Fuchs Heterochromic Iridocyclitis Research Articles

Fuchs heterochromic iridocyclitis-associated glaucoma: a retrospective comparison of primary Ahmed glaucoma valve implantation and trabeculectomy with mitomycin C

Background: The aim of this study was to compare the safety and efficacy of primary trabeculectomy with mitomycin C and Ahmed glaucoma valve (AGV) implantation in patients with Fuchs heterochromic iridocyclitis (FHIC)-related glaucoma, a rare complication of an uncommon form of uveitis. Methods: In this retrospective comparative case series, 26 FHIC-associated glaucoma patients received trabeculectomy (n=12) or an AGV (n=14). Primary outcome measures were surgical success, defined as intraocular pressure (IOP) ≤21 mmHg, decreasing ≥20% from baseline, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity (BCVA), and IOP. Results: The follow-up was 34.0±17.7 months in patients that received trabeculectomy and 33.4±18.6 months in AGV (P= 0.837). The cumulative probability of success rate was 41.7% for trabeculectomy and 85.7% for AGV, with no significant difference in complications (P>0.05). The IOP in patients that received trabeculectomy dropped from 23.4±3.3 mmHg to 21.6±5.2 mmHg at the final visit (P= 0.041). In patients that received AGV, the IOP decreased from 24±7.8 to 17.1±2.6 mmHg (P= 0.003). The number of glaucoma medications at baseline were 3.3±0.5 in those that received trabeculectomy and 3±0.6 in those that received AGV (P=0.233), and decreased to 2.4±1.0 (P=0.008) and 1.7±0.6 (P=0.002), respectively. BCVA was equal in both groups and did not change (P>0.05). Conclusion: Primary AGV had a higher success rate than trabeculectomy, with patients also needing fewer medications for the management of FHIC-associated glaucoma.

Risk of Complications of Vitrectomy for Floaters Based on Attached or Detached Status of Posterior Hyaloid Face

Purpose: To ascertain whether posterior hyaloid face (PHF) status (attached vs detached) affects the risk of intraoperative retinal breaks and number of operations in patients undergoing vitrectomy for floaters. Methods: Consecutive, comparative single-surgeon case series. All patients undergoing vitrectomy for visually disabling floaters between July 2003 and June 2016 were included in this study. Data were collected prospectively into a vitreoretinal database and reviewed retrospectively for the purpose of the study.The following data were collected on each patient: age in years, sex, axial length (mm), presence of myopia, pre- and postoperative visual acuity in logarithm of the minimal angle of resolution. The status of the PHF was ascertained using preoperative clinical and optical coherence tomography assessment that was confirmed intraoperatively. The presence or absence of a retinal break was considered the primary outcome measure. Significant visual loss (reduction in ≥2 log units visual acuity), number of operations, and time from surgery to discharge were considered the secondary outcomes. Sequential multiple logistic and Cox regression analyses were conducted. Results: Data were collected from 97 patients (55 males and 42 females). Indications for surgery were Fuchs heterochromic cyclitis (9 patients), asteroid hyalosis (12 patients), and vitreous syneresis (76 patients). Twenty-one patients were pseudophakic on presentation, while 76 underwent combined phacovitrectomy. Vitreous status was significantly associated with retinal breaks ( P = .010). Controlling for other parameters, the odds of a retinal break in patients with PHF attached were about 5.5 times those in patients with PHF detached (95% confidence interval [CI], 1.52 -20.4). Number of operations was also significantly associated with this outcome ( P = .027); the odds of a retinal break increase by 6.28 times (95% CI, 1.23 -32.1). A substantive difference in the proportion of patients with retinal breaks was observed between the 2 groups, with a 50% prevalence rate in the attached group and a 9.1% prevalence rate in the detached group. Vitreous status was not associated with either secondary outcome measures. Number of operations was also significantly associated with time to discharge ( P = .008; hazard ratio, 2.78; 95% CI, 1.30 -5.91) in a multiple Cox model. Hence an increasing number of operations is associated with longer time to discharge. Conclusion: The analysis has found evidence to link vitreous status with the primary outcome of the presence of a retinal break. Particular care should be taken in, cases with vitreous attached status, to prevent missed breaks and subsequent rhegmatogenous retinal detachment.

Topical Ganciclovir in Cytomegalovirus Anterior Uveitis.

To study the effects of topical ganciclovir 0.15% gel on cytomegalovirus (CMV) anterior uveitis in a tertiary uveitis referral center in Brussels, Belgium. A retrospective study of patients with a clinical diagnosis of CMV anterior uveitis/endotheliitis demonstrated by a positive polymerase chain reaction and/or Goldmann-Witmer coefficient (GWc). We report a series of 15 patients presenting clinical characteristics of CMV anterior uveitis. Patients had a pretreatment follow-up of 13.00 ± 12.78 months and a posttreatment follow-up of 42.64 ± 31.23 months. The 14 non-Asian patients (93.3%) had clinical characteristics of Posner-Schlossman syndrome, and the only Asian patient (6.7%) had keratic precipitates like Fuchs heterochromic iridocyclitis. At presentation, uveitis was unilateral in all patients, visual acuity (VA) was 0.91 ± 0.25, and all patients had an increased intraocular pressure (IOP), with a mean IOP of 41.40 ± 10.35 mmHg. At the end of the follow-up, 5 patients (33.3%) had glaucoma, 2 needed glaucoma surgery (13.3%). The mean final VA was 0.93 ± 0.11; 13 patients (86.5%) reached a final VA of 0.7 to 1. Patients had a significantly lower number of recurrences/year posttreatment (0.76 ± 0.57) than in the pretreatment period (3.76 ± 2.44) (P = 0.001). The mean time to recurrence increased from 4.03 months before treatment to 12.58 months after treatment (P = 0.003). Our results suggest that patients treated with 0.15% topical ganciclovir have a decreased frequency of CMV anterior uveitis recurrences, most preserve a relatively good central vision over time. However, glaucoma is a frequent and severe complication.

Niemann–Pick Disease Type C Associated with Fuchs Heterochromic Iridocyclitis

In this study, we report a 26-year-old female case of Niemann–Pick disease type C in association with Fuchs heterochromic iridocyclitis who was admitted with the complaint of ocular pain and redness following trauma. She had mild inflammatory signs and also vertical ocular motility limitations.

Outcomes of phacoemulsification in patients with uveitis at a tertiary center in São Paulo, Brazil: a review of cases from 2007 to 2012.

To evaluate the outcomes of phacoemulsification with intraocular lens (IOL) implantation in eyes with uveitis. Consecutive patients with uveitis and cataracts who had phacoemulsification and acrylic IOL implantation during 2007-2012 were evaluated for visual outcomes, etiology, and complications. Inflammation was controlled for at least 3 months before surgery, and oral prednisone (0.5 mg/kg/day) was administered to patients with non-infectious uveitis. This study investigated 45 eyes in 38 patients with a mean age of 52 ± 12.5 years. The most common etiologies among non-infectious causes (n=32; 73.3%) were Vogt-Koyanagi-Harada disease (n=9), Fuchs heterochromic iridocyclitis (n=4), and sympathetic ophthalmia (n=3). Four cases were idiopathic. Among infectious cases (n=13; 28.9%), the most common causes were toxoplasmosis (n=6) and presumed ocular tuberculosis (n=4). An acrylic IOL was implanted in-the-bag in all cases. After 1-year follow-up, an improvement in visual acuity of two or more lines was observed in 38 eyes (84.4%), and 28 eyes (62.2%) achieved a postoperative visual acuity of ≥0.5. Posterior capsule opacification was observed in 10 eyes (22.2%). Persistent postoperative inflammation (of >6 months) was observed in seven eyes (15.5%) and recurrence occurred in four eyes (8.8%). IOL was explanted in one eye. Intraocular hypertension was observed in six eyes (13.3%). Phacoemulsification with IOL implantation improved vision in most patients with coexisting cataracts and uveitis. Good preoperative and postoperative control of inflammation plays an important role in achieving favorable visual outcomes. Furthermore, the final visual outcome depends on the posterior segment status.

Risk Factors for Glaucoma in a Cohort of Patients with Fuchs Heterochromic Iridocyclitis

ABSTRACTPurpose: To describe the incidence and risk factors for ocular hypertension and/or glaucoma in patients with Fuchs heterochromic iridocyclitis (FHC).Methods: Retrospective analysis of 88 patients with FHC. Kaplan–Meier curves estimated the time to develop cataract and ocular hypertension/glaucoma. Possible prognostic factors were investigated in univariate Kaplan–Meier analyses using the Mantel–Cox logrank test.Results: At presentation with FHC, 52% of patients had a cataract and 26% of patients had ocular hypertension/glaucoma. The estimated percentage of patients with a cataract or ocular hypertension/glaucoma by 4 years after presentation was 71% (CI: 58–81%) and 39% (CI: 28–51%), respectively. Patients aged ≥50 years had significantly greater risk of developing glaucoma (p = 0.0065). After adjusting for age-group, having a cataract at presentation was associated with increased risk of glaucoma (p = 0.032).Conclusions: Risk factors for development of ocular hypertension/glaucoma were increasing patient age and having a cataract at presentation with FHC.

Uveitis in São Paulo, Brazil: 1053 New Patients in 15 Months

ABSTRACTPurpose: To describe the clinical profile of uveitis and analyze changes over a 34-year period in the frequency of different entities and demographics, anatomic data, diagnoses, and systemic associations in São Paulo, Brazil.Methods: A total of 1053 consecutive patients who presented for the first time at the outpatient uveitis clinic were analyzed in a prospective, observational study, conducted between July 2012 and September 2013. Age, gender, clinical characteristics, visual acuity, and clinical and etiologic diagnoses in patients with and without human immunodeficiency virus (HIV) were studied.Results: Mean age was 39.8 ± 17.8 years (56.8% female), with most between 41 and 64 years (41.79%); 10.9% of the patients were HIV-positive and 8.1% were legally blind (best-corrected visual acuity (BCVA): ≤ 20/400) at the first evaluation. The posterior, bilateral, and chronic forms of uveitis occurred most frequently and toxoplasmosis was the main cause (24.03%) but was less frequent than in 1980; the same was true for Fuchs heterochromic iridocyclitis. Syphilis, tuberculosis, Vogt–Koyanagi–Harada disease, and juvenile idiopathic arthritis-related uveitis had increased incidence rates.Conclusions: The current results can help determine the present epidemiology of uveitis and its changes over time in Brazil and increases essential information about the disease. Many uveitic entities are curable and visual damage can be prevented or limited if treated early and appropriately.

Fuchs' Heterochromic Iridocyclitis in an Italian Tertiary Referral Centre: Epidemiology, Clinical Features, and Prognosis.

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.

Phacoemulsification Versus Manual Small Incision Cataract Surgery in Patients With Fuchs Heterochromic Iridocyclitis.

To compare the safety and efficacy of phacoemulsification and manual small incision cataract surgery (SICS) to treat cataract in patients with Fuchs heterochromic iridocyclitis (FHI). A randomized, double-masked, prospective, multicenter study. Consecutive patients with cataract after FHI were randomly assigned to have phacoemulsification or manual SICS by 1 of 2 surgeons experienced in both techniques. Complications (intraoperatively and postoperatively), operative time, visual acuities, endothelial cell counts, and surgically induced astigmatism were compared. At 6 months, 65 (92.8%) patients in the phacoemulsification group and 70 (92.1%) in the manual SICS group had a corrected distance visual acuity of 20/63 or better (P = 0.974). Surgical time was significantly shorter in the SICS group (11.2 ± 2.4 minutes) than in the phacoemulsification group (14.2 ± 3.1 minutes) (P < 0.001). The mean surgically induced astigmatism was 0.8 ± 0.2 diopters (D) in the phacoemulsification group and 1.16 ± 0.2 D in the SICS group (P < 0.001). Endothelial cell counts at 1 week and at 6 months did not differ significantly in the phacoemulsification and SICS groups (t test; P = 0.133 and P = 0.032, respectively). Intraoperatively, 2 (3%) eyes randomized to receive phacoemulsification and 4 (5.3%) eyes randomized to receive SICS had posterior capsular rent (P = 0.465). Both techniques achieved good visual outcomes with low rates of complications. Manual SICS may be a viable alternative for cataract management in patients with FHI in settings with limited access to phacoemulsification.

Rheumatology-Ophthalmology Collaborative Uveitis Units may Improve the Diagnostic and Therapeutic Approach of this Pathology: Experience from a Uveitis Unit in a Secondary Spanish Hospital

Purpose: The aim of this study is analyze the Etiology of the Uveitis diagnosed in the first three years of a Uveitis unit in a small hospital and share the experience and organization of a collaborative Rheumatology-Ophthalmology Uveitis Unit. Methods: This study includes 136 patients with Uveitis. Results: The most common form of Uveitis was anterior Uveitis (67.2%) and the most common diagnoses were Ankylosing spondylitis (17.8%), Herpes (14.3%), HLA-B27+ (9.5%), Fuchs Heterochromic Iridocyclitis (3.5%). Posterior Uveitis were 16.8% and the most common diagnoses were toxoplasmosis (42.9%), Serpiginous choroidopathy (23.8%), Tuberculosis (4.8%) and Vogt Koyanagi Harada disease (4.8%). Panuveitis was diagnosed in 8.8% of the cases and the most frequent causes were Behcet's disease (18.8%), Endophthalmitis (9%), and Toxoplasmosis (9%). Intermediate Uveitis with 7.2% of the diagnoses, the most frequent were Sarcoidosis (11%), syphilis (11%), and multiple sclerosis (11%). Conclusion: This secondary center based study shows the difference in type of Uveitis and etiology in a secondary hospital from a tertiary one.

Patterns of uveitis at the Apex Institute for Eye Care in India: Results from a prospectively enrolled patient data base (2011-2013).

The purpose of the study was to identify the clinical and etiological profile of uveitis at the apex institute for eye care in India. This is a prospective, prevalence study. 980 consecutive patients with uveitis referred to uvea clinic, Dr. RP Centre for Ophthalmic Sciences (Ophthalmology division, All India Institute of Medical Sciences). Demographic data of each patient were noted and a thorough ocular examination including slit lamp examination and dilated fundus evaluation was carried out. OCT and fluorescein angiography were undertaken whenever indicated. Uveitis was classified based on the anatomic location of inflammation (IUSG classification). Relevant serological and radiological investigations were obtained based on systemic symptomatology, and if the uveitis was recurrent (even in the absence of systemic symptoms). The presence of a systemic disease was confirmed by obtaining an internist consultation. The main outcome measures include pattern of uveitis according to anatomical classification and the etiology. Out of 980 patients with uveitis, 413 (42.14%) patients had anterior uveitis, 131 (13.36%) had intermediate uveitis, 165 (16.83%) had posterior uveitis, 91 (9.2%) had panuveitis, 47 (4.7%) had retinal vasculitis, 22 (2.24%) had scleritis, 17 (1.7%) had masquerade syndromes, 8 (0.8%) had keratouveitis, 22 (2.24%) had sclerokeratouveitis, 19 (1.9%) had endophthalmitis and 45 (4.5%) had other causes of inflammation including trauma and intraocular surgery. Out of all uveitic patients definite etiological correlation could be made out in 225 (23%) patients; thus 77% were categorised as idiopathic. Only 9% of all patients were found to have uveitis with an infectious etiology. Amongst infectious causes of uveitis tuberculosis was the leading cause, accounting for sixty percent of all infectious uveitis (approximately 5% of overall uveitis). Non-infectious uveitis etiology accounted for more than 90% of all cases with ankylosing spondylitis being the most common followed by sarcoidosis and juvenile rheumatoid arthritis. Amongst known uveitic syndromes serpiginous like choroidopathy was the most common and was followed by acute posterior placoid pigmented epitheliopathy and Fuch's heterochromic iridocyclitis. Infection, including tuberculosis, is an infrequent cause of uveitis in the study population. Multicentric, collaborative efforts are required to improve levels of clinical evidence and evolve consensus in establishing stringent guidelines for labelling uveitis as being of infectious etiology.

Corneal Endothelial Cell Loss after Tube Shunt Surgery in Fuch's Heterochromic Iridocyclitis

Purpose: To report a case of corneal failure after implantation of the Ahmed glaucoma valve occurring in a patient diagnosed with Fuchs’ heterochromic iridocyclitis. Case summary: A 53-year-old male who complained of ocular pain and suddenly decreased visual acuity in his right eye visited our clinic. His visual acuity was 0.15 and intraocular pressure (IOP) was 55 mm Hg. The slit-lamp examination revealed edematous cornea, fine round or stellate keratic precipitates connected with fine filaments on the endothelium and depigmentation of the iris. The corneal endothelial cell density was 2,958 cells/mm. There was no specific finding in his left eye. The IOP did not improve with medical treatment, therefore, an Ahmed glaucoma valve was implanted in his right eye. At every follow-up exam the tube was well positioned and the IOP was maintained between 8 and 13 mm Hg. Eight months postoperatively, the patient complained of decreased visual acuity and the cell density was decreased to 1,408 cells/mm. Posterior subcapsular cataract opacity was observed as well as progression of depigmentation and distortion of the iris. Seventeen months after the surgery, the cell density was 700 cells/mm. On follow-up examination, his visual acuity was decreased to FC10 cm with the cataract progressing, therefore cataract surgery was performed. One month postoperatively, his vision improved to 0.1. However, the visual acuity deteriorated due to progression of the corneal edema and penetrating keratoplasty was performed. Conclusions: Aggravation of the corneal complication after Ahmed glaucoma valve implantation should be considered in patients with Fuchs’ heterochromic iridocyclitis-induced glaucoma. J Korean Ophthalmol Soc 2015;56(4):643-649

Fuch's Heterochromic Iridocyclitis in Iran: Is the Disease Going to Fade Away?

Fuch's Heterochromic Iridocyclitis in Iran: Is the Disease Going to Fade Away?

Small-incision cataract surgery in patients with Fuch's heterochromic iridocyclitis.

Fuch's heterochromic iridocyclitis (FHI) is often complicated by cataract formation. To assess the results of small-incision cataract surgery (SICS) in FHI and to study the effect of preoperative factors on postoperative vision. Sixty-three eyes of 59 patients with Fuchs heterochromic iridocyclitis who had SICS with in-the-bag implantation of intraocular lens (IOL) were evaluated retrospectively; and the primary and secondary outcome measures evaluated were the postoperative vision and complication rate. The mean age was 39.22±4.95 years. The mean pre-operative vision was 0.75±0.24 Log MAR units. The mean final vision was 0.27±0.10 Log MAR units (P=less than 0.001). At the final follow-up, 84.1% of the patients had a final Snellen's vision of 6/12 or better. The mean follow-up period was 12.06±2.06 months. The causes of corrected distance visual acuity (CDVA) worse than 6/60 were vitreous opacities, posterior keratic precipitates (KPs), glaucoma, persistent uveitis and cystoid macular edema (CME). Preoperative factors like iris atrophy (P=0.973), heterochromia (P=0.10) and vessels in angle (P=0.074) did not have a significant effect on the final vision. On the contrary, vitreous opacities (P=0.002) and posterior KPs (P=0.009) had a significant effect on the final visual outcome. SICS with in-the-bag implantation of IOL in patients with Fuch's heterochromic iridocyclitis resulted in good visual outcomes. SICS in complicated cataracts can be performed in rural settings and eye camps with minimal instrumentation, obviating the need for referral to tertiary care centers. Pre-operative factors like vitreous opacities and posterior KPs have a significant effect on the final vision.

Characteristics of Cytomegalovirus Uveitis in Immunocompetent Patients

Purpose: To present the clinical characteristics of patients with anterior uveitis who had evidence of cytomegalovirus (CMV) infection on polymerase chain reaction PCR-based assays for viral DNA in aqueous samples.Methods: This was a retrospective observational case series of 16 patients with CMV infection on qualitative polymerase chain reaction PCR-based assays for viral DNA in aqueous samples. Case records of 16 patients were reviewed and relevant clinical information was collected using a standardized data sheet.Results: There were 10 male and 6 female patients, with 16 eyes included. The median age at the first attack was 52 years (range 27–77 years). Thirteen patients (81.3%) presented with an initial BCVA of 20/40 or better. Eleven eyes (68.8%) had anterior chamber inflammation of 1+ cells or less. Eight eyes (50.0%) had concomitant sectoral iris atrophy, while 2 eyes were noted to have heterochromic irides. Eleven patients (68.8%) presented with an elevated intraocular pressure. Seven patients (43.8%) had clinical features that led to a presumptive diagnosis of Posner-Schlossman syndrome, while 3 patients (18.8%) were initially diagnosed with Fuchs heterochromic iridocyclitis. Six patients were initially treated for uveitic glaucoma or anterior uveitis of unknown cause.Conclusions: There is a spectrum of clinical manifestations of CMV anterior uveitis. A high index of suspicion of a possible viral etiology, especially CMV, and subsequent accurate identification of the virus involved are fundamental to the overall therapeutic approach.

Outcomes of Cataract Surgery in Patients With Uveitis: A Systematic Review and Meta-analysis

To critically assess the evidence base regarding outcomes following cataract surgery in uveitic cases. Systematic evidence-based review and meta-analysis. A comprehensive search query was performed on MEDLINE, EMBASE, CINHAL, and CENTRAL databases. Relevant publications were identified by reviewing query results and reference list searches. A total of 89 articles met eligibility criteria. Among uveitic eyes with quiet or mostly quiet uveitis before cataract surgery, 20/40 visual acuity or better (≥20/40) was achieved in 68% following phacoemulsification, 72% following extracapsular cataract extraction, and 40% following pars plana lensectomy. More eyes undergoing cataract surgery with intraocular lens (IOL) implantation than eyes left aphakic achieved ≥20/40 postoperatively (71% vs 52%). Eyes receiving acrylic IOLs or heparin-surface-modified (HSM) polymethylmethacrylate had better visual outcomes than those receiving non-HSM polymethylmethacrylate or silicone IOLs. Active uveitis at the time of cataract surgery was associated with worse visual outcomes. Compared with other uveitis cases, the proportion achieving 20/40 or better post cataract surgery was better for Fuchs heterochromic cyclitis cases and worse for uveitis related to Behçet disease, Vogt-Koyanagi-Harada disease, or sympathetic ophthalmia, and also posterior uveitis in general. Cataract surgery in eyes with uveitis resulted in normal range levels of visual acuity in most cases. The review suggests that preoperative control of uveitis, use of an acrylic or HSM IOL, and a diagnosis of Fuchs heterochromic cyclitis were associated with better outcomes. Posterior-involving uveitides tended to do worse, likely because of vision-limiting complications of uveitis. Average results may not be applicable to specific clinical scenarios.

Posner-Schlossman syndrome associated with cytomegalovirus infection: a case series from a non-endemic area

To describe clinical features, laboratory findings, course of disease and response to treatment in four patients diagnosed with Posner-Schlossman syndrome (PSS) who had evidence of cytomegalovirus (CMV) infection in their aqueous humour. Review of four consecutive CMV positive PSS patients seen at the Noor Eye Hospital. CMV was diagnosed by polymerase chain reaction analysis of their aqueous. All four patients were immunocompetent males. Mean age of onset was 44.5 years (range, 32-63 years). Maximum intraocular pressure ranged from 36 to 48 mmHg. Mild to moderate anterior chamber reaction, lack of posterior synechiae and posterior segment involvement were consistent features in all the patients. Three patients had diffuse iris atrophy. One patient with a stromal immune ring at presentation developed features of Fuch's heterochromic iridocyclitis (FHI) later in his course of disease. Heterochromia was also observed in another patient. All patients had a positive titre of IgG but not IgM against CMV, and none had concomitant CMV antigenemia. One patient who had recalcitrant uveitis and glaucoma and another patient who was suffering from frequent attacks and showed evidence of significant endothelial cell loss received anti-CMV therapy. In our population, PSS may be associated with CMV infection and may develop clinical features similar to FHI. Anti-CMV therapy should be reserved for cases with recalcitrant course or secondary complications.

Implantation of iris-claw Artisan intraocular lens for aphakia in Fuchs′ heterochromic iridocyclitis

Implantation of iris-claw Artisan intraocular lens (IOL) is a surgical option for correction of aphakia; however, these IOLs have not been used in eyes with uveitis including Fuchs’ heterochromic iridocyclitis (FHI) due to possible risk of severe postoperative intraocular inflammation. In the case reported here, we secondarily implanted an Artisan IOL in a 28-year-old man with FHI who had aphakia with no capsular support due to a previous complicated cataract surgery. Enclavation was easily performed and no intraoperative complication was noted. Postoperative course was uneventful with no significant anterior chamber inflammation during 12 months of follow-up. Although there were few deposits on the IOL surface, the patient achieved a best-corrected visual acuity of 20/20 without developing glaucoma or other complications. Therefore, Artisan IOL may be considered for correction of aphakia in patients with FHI. However, studies on large number of patients are required to evaluate safety of the procedure.

Cataractogenesis and surgical outcome in patients with uveitis

AbstractPurpose To compare the risk of cataract development, the surgical management and the prevalence of complications in 2 groups of patients with uveitis treated in 2000 and 2010.Methods Retrospective study of patients with uveitis referred to an academic centre for the diagnosis and treatment of uveitis. An extensive work‐up based on clinical presentation was performed when necessary. Corticosteroids were the mainstay of therapy in 2000 but new immunosuppressive molecules and biologics were used in 2010. Two groups were analyzed based on the year of cataract surgery (group A:2000 and group B:2010). Demographic factors, delay between onset of uveitis and cataract surgery, improvement of visual acuity and major complications were studied. Phacoemulsification and intraocular lens implantation were performed in all cases respecting a 3‐month quiescence of uveitis and an efficient perioperative anti‐inflammatory regimen.Results The study included 125 eyes of 107 patients. 59 eyes (48 patients: F/M: 1.29) were operated in 2000 (group A) and 66 (59 patients: F/M: 1.5) in 2010 (group B). An associated condition was determined in 81 cases (75.5 %): mainly herpetic uveitis (9), sarcoidosis (7), tuberculosis (10), birdshot chorioretinopathy (7), Behcet's disease (8), spondyloarthropathy (10), Vogt‐Koyanagi‐Harada disease (5), Fuchs heterochromic iridocyclitis (8). Delay between onset of uveitis and surgery was 58.86 months in group A and 111.68 months in group B (p&lt;0.01). Mean BCVA postoperatively improved from logMAR 0.927 and 0.731 to 0.439 and 0,242 in groups A and B, respectively.Conclusion During a 10‐year period, management of uveitis has dramatically improved. Better management of ocular inflammation based on biologic agents may delay cataractogenesis in active patients.

Pharmacological pseudo-Fuchs

Case reportA case of unilateral iridis hyperpigmentation and uveitis due to travoprost is presented. DiscussionAnterior uveitis is a rare side-effect of travoprost. In this case, heterochromic iris was also presented, which led us to the wrong diagnosis of a Fuchs heterochromic iridocyclitis. The differential diagnosis along with the associated literature is discussed.