Rubella virus is associated with fuchs heterochromic iridocyclitis

PURPOSE: To determine whether rubella virus (RV) is involved in the pathogenesis of Fuchs heterochromic iridocyclitis (FHI). DESIGN: Retrospective patient-controlled study. METHODS: Intraocular immunoglobulin G production against RV, herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii was determined in the aqueous humor of 14 patients with FHI, 13 control subjects with herpetic uveitis anterior, and 19 control subjects with ocular toxoplasmosis by calculation of the Goldmann-Witmer coefficient (GWC). RESULTS: All patients and control subjects were seropositive for RV. Intraocular antibody production (GWC >3) against RV was found in 13 of 14 patients (93%) with FHI. Intraocular antibody production against HSV, VZV, or T gondii was not detected. None of the control subjects with herpetic uveitis anterior or with toxoplasma chorioretinitis had a positive GWC for rubella virus (P < .0001, Fisher exact test). CONCLUSION: Rubella virus, but not HSV, VZV, or T gondii, is associated with FHI.     

Herpes simplex virus DNA identification from aqueous fluid in Fuchs heterochromic iridocyclitis

PURPOSE: To report the presence of herpes simplex virus DNA in the aqueous humor of an eye with Fuchs heterochromic iridocyclitis. METHODS: In an eye with a clinical diagnosis of Fuchs heterochromic iridocyclitis, samples of aqueous humor and anterior capsule of the lens were obtained during cataract surgery. Polymerase chain reaction was performed on the samples to detect the presence of viral DNA including herpes simplex virus, varicella-zoster virus, and cytomegalovirus. Serologic analysis was also performed for antiviral immunoglobulins. RESULTS: Herpes simplex virus DNA was identified in the aqueous humor but not in the anterior capsule. Serum immunoglobulin G was positive for herpes simplex virus, varicella-zoster virus, and cytomegalovirus. CONCLUSIONS: The presence of herpes simplex virus DNA in the aqueous humor of an eye with Fuchs heterochromic iridocyclitis suggests that herpes simplex virus infection may play a role in the pathogenesis of Fuchs heterochromic iridocyclitis.     

Chikungunya virus iridocyclitis in Fuchs' heterochromic iridocyclitis

We are reporting a case of bilateral Fuchs' heterochromic iridocyclitis with chikungunya virus infection in the left eye. A 20-year-old female was presented with a past history of fever suggestive of chikungunya with bilateral Fuchs' heterochromic iridocyclitis and complicated cataract. She had a tripod dendritic pattern of keratic precipitates by confocal microscopy in the left eye with a stippled pattern of keratic precipitates in both eyes. The real-time polymerase chain reaction (RT-PCR) assay in the aqueous humor detected 98 copies/ml of chikungunya virus RNA. The patient underwent clear corneal phacoemulsification with in-the-bag intraocular lens implantation in the left eye with a good visual outcome. This is the first report where the presence of chikungunya virus RNA has been associated with a case of bilateral Fuchs' heterochromic iridocyclitis.     

Surgical management of cataract and posterior chamber intraocular lens implantation in Fuchs‘ heterochromic iridocyclitis

Background: To determine the inflammatory course and level of visual rehabilitation after cataract extraction and posterior chamber lens implantation in patients withFuchs‘ heterochromic iridocyclitis complicated by cataract. Methods: In a clinical trial, 32 eyes (visual acuity of 20/160 or worse) of 30 patients underwent extracapsular cataract extraction (19 eyes) or lensectomy(13 eyes) accompanied by posterior chamber intraocular lens implantation. Indirect ophthalmoscopy was performed intraoperatively prior to intraocular lens implantation and the extent of vitreous haze was assessed. If vitreous haziness was 3+ or more, core vitrectomy (two eyes) or three-port pars plana deep vitrectomy (four eyes) was performed. Results: After an average follow up of14.4 months (6 to 24 months), there was no statistically significant increase in cell and flare in the anterior chamber and vitreous or in keratic precipitates compared with the preoperative status of the eyes. However, 12%of the eyes developed synechiae (anterior and/or posterior) in comparison to preoperative condition (p< 0.05). Eighty-seven percent of the eyes gained visual acuity of 20/40 or better (P < 0.005). Using the logistic regression model, a higher level of preoperative inflammation was associated with reduced likelihood of gaining visual acuity of 20/25 or more (OR = 0.25, 95%CI 0.049, 1.255). The complications of surgery were synechiae, 12%; opaque posterior capsule, 12%; vitreous loss, 3%; chronic glaucoma, 3%; and retinal detachment,3%. Conclusions: Implantation of a posterior chamber intraocular lens can be well tolerated in patients with Fuchs‘ heterochromic iridocyclitis. Vitrectomy, whenever indicated in addition to cataract extraction, improves visual rehabilitation. This revised version was published online in August 2006 with corrections to the Cover Date.     

Fuchs heterochromic cyclitis: rubella virus antibodies and genome in aqueous humor

PURPOSE: To characterize the polyspecific intraocular antibody synthesis in aqueous humor of patients with chronic inflammatory diseases of the eye and to detect the causative antigen in Fuchs heterochromic cyclitis (FHC). DESIGN: Retrospective case-control study. METHODS: Intraocular antibody synthesis is detected in aqueous humor with the Antibody Index [AI] (improved Goldmann-Witmer Index) and quantified as specific antibody fraction, F(s) (intraocular specific antibody concentration in percent of intraocular total immunoglobulin G in aqueous humor). Virus detection is by nested polymerase chain reaction. RESULTS: Fifty-two eyes of 52 patients with clinically defined FHC (aged 16-73 years) had an intraocular synthesis of rubella antibodies (AI > or =1.5). The rubella genome was detected in 5 (18%) of 28 aqueous humor samples investigated, or in 5 (56%) of 9 patients aged <40 years. Oligoclonal IgG was synthesized in 34 (87%) of 39 eyes. Unaffected fellow eyes (n = 3) or cerebrospinal fluid (n = 2) were normal. In FHC the median rubella AI = 20.6 (total range 1.5-309) was seven times higher than in multiple sclerosis (MS) patients (n = 15) with uveitis intermedia or periphlebitis retinae. In MS the intraocular rubella antibody synthesis (frequency 73%) is part of a polyspecific immune response (increased measles AI in 80%, varicella zoster virus AI in 47%, herpes simplex virus AI in 23%). The median rubella-F(s) = 2.6% in FHC (range = 0.14%-45.9%) was approximately 40 times higher than in MS, consistent with a virus-driven antibody response in FHC. Noninflammatory controls (50 senile cataracts) had neither an intraocular rubella antibody synthesis (normal AI < or =1.4) nor rubella antigen in aqueous humor. The rubella AI was normal in all patients with an intraocular toxoplasmosis (n = 24), anterior uveitis (n = 27), herpes simplex virus iritis (n = 25), and varicella zoster virus iritis (n = 14). CONCLUSIONS: Fuchs heterochromic cyclitis is a rubella virus-driven disease with persistence of the virus preferentially detected in the younger patients. The proposed laboratory supported diagnosis of FHC is based on the increased rubella Antibody Index. The virus etiology gives a rationale for omitting the ineffective corticosteroid therapy of FHC.     

超声乳化吸除术治疗Fuchs综合征并发白内障的疗效

目的:探讨超声乳化吸除术治疗Fuchs综合征并发白内障的临床效果.方法:分析在我院行超声乳化吸除术的Fuchs综合征并发白内障患者18例18眼,术中观察并发症的情况,术前及术后测量视力、眼压、角膜内皮细胞密度,术后观察眼内炎症反应程度、并发症等情况.结果:平均随访时间为9.8±3.3mo.术中唯一的并发症为周边虹膜出血(17%).最佳矫正视力(LogMAR)术前为0.98±0.85,术后6mo为0.08±0.14,差异具有统计学意义(P<0.001).眼压术前为15.11±2.63mmHg,术后有2眼一过性高眼压,术后6mo为14.94±2.49mmHg,与术前相比,差异无统计学意义(P>0.05).术后角膜内皮细胞丢失率为10%±6%.术后2眼出现轻度的瞳孔区纤维素样渗出,1眼囊袋收缩综合征以及4眼后发性白内障.结论:超声乳化吸除术治疗Fuchs综合征并发白内障安全有效、并发症少.     

The outcome of initial mitomycin C-augmented trabeculectomy with subconjunctival bevacizumab in the management of secondary glaucoma associated with Fuchs heterochromic iridocyclitis

International Ophthalmology - To investigate the outcome of mitomycin C (MMC)-augmented trabeculectomy with subconjunctival bevacizumab in the management of Fuchs heterochromic iridocyclitis...     

Fuchs' heterochromic iridocyclitis: A review of 26 cases

Fuchs' heterochromic iridocyclitis (FHI), an unusual form of uveitis of unknown etiology, is frequently misdiagnosed. Purpose: To report the analysis of 26 patients (27 eyes) with FHI who were diagnosed and observed over a period of 1–7 years (mean: 3.42 ± 2.2 years). Methods: Ocular and systemic examinations were performed on all patients. Results: The most common presenting symptom was visual deterioration (42.3%); one patient was affected bilaterally. Characteristic keratic precipitates (100%), cataracts (77.8%), and heterochromia (70.4%) were the major signs. Eleven eyes (40.7%) required cataract surgery. At the initial examination, four eyes (14.8%) had glaucoma, and no new cases of glaucoma developed during the follow-up period. One eye required filtration surgery. Vitrectomy was performed in two eyes (7.4%) because of vitreous opacities. Most patients (73.0%) did not require active treatment; pre- and postoperative anti-inflammatory treatment for cataract extraction was performed successfully to minimize the risk of inflammation. No severe uveitis was seen in any patient after surgery, but visual acuity did not improve greatly after cataract extraction; 54.5% eyes had visual acuity better than 20/40 before surgery, and 45.4% postoperatively. Conclusion: Posterior capsule opacification, glaucoma, and vitreous opacity were the major obstacles to visual rehabilitation after cataract surgery in patients with this type of uveitis.     

The epidemiologic association of Fuchs' heterochromic iridocyclitis and ocular toxoplasmosis

Between January 1983 and July 1987, I examined 25 patients at the Department of Ophthalmology, West Virginia University, who had the anterior segment characteristics of Fuchs' heterochromic iridocyclitis. Of these patients, 16 had fundus lesions suggestive of ocular toxoplasmosis. Of these 16 patients, 13 had a positive serologic test for toxoplasmosis, two patients were not tested, and one patient had a negative test at 1:16. The remaining nine patients with Fuchs' heterochromic iridocyclitis had no fundus lesions suggestive of toxoplasmosis. A chart review of 792 consecutive patients at the Retinal Unit, West Virginia University, during a six-month period disclosed that 24 of 590 patients (4%) had chorioretinal scars suggestive of toxoplasmosis. I concluded from these data that in at least one subgroup of patients with Fuchs' heterochromic iridocyclitis there is a significant association with the chorioretinal scars of toxoplasmosis (P less than .01), and this is suggestive of a causal relationship.     

Fuch's heterochromic iridocyclitis: an electron microscopic study of the iris

The irides of two patients with Fuch's heterochromic iridocyclitis were investigated by electron microscopy. The main findings were abnormal melanocytes with relatively few, small, and at times immature melanin granules, abundance of plasma cells, and membranous degeneration of nerve fibers. The defective melanin production may be due to abnormal adrenergic innervation, either primary or secondary to the inflammatory process. The cause for this inflammatory reaction was not evident in this study.     

Fuchs异色性虹膜睫状体炎临床特征及并发症处理

目的 分析Fuchs异色性虹膜睫状体炎患者的临床特征并探讨其并发症的临床治疗.方法 回顾性系列病例研究.选取1994年4月至2010年11月于青岛眼科医院就诊并且诊断为Fuchs异色性虹膜睫状体炎的患者101例(104眼),排除存在高血压、糖尿病、激素用药史、外伤等能引起眼部病变因素者,按年龄分为20～30岁、31～40岁、41～50岁、51～60岁、61～70岁、71～78岁6个年龄段,收集包括发病年龄、性别、病程、临床表现、并发症、手术方式、术后3d及长期随访的眼压及视力等临床资料.采用SPSS 17.0软件对术前与术后3d眼压、最佳矫正视力行配对符号秩和检验;对正常人与患病者角膜内皮细胞、六边形细胞比例、细胞变异率行独立样本秩和检验.结果 101例患者中3例(3.0％)双眼发病,男女之比1.2:1,各年龄段男女患病差异无统计学意义(x2=9.31,P＞0.05),左右眼患病差异无统计学意义(x2=10.628,P＞0.05).临床表现:100％患者视力下降;25.0％有角膜内皮色素沉着物,75.0％为脂状沉着物;24.0％患者发生虹膜异色;56.7％虹膜萎缩;100％患者玻璃体混浊;98.1％患者并发白内障;仅16.3％患者并发青光眼.与正常人相比,其角膜内皮细胞数目无明显减少,差异无统计学意义(Z=-1.601,P＞0.05);六边形细胞比例无明显降低,差异无统计学意义(Z=-0.961,P＞0.05),细胞变异率无明显升高,差异无统计学意义(Z=-0.321,P＞0.05).并发白内障者行白内障超声乳化联合人工晶状体植入术,术后3d视力较术前明显提高,差异有统计学意义(Z=-2.201,P＜0.05);并发青光眼者行小梁切除术,术前与术后3d眼压差异有统计学意义(Z=-2.201,P＜0.05);长期随访,有3例患者白内障术后1年并发青光眼,行小梁切除术后眼压稳定,视力无明显下降.结论 Fuchs异色性虹膜睫状体炎临床特征以视力下降、角膜内皮色素沉着物或脂状沉着物沉着、虹膜不同程度脱色素萎缩,甚至出现虹膜异色、前房及玻璃体轻度炎症表现为特点,随着病程的延长虹膜异色发生率可能增加;其对角膜内皮细胞数目、六边形细胞比例及细胞变异率无明显影响;抗青光眼手术或白内障术后患者的眼压仍需定期随访,以及时控制眼压保存视力.     

Outcomes of phacoemulsification and in-the-bag intraocular lens implantation in Fuchs' heterochromic iridocyclitis

PURPOSE: To evaluate the visual outcomes and complications of phacoemulsification (PE) and posterior chamber intraocular lens implantation, (PC IOL) in patients with Fuchs heterochromic iridocyclitis (FHIC). SETTING: Private clinic and an academic hospital. METHODS: In this noncomparative interventional case series, existing data for 41 eyes of 40 consecutive patients clinically diagnosed with FHIC and cataract were studied retrospectively. Scleral tunnel PE and in-the-bag IOL implantation were performed in all cases. Preoperative and postoperative visual acuities and intraoperative and postoperative complications were evaluated. RESULTS: Twenty-four male and 16 female patients aged 12 years to 70 (SD) (mean 35 +/- 12 years) were operated on and followed for 17.8 +/- 8.7 months. Preoperatively, best corrected visual acuity (BCVA) was less than 20/40 in all patients, which improved to 20/40 or better after surgery. Twenty-two eyes (53.6%) achieved BCVA of 20/20. The major cause of postoperative visual acuity less than 20/20 was vitreous haze. There were no major intraoperative complications. Postoperatively, mild anterior chamber fibrin reaction occurred in 4 patients (9.7%), IOL deposits occurred in 11 eyes (26.8%), and decentration was observed in 1 eye. During follow-up, 6 eyes (14.6%) developed posterior capsule opacification requiring a neodymium:YAG (Nd:YAG) laser capsulotomy. There was 1 case of clinical cystoid macular edema that resolved with medication. There were no cases of posterior synechias, postoperative glaucoma, or retinal detachment. CONCLUSION: Phacoemulsification with PC IOL implantation is a safe procedure with good visual outcomes in patients with FHIC and cataract.