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.
Highlights
Ernst Fuchs was the first in 1906 to report both the clinical and pathologic features of a consistent number of patients with a chronic low grade anterior chamber inflammation, heterochromia, and cataract [1]
Inclusion criteria was a diagnosis of Fuchs’ Heterochromic Iridocyclitis (FHI), which has been made upon several of the following clinical features: (i) small to medium-sized keratic precipitates involving the whole endothelial surface; (ii) a chronic inflammation in anterior chamber, usually ≤2+ according to SUN criteria [21]; (iii) diffuse iris stromal atrophy with or without heterochromia; (iv) lack of posterior synechiae unless there was a history of ocular surgery; (v) absence of snowbanks or choroidal/retinal infiltrates despite the presence of vitreous cells
The lower prevalence of heterocromia found in tertiary referral center for uveitis might be due to the possibility that only the most difficult-to-diagnose cases are sent for referral, while the true prevalence of heterochromia in general FHI population might be higher
Summary
Ernst Fuchs was the first in 1906 to report both the clinical and pathologic features of a consistent number of patients with a chronic low grade anterior chamber inflammation, heterochromia, and cataract [1]. Nowadays FHI is one of the most common forms of anterior uveitis, accounting for up to 8% of endogenous uveitis seen in referral center [2,3,4] Unilateral, it is characterized by the presence of diffusely distributed small, white, stellate, or rounded keratic precipitates, low grade inflammation in anterior chamber, absence of posterior synechiae, diffuse iris stroma atrophy with or without heterochromia, and variable vitreous inflammation [1, 4,5,6,7,8,9,10,11]. The visual prognosis of patients who undergo cataract surgery with intraocular lens implantation is usually good, with complete visual function recovery [18,19,20]
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