Fuchs Heterochromic Iridocyclitis Research Articles

Phacoemulsification with intraocular lens implantation in patients with anterior uveitis

To assess the results of phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation in patients with cataract secondary to anterior uveitis. Department of Ophthalmology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey. Case series. Consecutive patients with anterior uveitis and cataract were prospectively studied for outcomes after phacoemulsification and PC IOL implantation. Fifty-five eyes (48 patients; mean age 44.9 years ± 15.6 [SD]) were included. Patients were followed for 6 months. The etiology of uveitis was presumed idiopathic anterior uveitis (n = 22), herpes simplex virus-associated anterior uveitis (n = 10), Fuchs heterochromic iridocyclitis (n = 10), and anterior uveitis associated with collagen vascular disease (n = 13). Preoperative complications secondary to uveitis included posterior synechiae (12 eyes), glaucoma (26 eyes), and sequelae of cystoid macular edema (CME) (21 eyes). At the final visit, the corrected distance visual acuity (CDVA) was 20/40 or better in 52 eyes (94.5%) and 20/20 in 33 eyes (60.0%). The CDVA was worse than 20/40 in 3 eyes because of preoperative anterior and posterior segment abnormalities. Postoperative complications were CME, recurrent uveitis, and posterior capsule opacity in 7 eyes (12.7%) each; fibrinous anterior chamber reaction in 6 eyes (10.9%); raised intraocular pressure in 4 eyes; peripheral anterior synechiae in 1 eye (1.8%); and hypotony in 1 eye (1.8%). Patients with a history of anterior uveitis and cataract having phacoemulsification with PC IOL implantation had excellent visual results with a relatively low complication rate. No author has a financial or proprietary interest in any material or method mentioned.

Trends in Patterns of Anterior Uveitis in a Tertiary Institution in Singapore

Purpose: To report the trends in etiology of patients with anterior uveitis (AU) in Singapore over 6 years.Methods: A retrospective review of the clinical records of all new patients who presented with anterior uveitis to the uveitis subspecialty clinic from 2005 to 2010 at Tan Tock Seng Hospital, Singapore.Results: There were 552 new cases of AU. This comprised 59.5% of a total of 928 new patients diagnosed with uveitis from 2005 to 2010. The mean age was 48.0 ± 17.2 years. There was a male predominance (62.5%), with a male:female ratio of 1.7:1. The majority were of Chinese ethnicity (69%), followed by Malays (13.2%). Most cases were unilateral (79.5%) and idiopathic (50.4%). Common etiological causes included Fuchs heterochromic iridocyclitis (FHI) (5.6%), ankylosing spondylitis (AS)-related AU (5.1%), herpes simplex virus (HSV) (4.7%), and herpes zoster virus (HZV) (4.5%). There were increasing trends in AS-related AU from 3.2% in 2008 to 6.5% in 2010, and psoriasis-associated AU from 1.7% in 2005 to 4.0% in 2008. There were decreasing trends in the incidence of FHI from 10.6% in 2006 to 4.7% in 2009. No change in incidence of viral etiologies was noted, but cytomegalovirus-related immune-recovery uveitis (IRU) comprised 7.4%. IRU showed an increasing trend from 1.7% in 2005 to 11.9% in 2007, then decreased to 3.3% in 2010. Using the Pearson chi-square test, there was no statistically significant association between ethnicities (Chinese, Malay, Indian) comparing infectious and noninfectious cases (p = 0.788), idiopathic and nonidiopathic cases (p = 0.170), or between the various etiologies of uveitis (p = 0.168).Conclusions: AU was the predominant form of uveitis seen at our centers. Infectious etiologies (18.5%) are the most common among nonidiopathic cases, with herpes viruses (9.2%) being most prevalent. Despite increased use of polymerase chain reaction (PCR) in the detection of microbial and viral DNA, there was no overall increase in detection of infectious causes for uveitis. The changes in CMV-related immune recovery uveitis from 2005 to 2010 could reflect a change in HIV management in Singapore.

Polymorphisms of TNFAIP3 Gene in a Chinese Han Population with Fuchs Heterochromic Iridocyclitis

ABSTRACTPurpose: This study was performed to evaluate the potential association of the tumor necrosis factor alpha inducible protein 3gene (TNFAIP3) polymorphisms with Fuchs’ heterochromic iridocyclitis (Fuchs’ Syndrome) in a Chinese Han population.Methods: Five single-nucleotide polymorphisms (SNPs), rs10499194, rs610604, rs7753873, rs5029928 and rs9494885 of TNFAIP3 were genotyped in 225 Fuchs’ syndrome patients and 651 healthy controls using a PCR-restriction fragment length polymorphism assay. All control subjects were matched ethnically and geographically with the patients. Genotype counts in patients and controls were analyzed by the χ2 test.Results: All genotypic and allelic frequencies of the tested TNFAIP3 polymorphisms were in Hardy–Weinberg equilibrium. The genotypic and allelic frequencies of rs10499194, rs610604, rs7753873, rs5029928 and rs9494885 of TNFAIP3 were not different between patients with Fuchs’ syndrome and controls.Conclusions: Our results suggest that rs10499194, rs610604, rs7753873, rs5029928 and rs9494885 of TNFAIP3 are not associated with Fuchs’ syndrome in a Chinese Han population.

Associations of Fuchs heterochromic iridocyclitis in a South Indian patient population

BackgroundThe purpose of this study is to look for any possible associations in 58 consecutive cases of Fuchs heterochromic iridocyclitis (FHI) in a South Indian patient population. Fifty-eight consecutive cases (59 eyes) of FHI underwent a detailed ocular and systemic evaluation. Routine laboratory investigations for uveitis including serum angiotensin-converting enzyme and enzyme-linked immunosorbent assay (ELISA) for toxoplasmosis (IgG and IgM) were done in all the cases. Syndrome Evaluation System comprising of multiplex nucleic acid amplification and signature specific hybridization on the aqueous fluid was done in all 59 eyes for herpes simplex virus (HSV), varicella zoster virus, cytomegalovirus (CMV), rubella virus, chikungunya virus, Toxoplasma, and Mycobacterium tuberculosis. The results were statistically assessed using the SPSS (version 15) package.ResultsThirty-three males and 25 females with FHI were included in the study. Systemic sarcoidosis was seen in two cases. Serological tests failed to confirm an association with toxoplasmosis in all the cases. Aqueous fluid analysis showed positivity only to HSV (one case), CMV (one case), and chikungunya virus (one case).ConclusionsWe do see associations of sarcoidosis, HSV, and CMV in FHI in our patient populations as well. The detection of chikungunya virus in a patient with FHI in our series adds to the list of associations with FHI.

The association of human leukocyte antigen B27 with anterior uveitis in patients from the western region of Saudi Arabia: a retrospective study

BackgroundThe association of human leukocyte antigen B27 (HLA-B27) with anterior uveitis is well known. The prevalence of HLA-B27 and its relation to anterior uveitis is related to race and geographic location. The association is strongest in Western countries and weakest in Eastern countries. Data regarding this association from Middle Eastern countries are limited. Thus, we undertook the study reported here to evaluate the association of HLA-B27 with anterior uveitis in patients in a tertiary center in the western region of the Saudi Arabia.MethodsThe study involved a retrospective analysis of the records of patients with anterior uveitis, referred to the uveitis clinic in Magrabi Eye and Ear Hospital, Jeddah, Saudi Arabia, from 1999 to 2010. The cost-effectiveness of HLA-B27 testing was analyzed.ResultsAmong the 587 cases of uveitis, 335 (57.1%; mean age 37.56±12.82 years; 203 male and 132 female) cases were of anterior uveitis. All patients with anterior uveitis were investigated for HLA-B27 positivity. Idiopathic anterior uveitis was the most common (80%), followed by Fuchs heterochromic cyclitis (7.45%) and ankylosing spondylitis (3.8%). Only two patients were HLA-B27 positive. The cost-effectiveness of HLA-B27 testing was found to be 165,000 Saudi riyals (44,594 US dollars) per positive case.ConclusionHLA-B27-related uveitis appears to be very rare in our part of the world. Idiopathic uveitis is the most common type of anterior uveitis. The cost-effectiveness of HLA-B27 testing is low for patients with anterior uveitis in the western region of Saudi Arabia.

Cytomegalovirus anterior uveitis in immunocompetent individuals following topical prostaglandin analogues

BackgroundThe aim of this study is to report two interesting cases of cytomegalovirus (CMV) anterior uveitis following topical prostaglandin analogue administration for glaucoma. Two retrospective case studies are presented.FindingsA 40-year-old immunocompetent lady with a history of Fuchs heterochromic iridocyclitis with secondary glaucoma in the right eye since 2005 was diagnosed to have CMV anterior uveitis by a multiplex polymerase chain reaction (PCR) in 2009. She developed a reactivation of anterior uveitis following the addition of latanoprost 0.005% eye drops unknowingly by her local ophthalmologist. The pattern of endothelial deposits seen with this reactivation of uveitis was different from that seen in earlier or in subsequent reactivations. A 46-year-old immunocompetent lady with a history of primary open-angle glaucoma and no history of uveitis presented with anterior uveitis with medium-sized keratic precipitates following administration of travatoprost 0.004% eye drops. In both cases, the CMV antigen was demonstrated in the aqueous by multiplex PCR at the time of reactivation. Both cases required treatment with dexamethasone eye drops, ganciclovir 1% gel and oral valganciclovir for the control of inflammation along with antiglaucoma medications.ConclusionsWe report two immunocompetent cases with the development of CMV-related anterior uveitis following administration with prostaglandin analogues. These cases increase the awareness of CMV anterior uveitis in immunocompetent individuals and the need to use prostaglandin analogues with caution.

Pseudo-Fuchs farmacológico

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 differencial diagnosis along with the associated literature is discussed.

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

The purpose of this article is to report the development of Fuchs' heterochromic cyclitis (FHC) secondary to toxoplasmosis chorioretinitis. The design is based on observational case series report. We report in this article six cases of typical FHC developing secondary to ocular toxoplasmosis. Intraocular immunoglobulin G production against Toxoplasma gondii was determined in the aqueous humor of five patients by calculation of the Goldmann-Witmer coefficient (GWC). The clinical examination revealed typical FHC with no active chorioretinal scar. We report on five women and one man (aged 33-64 years old; median 44.6 years) who developed FHC over a period of time ranging from 2-13 years. A positive GWC (>3) was found in four patients; of the two remaining patients one was negative and the other did not have anterior chamber paracentesis. Four patients were treated for an active ocular toxoplasmic lesion before the development of FHC with pyrimethamine, sulfadiazine and corticosteroids. Two patients had negative anti-toxoplasmic therapy for FHC (one with trimethoprim-sulfamethoxazole for 3 weeks and the other with pyrimethamine, sulfadiazine and corticosteroids for 8 weeks). One never had any treatment. All the patients had mild anterior chamber reaction with no synechia, diffuse and characteristic white stellate keratic precipitates and vitritis; five patients had posterior subcapsular cataract and heterochromia and three had elevated intraocular pressure. The findings help us to conclude that FHC can develop over a period of time after ocular toxoplasmosis. This could be a main association to search for when a Fuchs' uveitis is found with a chorioretinal scar. Ocular inflammation does not mean reactivation of ocular toxoplasmosis. FHC could be a secondary immune reaction with a past antigenic stimulation to a previous infection, i.e., toxoplasmosis, etc.

Outcomes of phacoemulsification and intraocular lens implantation in cataracts secondary to uveitis

AbstractPurpose Cataract is a common complication of uveitis. Development of cataract depends on factors such as severity or chronicity of the process, steroid treatment and posterior irido crystalline synechiae formation. The aim of our study was to evaluate the results of phacoemulsification and intraocular lens(IOL) implantation in patients with cataracts secondary to uveitis.Methods We conducted a retrospective observational study of cataract surgeries secondary to uveitis after 3 months of no inflammation. Phacoemulsification and IOL implantation were performed between january of 2004 and 2010. Studied variables were sex, age, type of uveitis, visual acuity before and after surgery, uveitis sequelae and surgical complications.Results We studied 32 eyes of 21 patients (12 women and 9 men). The average age was 49.19+/‐15.4 years. Average preoperative best corrected visual acuity was 0.24+/‐0.1 while the final best corrected visual acuity was 0.75+/‐0.2. The most common inflammatory process was idiopathic anterior uveitis.Other inflammation processes were Fuchs heterochromic cyclitis or pars planitis. There was no postoperative recurrence of uveitis in 29 eyes(90.6%) during the first month. The most frequent early postoperative complication was corneal edema and the late one was iris atrophy due to pupillary distention. Posterior capsule opacification appeared in 21 cases(66%) during the first six months after surgery. In 79% of patients achieved a final visual acuity from 0.6 to 0.9.Conclusion Phacoemulsification with IOL implantation is, at this moment,the chosen surgical technique in most postuveítis cataract because it causes less inflammation and provides good visual results.

Characteristics of Uveitis Presenting for the First Time in the Elderly: Analysis of 91 Patients in a Tertiary Center

Purpose: To describe uveitis clinical characteristics in the elderly.Methods: Retrospective review of 91 patients at the age of 60 or more years at the authors’ uveitis tertiary center over a 7-year period.Results: Uveitis in the elderly accounted for 30.1% of this population. Uveitis localization was anterior in 22.0% of patients, intermediate in 8.8%, posterior in 20.9%, while 41.7% patients presented with panuveitis. Sarcoidosis (37.4%) and idiopathic uveitis (36.3%) accounted for the majority of cases, whereas other diagnostic entities accounted for 26.3%. Panuveitis (41.7%) and sarcoidosis (37.4%) were detected at a significantly higher frequency than in the younger population. Contrarily, ankylosing spondylitis and established ophthalmological entities (pars planitis, Birdshot chorioretinopathy, Fuchs heterochromic cyclitis) were more common in patients younger than 60 years old.Conclusion: In the authors’ experience, sarcoidosis is the leading cause of uveitis in the elderly. Idiopathic uveitis and other specific entities account for less than two-thirds of cases.

Corneal Astigmatism in Unilateral Fuchs Heterochromic Iridocyclitis

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.

Morphological Changes of Trabeculectomy Specimens in Different Kinds of Uveitic Glaucoma

Purpose: To analyze morphological changes in trabeculectomy specimens of patients suffering from uveitic secondary open angle glaucoma (UG).Material and Methods: Trabeculectomy specimens of six patients suffering from uveitis for 2 to 19 years and having been treated with steroids for 5 to 86 months were obtained during antiglaucomatous surgery after failed antiglaucomatous drug treatment. Six specimens, four from patients with Fuchs’ heterochromic cyclitis (FHC), one with Herpes simplex-associated uveitis (HS), and one with juvenile idiopathic arthritis-associated uveitis (JIA) were analyzed by light and electron microscopy. Deposits of extracellular material (ECM) underneath the inner wall of Schlemm’s canal (SC) were analyzed quantitatively.Results: In the patients with FHC, most trabecular beams were thickened by fibrillar material deposited between trabecular cells and basement membranes. Some single lamellae appeared to be destroyed. Underneath the inner wall endothelium there was an increase of “plaques” morphologically comparable to those seen in patients with primary open angle glaucoma. The specimen with JIA showed also “plaque” accumulations at the inner wall and thickening of the trabecular beams, but the latter was due to thickening of the basement membrane itself with inclusions of long-spacing collagen. In the specimen with HS, large amounts of fingerprint-like basement membrane material were found between the trabecular lamellae. The subendothelial region displayed an increase in plaques and fibrillar material.Conclusions: In all specimens derived from patients with UG, there was an increase in ECM in the subendothelial region of SC, presumably contributing to the elevations in intraocular pressure. The trabecular meshwork also exhibited signs of lytic activity, but this was much less prominent than the thickening of the lamellae due to ECM deposits surrounding the central cores of the lamellae.

Etiologies of Chronic Anterior Uveitis at a Tertiary Referral Center over 35 Years

Purpose: To describe the epidemiology of chronic anterior uveitis (CAU) at a tertiary center over 35 years.Methods: Data regarding etiology of CAU was collected from medical records of patients evaluated between 1973-2007. Relative frequencies of each diagnosis of CAU were calculated. Linear regression analyses were performed on the common types of CAU.Results: 5970 patients were evaluated between 1973-2007; 31% carried a diagnosis of CAU. Idiopathic disease was diagnosed in 54% of patients (39 to 72% annually), ocular sarcoidosis in 14% of patients (2 to 20% annually), Fuchs heterochromic iridocyclitis (FHI) in 12% of patients (4 to 22% annually), and juvenile idiopathic arthritis (JIA) in 6% of patients (2 to 13% annually). The frequency of diagnosis of idiopathic CAU decreased over time, with no significant change for sarcoidosis, FHI or JIA. An increase in frequency of diagnosis was observed for HLA-B27-related disease and uveitis related to multiple sclerosis and inflammatory bowel disease.Conclusions: The relative frequency of idiopathic disease has decreased over the past 35 years at our center. This may be related to an increase in the diagnosis of CAU associated with HLA-B27 positivity, inflammatory bowel disease (including family history) and multiple sclerosis. Despite the advances over the last 35 years, idiopathic disease still comprises at least 39% of our patients with CAU each year.

New spectrum of Herpes virus‐associated anterior uveitis in immunocompetent patients: a PCR‐based study

Abstract Purpose To study clinical characteristics and long term follow up of patients with positive viral PCR in the aqueous humor. Clinical specificities of patients with HSV, VZV ans CMV infection are reviewed. Methods 34 patients (19 M/15F) were included in this retrospective study.We counted the repartition of each virus among the positive viral PCR in the aqueous humor realised for anterior uveitis. We also noticed clinical features for each virus :sex, age, laterality, iris atrophy, synechiae, hypertonia, type and localisation of keratic precipitates, glaucoma. Results Mean age at diagnosis was 49.5 (range 19‐73) years for CMV, 64 (range 21‐69) years for VZV, 53 (range 32‐72) years for HSV. Sex ratio (M:F) was 10/9 for CMV, 4/2 for VZV and 5/3 for HSV positive patients. Viral anterior uveitis was CMV‐related in 58% of cases, VZV‐related in 15% of cases, and HSV‐related in 27% of patients. Uveitis was unilateral in 100% of HSV and VZV patients and in 84% of CMV patients. Iris atrophy, when present, was diffuse in 100% of CMV positive patients and sectoral in 50% HSV and 20% of VZV patients. No patient with CMV infection had synechiae, but 56% of patients had synechiae in the HSV group. Glaucoma complicated uveitis in 79% of CMV cases, 60% of VZV cases, and 56% of HSV cases. None of the patients with positive PCR had the clinical presentation of Fuchs heterochromic cyclitis. Conclusion CMV‐related anterior uveitis has a large place among viral anterior uveitis. Specific clinical features should lead to high suspicion of this diagnosis, and PCR should be applied to the aqueous humor in order to initiate the appropriate treatment.

Rubella virus as a possible etiological agent of Fuchs heterochromic iridocyclitis

To determine whether rubella virus is involved in the pathogenesis of Fuchs heterochromic iridocyclitis (FHI). Fourteen patients (14 eyes) diagnosed with FHI based on characteristic ocular manifestations and eight control subjects were studied. Aqueous humor (AH) samples from 14 FHI patients and one vitreous sample from a FHI patient were analyzed for intraocular antibody production against rubella virus by calculation of the Goldmann-Witmer coefficient (GWC). Viral detection by nested polymerase chain reaction and isolation by culture in RK-13 cells were conducted in nine FHI patients. In addition to laboratory examinations, medical history of rubella virus vaccination was also obtained. Ten patients with FHI examined showed intraocular synthesis of rubella virus antibodies (GWC > 3). A high index of rubella virus antibody production was also found in the vitreous sample (GWC = 30.6). GWC in all control subjects were below detectable level. The rubella genome was detected in two of nine patients, and rubella virus was isolated from one of nine patients with FHI. None of the patients with FHI had been vaccinated against rubella. Our laboratory data strongly suggest a relationship between FHI and rubella virus.

Confocal Scan of Keratic Precipitates in Uveitic Eyes of Various Etiologies

To specify confocal scan features of keratic precipitates (KPs) in uveitic eyes of various etiologies. Confocal scan was performed on 129 eyes of 93 patients with different types of uveitis to characterize the morphologic features of KPs. The study included Fuchs heterochromic iridocyclitis (FHIC) in 50 eyes, idiopathic granulomatous uveitis in 27, herpetic anterior uveitis in 10, pars planitis associated with endotheliitis in 9, Vogt-Koyanagi-Harada syndrome in 8, multiple sclerosis-related uveitis in 7, sarcoidosis in 3, acute anterior uveitis not associated with HLA B27 in 3, acute retinal necrosis in 2, psoriatic uveitis in 2, chronic endophthalmitis in 2, sclerouveitis in 2, HLA B27-associated anterior uveitis in 2, sympathetic ophthalmia in 1, and toxoplasmosis in 1. The differences in types of KPs between various uveitic groups were analyzed. Mean age of the patients was 32.5 +/- 11.2 (range, 14-67) years, and 58 (62.36%) were female. Bilateral involvement was observed in 36 cases (38.7%). Stippled and globular KPs were predominantly observed in almost all types of uveitis. With comparing the infectious versus noninfectious uveitis, dendritiform KPs were almost more common in infectious uveitis (P = 0.053) and smooth-rounded KPs were significantly more common in noninfectious uveitis (P = 0.000). Dendritiform KPs were observed more commonly in nongranulomatous uveitis than in the granulomatous ones (P = 0.005). Smooth-rounded KPs were more common in chronic uveitis than in the acute forms (P = 0.000). Predominant morphologies of KPs in FHIC were dendritiform (80.0%) and infiltrating (78.0%). The most commonly observed morphologies of KPs in intermediate uveitis were dendritiform (56.3%) and smooth rounded (56.3%). Cruciform KPs were more frequently seen in cases with FHIC (60.0%). In bilateral cases, the morphologic features were similar. Morphologic features of KPs in various types of uveitis are diverse. Stippled and globular KPs may be observed in almost all types of uveitis. Certain types of KPs are more frequently associated with specific forms of uveitis, that is, smooth-rounded KPs may be an indicative of a granulomatous uveitis and infiltrating and dendritiform in infectious uveitis. Confocal scan may play a potential important role in identification of underlying mechanisms in complex forms of uveitis.

Kortikosteroidtherapie und sekundäre Augeninnendruckerhöhung bei Fuchs-Heterochromiezyklitis und idiopathischer chronischer anteriorer Uveitis

Due to different influences on anterior chamber angle structures, corticosteroids have a significant impact on secondary elevated intraocular pressure. This study examines the influence of corticosteroid therapy on the incidence of secondary elevated intraocular pressure in patients with Fuchs heterochromic cyclitis (FHC) and chronic anterior uveitis. Retrospective chart analyses of patients undergoing topical and systemic corticosteroid therapy were carried out. Overall, data of 54 FHC and 49 CAU patients were analysed. Patients did not differ with respect to age, gender distribution and follow-up period. Seventeen (37 %) of the FHC patients and eight (18 %) of the CAU patients had secondary elevated intraocular pressure (p = 0.08). Number of months with topical therapy (54 vs. 20 months, p = 0.025) and number of months multiplicated with the frequency of topical maintenance therapy (158 vs. 61 p = 0.027) were significantly higher in the FHC patients. Only in the FHC group was an association with age (OR 1.16; 95 % CI 1.03 - 1.2; p = 0,006) and in the CAU group with the number of topical corticosteroid therapies (OR 1.15; 95 % CI 0.99 - 1.34; p = 0.03) evident in the multivariate analysis. Pathomechanisms, resulting in secondary elevated intraocular pressure in patients with FHC and CAU, must be different as only in CAU patients was an association to corticosteroid therapy found.

Confocal Scan Features of Keratic Precipitates in Fuchs Heterochromic Iridocyclitis

To characterize confocal scan features of keratic precipitates (KPs) in Fuchs heterochromic iridocyclitis. Confocal scans of KPs in patients with Fuchs uveitis were performed. Polymerase chain reaction technique of aqueous for herpes simplex, herpes zoster, Toxoplasma, cytomegalovirus, and rubella was performed for 4 patients. Confocal scan was performed in 40 eyes of 34 patients [18 males and 16 females, mean age 30.7 +/- 10.5 years (range 18-57 years)]. Fuchs heterochromic iridocyclitis was bilateral in 6 and unilateral in 28 patients. All eyes had KPs: globular KPs were found in 34 eyes, infiltrating and dendritiform in 31 eyes, stippled in 27 eyes, and cruciform in 19 eyes. Polymerase chain reaction of aqueous specimens for the above-mentioned infectious agents was negative in 4 eyes of 4 individuals who had infiltrating and dendritiform KPs on confocal scan, with no other concurrent disorder. Confocal features of KPs in Fuchs uveitis are diverse. The presence of dendritiform and infiltrating KPs on confocal scan may not be suggestive of an infectious etiology.

Intraocular antibody synthesis against rubella virus and other microorganisms in Fuchs' heterochromic cyclitis

Fuchs' heterochromic cyclitis (FHC) is a common intraocular disease of uncertain etiology that has recently been related to rubella virus (RV) infection. We investigated the synthesis of RV-specific IgG using aqueous humor and serum samples from 63 consecutive patients with FHC. In addition, intraocular immunoglobulin G production against herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV) and toxoplasma gondii was determined. In 20 patients, the detection of RV RNA was additionally performed by RT-PCR on the E1 gene. Forty-six patients with HSV- and VZV-associated uveitis, HLA B-27 positive anterior uveitis, and Posner-Schlossman syndrome served as controls. Specific intraocular antibody synthesis against RV was confirmed in all 63 FHC patients, whereas none of the 46 controls was positive for RV IgG. Interestingly, in 11 patients with positive RV IgG synthesis, additional HSV (eight), VZV (one) and CMV (two) specific antibodies could be detected. Only twice was viral RNA detectable by PCR in a patient with FHC. In this largest reported series of FHC patients, we detected a strong association between FHC and intraocular antibody synthesis against rubella virus. Furthermore, in 11 patients, it was possible to confirm an additional intraocular antibody synthesis, in particular HSV. PCR-positive results in the aqueous humor were exclusively obtained for RV. In contrast to other studies, the RV genome could only be identified in two patients (10%).

Evaluation of keratic precipitates and corneal endothelium in Fuchs’ heterochromic cyclitis by in vivo confocal microscopy

Purpose:To analyse keratic precipitates in Fuchs’ heterochromic cyclitis (FHC) by in-vivo confocal microscopy (IVCM).Patients and methods:A retrospective chart review of 13 consecutive patients with FHC was conducted. Data collection included...