral were collected and correlated with IOP values over time, occurrence, and severity of glaucoma. Results Sixty-eight eyes of 68 patients were included. Mean age at diagnosis was 40.7 ± 11.1 years. Mean follow-up was 4.3 ± 4.3 years. Mean baseline Crv and Cctl values were 12.34 ± 14.67 and 216.70 ± 98.4, respectively. Mean baseline IOP was 17.2 ± 7.2 mm Hg (range, 9-40) and 15.6 ± 5.6 (range, 3-30) 5 years after referral. The predictive factors for pejorative IOP evolution over time and glaucoma severity were male sex (P = 0.03) and decreased Crv (P = 0.04) and presence of iris nodules (P < 0.001) and decreased Cctl (P = 0.02), respectively. Diagnostic delay was associated with increased likelihood of undergoing glaucoma surgery (P = 0.02). Conclusions Time to diagnosis, male sex, presence of iris nodules at baseline, and decreased Crv and Cctl ratios were associated with increased likelihood of pejorative IOP evolution over time. Given the aggressiveness of glaucoma in FHC, these results provide interesting insight into what category of patients should need the closest screening.
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Affiliation(s)
- Sara Touhami
- Ophthalmology Department, Reference Center in Rare Diseases, Département Hospitalo Universitaire Sight Restore, Hôpital Pitié Salpêtrière, University Paris VI, Paris, France
| | - Antoine Vanier
- Inserm, University Bretagne Loire, University of Nantes, University of Tours, Unité Mixte de Recherche, U1246 Sciences Philosophie Histoire, Nantes, France
| | - Alessandra Rosati
- Ophthalmology Unit, Dipartimento di Neuroscienze Salute Mentale e Organi di Senso, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Magdalena Bojanova
- Virology Department, Hôpital Cochin, Paris Descartes University, Paris, France
| | - Bouchra Benromdhane
- Ophthalmology Department, Reference Center in Rare Diseases, Département Hospitalo Universitaire Sight Restore, Hôpital Pitié Salpêtrière, University Paris VI, Paris, France
| | - Phuc Lehoang
- Ophthalmology Department, Reference Center in Rare Diseases, Département Hospitalo Universitaire Sight Restore, Hôpital Pitié Salpêtrière, University Paris VI, Paris, France
| | - Flore Rozenberg
- Virology Department, Hôpital Cochin, Paris Descartes University, Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, Reference Center in Rare Diseases, Département Hospitalo Universitaire Sight Restore, Hôpital Pitié Salpêtrière, University Paris VI, Paris, France
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Elgin U, Sen E, Ozdemir K, Ozdal P, Berker N. The outcome of initial mitomycin C-augmented trabeculectomy with subconjunctival bevacizumab in the management of secondary glaucoma associated with Fuchs heterochromic iridocyclitis. Int Ophthalmol 2019; 40:795-802. [PMID: 31792855 DOI: 10.1007/s10792-019-01240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the outcome of mitomycin C (MMC)-augmented trabeculectomy with subconjunctival bevacizumab in the management of Fuchs heterochromic iridocyclitis (FHI)-related glaucoma in 1-year follow-up period. METHODS This retrospective study included 50 eyes with FHI-related glaucoma those had underwent initial trabeculectomy with MMC (0.2 mg/ml-3 min). Thirty-one of them had single-dose bevacizumab injection (1.25 mg/0.05 ml) into the bleb area just at the end of the surgery, while 19 eyes did not have. The intraocular pressure (IOP) and the mean number of anti-glaucomatous medications were evaluated. The IOP value ≤ 21 mmHg was defined as complete or qualified surgical success in terms of using medical anti-glaucomatous treatment. Bleb height and vascularity were evaluated with Indiana bleb grading system. Paired sample t test, t test, Chi-square and Kolmogorov-Smirnov tests were used for statistical analysis. RESULTS The preoperative IOP values of bevacizumab and without bevacizumab groups were 32.8 ± 4.5 mmHg and 32.8 ± 4.5 mmHg, respectively, and they decreased to 17.5 ± 4.6 mmHg and 17 ± 5.2 mmHg at the final visit (p < 0.001 for all values). There were no significant differences in postoperative IOP and the number of medications between the groups at the final visit. In bevacizumab group, complete success was achieved in 100% within the third month but decreased to 22.5% (complete) and 74.1% (qualified) at the first year. In the other group (without bevacizumab group), complete success was achieved in 94.7% within the third month but decreased to 15.8% (complete) and 84.2% (qualified) at the first year. CONCLUSION Initial trabeculectomy with MMC and subconjunctival bevacizumab injection was found to have lower rates of complete success with relatively acceptable qualified success rates in the management of FHI-related glaucoma. Subconjunctival bevacizumab was not found to have additional effect to improve the surgical success.
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Affiliation(s)
- Ufuk Elgin
- Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ulucanlar caddesi No:59, 06240, Altindag, Ankara, Turkey.
| | - Emine Sen
- Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ulucanlar caddesi No:59, 06240, Altindag, Ankara, Turkey
| | - Kubra Ozdemir
- Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ulucanlar caddesi No:59, 06240, Altindag, Ankara, Turkey
| | - Pinar Ozdal
- Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ulucanlar caddesi No:59, 06240, Altindag, Ankara, Turkey
| | - Nilufer Berker
- Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ulucanlar caddesi No:59, 06240, Altindag, Ankara, Turkey
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A literature review on Fuchs uveitis syndrome: An update. Surv Ophthalmol 2019; 65:133-143. [PMID: 31622627 DOI: 10.1016/j.survophthal.2019.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/14/2022]
Abstract
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.
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Bauer D, Kasper M, Walscheid K, Koch JM, Müther PS, Kirchhof B, Heiligenhaus A, Heinz C. Alteration of MCP-1 and MMP-9 in Aqueous Humor Is Associated with Secondary Glaucoma in Fuchs Uveitis Syndrome. Ocul Immunol Inflamm 2019; 28:688-698. [PMID: 31268809 DOI: 10.1080/09273948.2019.1609049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To analyze changes in concentrations of pro- or anti-inflammatory cytokines, chemokines, or metalloproteinases (MMP) in the aqueous humor (AH) in Fuchs uveitis syndrome (FUS) patients with (FUSwG) or without (FUSwoG) secondary glaucoma. METHODS AH samples were collected from 43 eyes of Caucasian subjects (FUSwoG: n = 11; FUSwG: n = 8; control eyes: n = 24). Concentrations of IL-8, MCP-1, MMP-1,-2,-3,-9, SAA, TGFß-1,-2,-3, and TNF-α were measured by multiplex bead assay analysis. RESULTS Compared with the control group, levels of IL-8, MCP-1, MMP-3, and MMP-9 in the AH were significantly increased in FUSwG and FUSwoG patients. In contrast to FUSwoG patients, MCP-1 and MMP-9 level were lower in FUSwG, while expression of MMP-2, MMP-3, and TGFβ-1 was increased. CONCLUSION In our experiments, glaucoma in FUS patients was associated with low levels of MCP-1 and MMP-9 in the AH, while expression of MMP-2, MMP-3, and TGFβ-1 increased. The alteration in these molecular patterns may contribute to the development of glaucoma in FUS.
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Affiliation(s)
- D Bauer
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus Hospital Münster , Münster, Germany
| | - M Kasper
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus Hospital Münster , Münster, Germany
| | - K Walscheid
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus Hospital Münster , Münster, Germany
| | - J M Koch
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus Hospital Münster , Münster, Germany
| | - P S Müther
- Center for Ophthalmology, University Cologne , Köln, Germany
| | - B Kirchhof
- Center for Ophthalmology, University Cologne , Köln, Germany
| | - A Heiligenhaus
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus Hospital Münster , Münster, Germany.,Center for Ophthalmology, University of Duisburg-Essen , Essen, Germany
| | - C Heinz
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus Hospital Münster , Münster, Germany.,Center for Ophthalmology, University of Duisburg-Essen , Essen, Germany
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Nilforushan N, Yadgari M, Alemzadeh SA. Surgical management of glaucoma in Fuchs uveitis syndrome: Trabeculectomy or Ahmed glaucoma valve. J Curr Ophthalmol 2018; 31:24-30. [PMID: 30899842 PMCID: PMC6407154 DOI: 10.1016/j.joco.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 10/07/2018] [Accepted: 10/15/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose To evaluate the outcome of trabeculectomy versus Ahmed glaucoma valve (AGV) surgery in patients with Fuchs uveitis Syndrome (FUS). Methods Twenty-eight eyes with uncontrolled glaucoma and at least 6 months of follow-up were enrolled. In 16 eyes trabeculectomy and in 12 eyes AGV implant were performed. The primary outcome measure was surgical success defined as 5 < intraocular pressure (IOP) ≤ 21 mmHg (criterion A) and 5 < IOP ≤ 16 mmHg (criterion B), with at least 20% reduction in IOP, either with no medication (complete success) or with no more than preoperative medications (qualified success). The sum of complete and qualified success was defined as cumulative success. Results The mean age of the patients in the trabeculectomy group and the AGV group was 44.92 ± 9.02 and 45.76 ± 7.10 years, respectively (P = 0.79). The mean duration of follow-up was 23.06 ± 12.03 months in the trabeculectomy group and 22.83 ± 13.63 months in the AGV group (P = 0.96). The baseline mean IOP in trabeculectomy was 26.81 ± 6.69 mmHg which decreased to 11.61 ± 4.15 mmHg at last visit (P < 0.001). In the AGV group, mean IOP was 31.41 ± 6.76 at baseline that changed to 22.41 ± 5.09 at last visit (P = 0.005). According to criterion A, cumulative success rates were 100% and 91% at 6 months and 76% and 9% at 36 months in the trabeculectomy and the AGV group, respectively. Cumulative success rates at 6 months were 93% and 58% and 65% and 7% at 36 months according to criterion B in the trabeculectomy and the AGV group, respectively.Kaplan-Meier survival analysis revealed a significant association between surgical method and cumulative success rate over 36 months (based on criteria A: P = 0.02, and based on criteria B: P = 0.007). Conclusion The success rate of trabeculectomy was higher than AGV in the surgical management of glaucoma in FUS during a medium-term follow-up.
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Affiliation(s)
- Naveed Nilforushan
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Yadgari
- Eye Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayyed Amirpooya Alemzadeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
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Chan NS, Chee S. Demystifying viral anterior uveitis: A review. Clin Exp Ophthalmol 2018; 47:320-333. [DOI: 10.1111/ceo.13417] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/07/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | - Soon‐Phaik Chee
- Singapore National Eye Centre Singapore Singapore
- Singapore Eye Research Institute Singapore Singapore
- Department of Ophthalmology, Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
- Duke‐NUS Medical School Singapore Singapore
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AlBloushi AF, Alfawaz AM, Al-Dahmash SA, Al Owaifeer AM, AlEnezi SH, Al-Fakhri AS, Gikandi PW, Abu El-Asrar AM. Incidence, Risk Factors and Surgical Outcomes of Cataract among Patients with Uveitis in a University Referral Hospital in Riyadh, Saudi Arabia. Ocul Immunol Inflamm 2018; 27:1105-1113. [DOI: 10.1080/09273948.2018.1504970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | | | - Saad H. AlEnezi
- Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia
- Ophthalmology Department, College of Medicine, Majmaah University, Al Majma'ah, Saudi Arabia
| | | | | | - Ahmed M. Abu El-Asrar
- Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Zarei M, Darabeigi S, Mehrpour M, Roohipoor R, Ghassemi H, Ebrahimiadib N. Fuchs' Uveitis in Iranian Patients: A Review of 89 Eyes. Ocul Immunol Inflamm 2018; 27:1077-1085. [PMID: 30059646 DOI: 10.1080/09273948.2018.1500612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To describe clinical and imaging features of Fuchs' Uveitis (FU) and investigate the rate of misdiagnosis in Iranian patients. Methods: Records of 82 FU patients (89 eyes) were reviewed retrospectively. Results: Remarkable findings included iris heterochromia in 14 (17.1%) patients and Fuchs' keratic precipitates in 97.8%, vitritis in 89.7% and cataract in 69.7% eyes. FU discovered as an incidental finding in 7 patients (10.0%). Imaging revealed disc hyperfluorescence, mild vascular leakage and epiretinal membrane in 72.7%, 32.5% and 19.4% of eyes, respectively. The rate of misdiagnosis was 19.5% (16 patients) with intermediate uveitis being as the most common erroneous diagnosis (10 patients). Patients with the wrong diagnosis were significantly younger (p = 0.045) and more likely to have bilateral involvement (p = 0.004) or no anterior chamber cells (p = 0.039). Conclusions: Heterochromia is an infrequent clinical feature in Iranian FU patients, however, vitreous involvement is common. Intermediate uveitis is a usual misdiagnosis.
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Affiliation(s)
- Mohammad Zarei
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Sahel Darabeigi
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Mohammad Mehrpour
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Ramak Roohipoor
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Hamed Ghassemi
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Nazanin Ebrahimiadib
- Farabi Eye Research Center, Tehran University of Medical Sciences , Tehran , Iran
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De Groot-Mijnes JDF, Chan ASY, Chee SP, Verjans GMGM. Immunopathology of Virus-Induced Anterior Uveitis. Ocul Immunol Inflamm 2018. [DOI: 10.1080/09273948.2018.1439069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Anita S. Y. Chan
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore
- Histopathology, Pathology Department, Singapore General Hospital, Singapore
- Ocular Inflammation and Immunology Research Group, Singapore Eye Research Institute, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | - Soon-Phaik Chee
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore
- Ocular Inflammation and Immunology Research Group, Singapore Eye Research Institute, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Georges M. G. M. Verjans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine, Hannover, Germany
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Tekin K, Erol YO, Sargon MF, Inanc M, Ozdal PC, Berker N. Effects of Fuchs uveitis syndrome on the ultrastructure of the anterior lens epithelium: A transmission electron microscopic study. Indian J Ophthalmol 2017; 65:1459-1464. [PMID: 29208835 PMCID: PMC5742983 DOI: 10.4103/ijo.ijo_691_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of the study was to investigate the electron microscopic findings of the lens epithelial cells (LECs) in patients with Fuchs uveitis syndrome (FUS) who suffered from cataracts and to compare those with age-matched controls. METHODS This study was a prospective, comparative case series. The anterior lens capsules (ALC: basement membrane and associated LECs) were taken from 12 eyes of 12 cases of FUS and ten eyes of ten control patients. The ALCs were obtained from cataract surgery and prepared for transmission electron microscopy (TEM). RESULTS There were no statistically significant differences regarding the age or gender between the FUS group and the control group (P > 0.05). In the TEM examinations of the ALCs, all of the FUS cases revealed similar significant ultrastructural changes when compared to the control patients. In the FUS group, the LECs showed homogeneous thickening and irregularity which included some small vacuoles in different areas of the epithelial tissue. Moreover, in some areas of the LECs, widespread, oval-shaped, pigment clusters were detected. Conversely, in the control group, the LECs and all of their elements were in normal ultrastructural patterns, with the exception of some small intraepithelial vacuoles which were fewer and smaller than those in the FUS group. CONCLUSION Ultrastructural analysis of the ALC of the patients with FUS disclosed some significant alterations which may be related to the summation of oxidative stress, intraocular inflammation, and iris atrophy.
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Affiliation(s)
- Kemal Tekin
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Yasemin Ozdamar Erol
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | | | - Merve Inanc
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pinar Cakar Ozdal
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Nilufer Berker
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Rashid W, Lone I, Mir AM, Rashid A, Latif M. Fuchs Heterochromic Iridocylitis: Clinical Characteristics and Outcome of Cataract Extraction with Intra Ocular Lens Implantation in a Kashmiri Population- A Hospital Based Study. J Clin Diagn Res 2017; 10:NC13-NC16. [PMID: 28208900 DOI: 10.7860/jcdr/2016/21244.9111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/19/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Fuchs Heterochromic Iridocylitis (FHI) is a rare form of uveitis which is frequently complicated by cataract and glaucoma, but it does not show typical features of uveitis like pain, redness and posterior synechia. AIM To study the clinical characteristics and outcome of cataract extraction with Intra Ocular Lens (IOL) implantation in patients with FHI. MATERIALS AND METHODS The present prospective study was carried out in the Postgraduate Department of Ophthalmology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Bemina from March 2012 to January 2015. The study included 33 eyes of 32 patients of FHI who underwent thorough clinical examination and cataract surgery with IOL implantation and were evaluated based on their visual outcome and intra and post-operative complications. Post-operative follow-up was done on 1st day, one week, one month, two month, six month and at twelve months. RESULTS Mean age of our study group was 33.9 years (Range 18 to 65 years). No male or female preponderance was seen. There was bilateral involvement of eyes in only one case. Cataract and stellate keratic precipitates were present in all cases whereas, heterochromia was present in only six eyes (18.75%). Best Corrected Visual Acuity (BCVA) showed a significant improvement following cataract surgery (p<0.001). Post-operatively, 26 eyes (78.78%) showed an improvement of four lines or more (BCVA of > 6/12). Most common causes of decreased vision post-operatively were vitreous opacities in nine eyes (27.27%) followed by glaucoma in eight eyes (24.24%) and posterior capsular opacification in six eyes (18.18%). CONCLUSION Cataract extraction with IOL lens implantation in FHI is a safe procedure associated with good visual prognosis and few complications. However, glaucoma is one of the main concerns and should be closely monitored both pre and post-operatively.
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Affiliation(s)
- Wasim Rashid
- Senior Resident, Department of Ophthalmology, SKIMS, Medical College , Bemina, Srinagar, India
| | - Imtiyaz Lone
- Assistant Professor, Department of Opthalmology, SKIMS, Medical College , Bemina, Srinagar, India
| | - Adil Majid Mir
- Fellow Paediatric Ophthalmology, LVPEI , Hyderabad, India
| | - Aamir Rashid
- Post Doctoral Fellow Paediatric Cardiology, SCTIMST , Trivenderum, Kerela, India
| | - Mehreen Latif
- Tutor Demonstrator, Department of Forensic Medicine, SKIMS, Medical College , Bemina, Srinagar, India
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Fuchs' Heterochromic Iridocyclitis in an Italian Tertiary Referral Centre: Epidemiology, Clinical Features, and Prognosis. J Ophthalmol 2016; 2016:1458624. [PMID: 27781126 PMCID: PMC5066004 DOI: 10.1155/2016/1458624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 12/17/2022] Open
Abstract
Purpose. To study epidemiology, clinical findings and visual prognosis of patients with Fuchs' Heterochromic Iridocyclitis (FHI). Methods. A retrospective analysis was performed on 158 patients with FHI. Thirty-five patients were observed only once; the remaining 123 had a mean follow-up of 30.7 months (50 of them had a mean follow-up of 63.5 months) and in those we assessed complications, medical and surgical treatment, and long-term visual prognosis. Results. Average age at uveitis diagnosis was 27.2 years and 18.3% of patients were children. Blurred vision (54.5%) and floaters (40.5%) were the most frequent presenting symptoms. Small to medium-sized keratic precipitates (95.6%), iris atrophy (86.8%), and vitreous opacities (91.2%) were the most common signs; the prevalence of cataract and IOP increase was 63.5% and 20.1%, respectively, and their incidence was 0.1 and 0.06 eye/year. Significant risk factor for visual loss was IOP increase at presentation (p = 0.02). At final examination 98% of the eye had a visual acuity ≥ 0.6, and topical (p < 0.001) and systemic (p < 0.001) corticosteroids therapy were used less frequently than before referral. Conclusions. FHI has a good visual prognosis, despite the significant incidence of cataract and glaucoma. A correct and prompt diagnosis might avoid unnecessary therapies and provide excellent visual outcomes.
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Toniolo JT, Hall AJ, Smith JG, Levy J, Lim LL. Risk Factors for Glaucoma in a Cohort of Patients with Fuchs Heterochromic Iridocyclitis. Ocul Immunol Inflamm 2016; 25:753-759. [DOI: 10.1080/09273948.2016.1199712] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jason T. Toniolo
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Ophthalmology, University of Melbourne, Department of surgery, Melbourne, Victoria, Australia
| | - Anthony J. Hall
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
- Eye Surgery Associates, Melbourne, Victoria, Australia
| | | | - Jaime Levy
- Department of Ophthalmology, Ben-Gurion University of the Nagev, Ba’er Sheva, Israel
| | - Lyndell L. Lim
- Eye Surgery Associates, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Ophthalmology, University of Melbourne, Department of surgery, Melbourne, Victoria, Australia
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Abdala-Figuerola A, Bobadilla Mayorquín RY, Lichtinger A. Challenges in the diagnosis of Fuchs uveitis syndrome in children. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1210005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nalçacıoğlu P, Çakar Özdal P, Şimşek M. Clinical Characteristics of Fuchs' Uveitis Syndrome. Turk J Ophthalmol 2016; 46:52-57. [PMID: 27800260 PMCID: PMC5082249 DOI: 10.4274/tjo.99897] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 06/22/2015] [Indexed: 12/15/2022] Open
Abstract
Objectives: To evaluate the clinical and demographic properties of Fuchs’ uveitis syndrome (FUS) in Turkish patients. Materials and Methods: The medical records of 161 patients with FUS followed in the Uveitis Division of Ulucanlar Eye Hospital between 1996 and 2014 were respectively reviewed. The mean age at diagnosis, sex, the number of affected eyes, follow-up period, clinical findings at presentation, complications during the follow-up period, medical and surgical treatments, and best corrected visual acuity at the initial and final visits were recorded. Results: The study included 171 eyes of 161 patients diagnosed with FUS. Of the patients, 94 (58.4%) were female and 67 (41.6%) were male. The mean age at presentation was 35.2±11.0 (11-65) years. The mean follow-up period was 23.5±32.8 (2-216) months. Ten (6.2%) patients had bilateral involvement. The most common symptoms at presentation were decreased visual acuity or blurred vision in 63 (39.1%) and floaters in 19 (11.8%) patients. Clinical findings at presentation included diffuse small, round, white keratic precipitates in 128 (74.8%) eyes, anterior chamber reaction in 82 (47.9%), vitreous cells in 122 (71.3%), heterochromia in 47 (27.4%) and iris nodules in 32 (18.7%) eyes. During the follow-up period, elevated intraocular pressure occured in 31 (18.1%) eyes and the most common complication was cataract development (89 eyes, 52.0%). Conclusion: Heterochromia was observed in 27.4% of patients in our study. However, the diffuse small, round keratic precipitates, low-grade anterior chamber reaction and varying degrees of vitreous reaction are more common clinical characteristics that are helpful in making the diagnosis.
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Affiliation(s)
- Pınar Nalçacıoğlu
- Yıldırım Beyazıt University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | | | - Mert Şimşek
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Liu Q, Jia Y, Zhang S, Xie J, Chang X, Hou J, Li G, Koch DD, Wang L. Iris autofluorescence in Fuchs' heterochromic uveitis. Br J Ophthalmol 2016; 100:1397-402. [PMID: 26758535 DOI: 10.1136/bjophthalmol-2015-307246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/12/2015] [Indexed: 11/03/2022]
Abstract
AIMS To explore the characteristic autofluorescence patterns of iris depigmentation in eyes diagnosed with Fuchs' heterochromic uveitis (FHU). METHODS Near-infrared autofluorescence images and colour images of iris were taken in 21 eyes of 21 patients with FHU, 30 eyes of 15 normal subjects, 30 eyes of 15 normal age-related iris atrophy and 33 eyes of 20 patients with uveitis other than FHU. The confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph 2, HRA2) was used for melanin-related autofluorescence imaging. The indocyanine green angiography mode of HRA2 was applied for near-infrared laser imaging, and the wavelength of the excitation laser was 795 nm. Iris colour images were also taken with the slit lamp. RESULTS In normal iris, moderately intense autofluorescence was noted for the pigment ruff at the pupillary border, the crests in the pupillary zone and the collarette; and there was mild autofluorescence in the ciliary zone. In eyes with age-related iris atrophy and uveitis, much less autofluorescence was seen than the healthy normal irides. In eyes with FHU, there was moderate but discontinuous autofluorescence in the pigment ruff, a petaloid pattern of autofluorescence in the pupillary zone, moderate autofluorescence in the collarette and reticular pattern of autofluorescence in the ciliary zone. CONCLUSIONS Characteristic autofluorescence patterns appeared in eyes diagnosed with FHU. Near-infrared autofluorescence is a promising objective technique to document the iris changes in FHU.
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Affiliation(s)
- Qian Liu
- Retinal Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, China
| | - Yading Jia
- Retinal Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, China
| | - Suhua Zhang
- Retinal Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, China
| | - Juan Xie
- Retinal Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, China
| | - Xin Chang
- Retinal Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, China
| | - Jia Hou
- Retinal Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, China
| | - Gaiyun Li
- Retinal Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, China
| | - Douglas D Koch
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Li Wang
- Retinal Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, China Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA
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Couto C, Hurtado E, Faingold D, Demetrio C, Schlaen A, Zas M, Zarate J, Rosetti S, de Lima AP, Croxatto JO, Chiaradía P, Burnier MN. Atypical Bilateral Fuchs Uveitis: Diagnostic Challenges. Case Rep Ophthalmol 2015; 6:284-8. [PMID: 26483668 PMCID: PMC4608646 DOI: 10.1159/000439081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Bilateral Fuchs uveitis associated with vitreous infiltration and posterior segment involvement requires a thorough diagnostic evaluation. The lack of well-defined diagnostic criteria makes identification of this entity difficult. The aim of this case report was to present the characteristics of a patient with atypical Fuchs uveitis and the procedures needed to rule out the differential diagnosis with specific attention to the utility of in vivo confocal microscopy (IVCM).
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Affiliation(s)
- Cristóbal Couto
- Uveitis, Retina and Cornea Clinics, Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - Erika Hurtado
- Uveitis, Retina and Cornea Clinics, Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - Dana Faingold
- Ocular Pathology Laboratory, Department of Ophthalmology, McGill University, Montréal, Qué., Argentina
| | - Carmen Demetrio
- Uveitis, Retina and Cornea Clinics, Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - Ariel Schlaen
- Uveitis, Retina and Cornea Clinics, Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Zas
- Uveitis, Retina and Cornea Clinics, Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - Jorge Zarate
- Department of Pathology, University of Buenos Aires, Buenos Aires, Argentina
| | - Silvia Rosetti
- Microbiology and Pathology Laboratory, Fundación Oftalmológica Argentina, Buenos Aires, Argentina
| | - Andrea Paes de Lima
- Department of Pathology, University of Buenos Aires, Buenos Aires, Argentina
| | - Juan Oscar Croxatto
- Microbiology and Pathology Laboratory, Fundación Oftalmológica Argentina, Buenos Aires, Argentina
| | - Pablo Chiaradía
- Uveitis, Retina and Cornea Clinics, Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - Miguel N Burnier
- Ocular Pathology Laboratory, Department of Ophthalmology, McGill University, Montréal, Qué., Argentina
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Al Rubaie K, Al Dhahri H, Al Fawaz A, Hemachandran S, Mousa A, Mohamed AG, Al-Obeidan SA, Abu El-Asrar AM. Incidence and Risk Factors for Developing Glaucoma Among Patients with Uveitis in a University-based Tertiary Referral Center in Riyadh, Saudi Arabia. Ocul Immunol Inflamm 2015; 24:571-8. [DOI: 10.3109/09273948.2015.1047036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Clinical manifestation of Fuchs uveitis syndrome in childhood. Graefes Arch Clin Exp Ophthalmol 2015; 253:1169-74. [PMID: 25694152 DOI: 10.1007/s00417-015-2960-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The aim of this study was to describe clinical signs and complications of Fuchs uveitis syndrome (FUS) with onset in childhood. METHODS Ophthalmologic findings and complications in patients with FUS becoming manifest before the age of 16 years were analyzed in a retrospective study at a tertiary referral uveitis center. Inclusion criteria were the presence of pathognomonic FUS findings at any time point and exclusion of any systemic immune-mediated or infectious disease. RESULTS A total of 23 patients (male = 16, female = 7) with juvenile FUS (unilateral n = 20, bilateral n = 3 patients) were included in the study. Mean ages at uveitis and FUS diagnosis were 12.0 ± 4.2 and 22.7 ± 10.7 years, respectively. In six patients, inflammation was noted at age ≤ 7 years. The following inflammatory signs were observed in a total of 26 eyes: ≤ 1+ anterior chamber cell grade (n = 26), vitreous cells (n = 24), fine keratic precipitates (KPs; n = 23), stellate KPs (n = 11), mutton-fat KPs (n = 23), diffuse (n = 24) or inferior (n = 8) distribution of KPs, Koeppe nodules (n = 10), and iris heterochromia (n = 14). A representative subgroup of patients (n = 5) is shown who presented with non-specific clinical signs in the beginning and in whom typical FUS signs became manifest only at a later stage. Secondary complications such as cataract (n = 19), ocular hypertension (n = 3), or glaucomatous disc damage (n = 2) were found after a mean uveitis duration of 11.6, 19.5, and 20.3 years, respectively. CONCLUSION FUS may begin in early childhood, and the characteristic findings may not be present at onset of disease. The diagnosis is often delayed for years, occasionally with the consequence of overtreatment with anti-inflammatory drugs.
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Lee JA, Cho YK, La TY, Choi JA. Corneal Endothelial Cell Loss after Tube Shunt Surgery in Fuch's Heterochromic Iridocyclitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.4.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jin Ah Lee
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Yang Kyung Cho
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Tae Yoon La
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Jin A Choi
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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Aziz S, Arya B, Westcott M, Pavesio C. An Investigation of the Disc Hyperfluorescence in Fuchs Uveitis Syndrome Using Optical Coherence Tomography Imaging. Ocul Immunol Inflamm 2014; 23:152-6. [DOI: 10.3109/09273948.2014.890229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Bawazeer AM. Clinical characteristics of Fuchs’ Heterochromic Iridocyclitis in a tertiary medical center in Makkah region of Saudi Arabia: A retrospective study. J Taibah Univ Med Sci 2014. [DOI: 10.1016/j.jtumed.2013.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Tandon M, Malhotra PP, Gupta V, Gupta A, Sharma A. Spectrum of Fuchs uveitic syndrome in a North Indian population. Ocul Immunol Inflamm 2012; 20:429-33. [PMID: 23163642 DOI: 10.3109/09273948.2012.723113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To describe patients with Fuchs uveitis syndrome (FUS) in North India. DESIGN Retrospective case series. METHODS One hundred ninety-eight eyes of 183 patients with FUS were reviewed at the Post Graduate Institute of Medical Education and Research, Advanced Eye Centre, Department of Ophthalmology, between December 1996 and September 2011. Demographic profile, clinical findings at presentation, risk of new complications, and rate of decreased vision were the main outcome measures. RESULTS The mean age at presentation was 30.1 ± 9.4 years. Male-to-female ratio was 1.1:1. Fifteen patients (8.1%) had bilateral involvement. Clinical findings at presentation included diffuse keratic precipitates (92.4%), anterior chamber cells (54.5%), diffuse iris atrophy without hypochromia (29.3%), heterochromia (24.7%), iris nodules (16.1%), cataract/pseudophakia (79.3%), vitreous cells (61.1%), elevated intraocular pressure (13.6%), and chorioretinal scars (2%). On fluorescein angiography, hyperfluorescence of the optic disc was detected in 28 of 51 eyes (55%), peripheral vasculitis in 1 (2%) and both in 8 eyes (15.7%). OCT showed traction papillopathy in 6 of 34 eyes (17.6%). None of the eyes showed cystoid macular edema. CONCLUSION Heterochromia is seen only in 25% of patients with Fuchsheterochromic uveitis in brown irides. Diffuse stellate keratic precipitates, low cellular reaction, vitritis, vitreous opacities, diffuse iris stromal atrophy in the absence of posterior synechia, and macular edema are other parameters helpful in diagnosing FUS.
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Affiliation(s)
- Manjari Tandon
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Urbach-wiethe syndrome and the ophthalmologist: review of the literature and introduction of the first instance of bilateral uveitis. Case Rep Med 2012; 2012:281516. [PMID: 22899939 PMCID: PMC3415139 DOI: 10.1155/2012/281516] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 11/18/2022] Open
Abstract
Patients suffering from Urbach-Wiethe syndrome (UWS), also known as lipoid proteinosis or hyalinosis cutis et mucosae, may have an ophthalmologist involved in the diagnosis and management of their disease. Along with moniliform blepharosis as a pathognomonic feature of the disease, an ophthalmologist may encounter other manifestations of UWS in any part of the eye such as cornea; conjunctiva; sclera; trabecular meshwork; iris/pupil; lens and zonular fibers; retina; nasolacrimal duct. This paper provides a review on the pathogenesis and the diverse ocular manifestations seen in UWS patients. Uncommon complications are discussed in this paper (glaucoma; dry eye and epiphora; complications of lens, retina, cornea; iris/pupil and conjunctiva). Moreover, a 27-year-old male UWS patient is described with bilateral diffuse anterior stromal iris atrophy, diffuse keratic precipitates; posterior subcapsular cataract; 1 + vitreous cell in anterior vitreous examination. This case was thought to be the first instance of bilateral uveitis associated with UWS. Overall, ophthalmologists may encounter diverse ocular complications accompanying this syndrome. They should be familiar with well-established ophthalmologic manifestations leading them to cooperate with other specialists in diagnosis and management of the disease.
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Abstract
AIMS To assess the possible role of virus infection in patients with unexplained anterior uveitis (AU). METHODS Intraocular fluid and plasma samples of 30 HIV-negative AU patients who were unresponsive or poorly responsive to topical steroid therapy were analyzed for nucleic acid of cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella zoster virus (VZV) by real-time polymerase chain reaction (PCR) and for intraocular antibodies against these viruses by Goldmann-Witmer coefficient (GWC) analysis. Of these 30 cases, 21 were tested for rubella virus by GWC analysis, 16 of which also had PCR assessment of aqueous for rubella virus. RESULTS Viral uveitis determined by either real-time PCR and/or GWC was documented in 20 out of 30 patients (67%). Of 30 paired samples tested by both methods for HSV, CMV, and VZV, 15 showed positive results (CMV (10), HSV (4), and VZV (1)). Real-time PCR was positive in 8/15 (53%), whereas GWC was positive in 10/15 (67%). Out of 10 CMV-positive patients, four had endotheliitis, two had Posner-Schlossman syndrome, and one Fuchs heterochromic uveitis syndrome (FHUS). Five out of 21 (24%) samples tested by GWC for Rubella virus were positive, three of which exhibited clinical features of FHUS. CONCLUSIONS Our results indicate that CMV is a major cause of AU in Thailand and show that FHUS can be caused by both CMV and Rubella virus.
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Bouchenaki N, Herbort CP. Fuchs' Uveitis: Failure to Associate Vitritis and Disc Hyperfluorescence with the Disease is the Major Factor for Misdiagnosis and Diagnostic Delay. Middle East Afr J Ophthalmol 2011; 16:239-44. [PMID: 20404990 PMCID: PMC2855664 DOI: 10.4103/0974-9233.58424] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: Fuchs' uveitis is often diagnosed with substantial delay at the origin of deleterious consequences such as unnecessary treatment. The aim of the study was to analyse the type and frequency of posterior inflammatory and fluorescein angiographic signs in Fuchs' uveitis in conjunction with the other clinical signs and evaluate their respective importance in the diagnosis of the disease. In particular, diagnostic delay and erroneous diagnoses were investigated. Patients and Methods: Patients seen in our centers between 1995 and 2008 with the diagnosis of Fuchs' uveitis were analysed. The data collected included age, initial and final visual acuities, clinical findings at presentation, mean diagnostic delay, erroneous diagnoses, laser flare photometry values, fundus and fluorescein angiography manifestations and ocular complications. Results: One hundred and five patients were included. The mean age at diagnosis was 34 years. Twelve patients (11.4%) had bilateral involvement. The mean diagnostic delay was 3.04 ± 4.30 years. The most frequent clinical signs were vitreous infiltration (97.40%), typical Fuchs' keratic precipitates (94.90%), crystalline lens opacities or cataract (47%), heterochromia (42.60%), ocular hypertension or glaucoma (12.80%). The mean laser flare photometry value at presentation was 9.85 ± 6.28 ph/ms. Thirty-nine patients (37.14%) had undergone fluorescein angiography showing disc hyperfluorescence in 97.7% and peripheral retinal vascular leakage in 13.6%. Conclusions: Fuchs' uveitis is significantly underdiagnosed likely because vitreous involvement was previously described but not commonly recognized as an association with Fuchs' uveitis in the clinician's mind and therefore has often been given a different diagnostic label. Moreover, the very frequent inflammatory signs on fluorescein angiography such as disc hyperfluorescence and more rarely peripheral retinal vascular leakage, which has not been typically associated with Fuchs' uveitis, appear to represent an additional factor leading to misdiagnosis. Such clinical findings need to be publicised in order to reduce misdiagnosis, and diagnostic delay.
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Affiliation(s)
- Nadia Bouchenaki
- Inflammatory and Retinal Eye Diseases, Center for Ophthalmic Specialized Care (COS); Lausanne, Switzerland
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Faramarzi A, Soheilian M, Jabbarpoor Bonyadi MH, Yaseri M. Corneal astigmatism in unilateral Fuchs heterochromic iridocyclitis. Ocul Immunol Inflamm 2011; 19:151-5. [PMID: 21595529 DOI: 10.3109/09273948.2011.555054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To analyze the results of scanning slit topography in both eyes of patients with unilateral Fuchs heterochromic iridocyclitis (FHI). METHODS A noninterventional, case-controlled study was conducted with 30 patients with unilateral FHI. Corneal topographic parameters, obtained with the Orbscan II (Bausch & Lomb), were compared between the two eyes and analyzed statistically. The same number of age-matched normals was enrolled as a control group. RESULTS Thirty patients were enrolled in this study. The mean age was 33.3 years ± 10.6 (SD). The mean Sim K astigmatism was 1.65 ± 1.27 diopter in the FHI eyes and 0.88 ± 0.52 diopter in the normal eyes (p = .001). CONCLUSION Corneal astigmatism is a common finding in patients with FHI and disparity of corneal astigmatism between the two eyes can be considered a sign of the unilateral form of this disease.
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Affiliation(s)
- Amir Faramarzi
- Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shaheed Beheshti Medical University, Tehran, Iran.
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Fuchs' Heterochromic Iridocyclitis. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tugal-Tutkun I, Güney-Tefekli E, Kamaci-Duman F, Corum I. A cross-sectional and longitudinal study of Fuchs uveitis syndrome in Turkish patients. Am J Ophthalmol 2009; 148:510-515.e1. [PMID: 19477709 DOI: 10.1016/j.ajo.2009.04.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/08/2009] [Accepted: 04/08/2009] [Indexed: 12/17/2022]
Abstract
PURPOSE To describe Turkish patients with Fuchs uveitis syndrome (FUS). DESIGN Retrospective observational case series. METHODS We reviewed the records of 172 patients with FUS seen at Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, between January 1995 and July 2007. The main outcome measures were demographic features, clinical findings at presentation, laser flare photometry values, risk of new complications, and rate of decreased vision. RESULTS The mean age was 29.5 + 8.4 years. Male-to-female ratio was 1:1.3. Nine patients (5.2%) had bilateral involvement. The diagnosis of FUS had been made in only 10 of 115 (8.7%) referrals. Clinical findings at presentation included diffuse keratic precipitates (medium-sized round in 74.6%, fine-stellate in 22.1%), anterior chamber cells (74%), diffuse iris atrophy without hypochromia (48.6%), heterochromia (39.8%), iris nodules (32%), cataract/pseudophakia (69.1%), vitreous cells (71.8%), elevated intraocular pressure (12.7%), and chorioretinal scars (7.7%). The mean flare was 8.4 + 3.1 photons/ms in eyes with FUS and 3.7 + 0.8 photons/ms in the fellow eyes (P < .001). Hyperfluorescence of the optic disc was the only fluorescein angiographic finding, detected in 7 of 32 eyes (22%). Kaplan-Meier analysis estimated risks of cataract formation and intraocular pressure elevation as 42% and 17%, respectively, at 4 years. The rate of decreased visual acuity by 2 lines or more was 0.06/eye-year. CONCLUSIONS The referral patterns suggest that FUS is frequently misdiagnosed in Turkish patients. Diffuse medium-sized round keratic precipitates, low flare readings, iris stromal atrophy without hypochromia, and vitreous opacities in the absence of macular edema are more often helpful clues to the diagnosis than heterochromia.
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