Fuchs' heterochromic uveitis: a longitudinal clinical study

Abstract

ABSTRACT.Purpose: To carry out a longitudinal study of patients with Fuchs' heterochromic uveitis (FHU) in western Sweden and to establish the factors responsible for diagnostic delay. Methods: A sample of 54 patients, 51 with monocular and three with binocular FHU, were followed for periods ranging from 8 months to 15 years. Firm diagnostic criteria were set. A detailed anamnesis regarding ocular and extraocular symptoms was taken. The eyes were repeatedly examined. Toxoplasma serology was analysed. Complications were noted. Results: The delay between the first visit to an ophthalmologist and diagnosis was 0)26 years. The most common first symptom was floaters. Iris heterochromia was absent in 11 patients and discrete in 26. Iris atrophy (a diagnostic criterion) was easy to miss. Chorioretinal scars were found in six patients. Toxoplasma serology was positive in 18 (35%) patients. The only serious complication was glaucoma. Conclusions: The most important reason for delay in diagnosis of FHU is, in our opinion, failure to consider the disease as a diagnosis. This failure may occur because heterochromia is often missing or discrete, iris atrophy is easily overlooked, and vitreous opacities are common, often cause early symptoms and can explain prolonged workup and therapy. A connection with toxoplasmosis in individual cases cannot be excluded but toxoplasmosis cannot be considered a major aetiological factor. If detailed anamnesis is negative and diagnostic criteria are fulfilled, no further workup is required.

Viral causes of unexplained anterior uveitis in Thailand

“…It is observed in about 2-3% of all patients in large uveitis surveys. 6,20,21 Infectious causes of FHUS have long been suspected. An American study reported that Toxoplasma gondii was involved in the pathogenesis of FHUS.…”

Corneal Astigmatism in Unilateral Fuchs Heterochromic Iridocyclitis

“…The mean interval between the first visit to an ophthalmologist and diagnosis is 3 years (up to 26 years), 21 but there are several reasons why diagnosis of FHI is often delayed. Keratic precipitates are not always stellate and diffuse.…”

Fuchs Uveitis Syndrome in the Developing World

“…In patients with brown irides, the heterochromia can be subtle or absent, as both anterior and posterior layers have similar pigmentation and texture. 25,26 Although clinic-based studies from North America 22,25 and Europe 16,14,[27][28][29] have reported anywhere from 70.4% to 100% heterochromia in patients with FUS, similar studies from Brazil, 16 Mexico, 30 Turkey, 31 and China 15 reported heterochromia rates of 34%, 25.3%, 39.7%, and 12.7%, respectively. Iris atrophy, in contrast, was present in 53.3% of Mexican patients, 30 88.4% of Turkish patients, 31 and 100% of Chinese patients.…”