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Heterochromic iridocyclitis Fuchs: causes, symptoms, diagnosis, treatment
Last reviewed: 25.06.2018
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Heterochromic iridocyclitis Fuchs is a one-sided chronic inactive non-granulomatous anterior uveitis associated with secondary posterior subcapsular cataract and glaucoma in 13-59% of cases.
As a result of intraocular inflammation, iris atrophy occurs and a heterochromy characteristic for this state arises.
[Epidemiology of Fuchs heterochromic iridocyclitis
It is believed that the heterochromic iridocyclitis of Fuchs is a relatively rare form of anterior uveitis, ranging from 1.2 to 3.2% of all uveitis. In 90% of cases there is a one-sided defeat. The disease is met equally often in men and women. Usually, the disease is diagnosed at the age of 20-40 years. In 15% of cases, even when the diagnosis of heterochromic iridocyclitis Fuchs is diagnosed, inflammatory glaucoma is detected, and in 44% of cases it develops later. The overall incidence of secondary glaucoma in patients with heterochromic Fuchs iridocyclitis is 13-59%, but this figure may be higher in patients with bilateral lesions and in the population of African Americans.
What causes fuchs heterochromic iridocyclitis?
It is believed that the increase in intraocular pressure in heterochromic Fuchs iridocyclitis occurs as a result of disturbed outflow of intraocular fluid due to obstruction of the trabecular network by inflammation cells or a hyaline membrane.
Symptoms of Fuchs heterochromic iridocyclitis
Heterochromic iridocyclitis Fuchs has an asymptomatic course, only in some cases patients complain of slight discomfort and blurring of the image. Communication with systemic diseases has not been identified. Patients often get to the doctor due to a decrease in visual acuity with the progression of cataracts.
Course of the disease
Anterior uveitis with fuchs heterochromic iridocyclitis progresses slowly and has an asymptomatic course. Neovascularization of the iris and angle of the anterior chamber with slight trauma can lead to a slight intraocular hemorrhage, but peripheral anterior sinuschi or neovascular glaucoma are not formed. The most frequent complications of the disease are cataract and glaucoma. The formation of cataracts was noted in 50% of patients suffering from Fuchs heterochromic iridocyclitis. Cataract extraction usually does not cause complications, and postoperative exacerbation of intraocular inflammation is less common than with other uveitis. Zadnekamernaya implantation of the intraocular lens is safe. Glaucoma, which develops with Fuchs heterochromic iridocyclitis, resembles the primary open-angle glaucoma in its course.
Ophthalmological examination
With external examination, the eye is usually calm, with no signs of inflammation. When examining the anterior segment of the eye, one-sided inactive non-granulomatous anterior uveitis is usually detected. Starchy precipitates are scattered throughout the corneal endothelium, which is a characteristic diagnostic feature. Intraocular inflammatory process leads to atrophy of the iris stroma, as a result of which the dark iris will look lighter. In patients with light irises as a result of stroma atrophy, the affected eye will appear darker due to the exposure of the pigment epithelium of the iris. Another important diagnostic feature in patients suffering from heterochromic Fuchs iridocyclitis is neovascularization of the iris or anterior chamber angle (revealed in gonioscopy). Despite the chronic course of intraocular inflammation, peripheral anterior and posterior synechiae almost never form in patients. However, posterior subcapsular cataract is a fairly frequent complication. Usually, the posterior segment of the eye is not affected, but cases of the formation of chorioretinal foci in patients suffering from heterochromic Fuchs iridocyclitis have been described.
Differential diagnostics of heterocromic iridocyclite Fuchs
It is necessary to carry out differential diagnostics of heterochromic iridocyclitis Fuchs with Posner-Schlossman's syndrome, sarcoidosis, syphilis, herpetic uveitis, and with lesion of the posterior segment - with toxoplasmosis.
Laboratory research
There are no laboratory studies that make it possible to diagnose the fuchs heterochromic iridocyclitis. In the intraocular fluid of patients suffering from this disease, lymphocytes and plasma cells were detected. The diagnosis is based on clinical manifestations: the distribution of precipitates on the corneal endothelium, the inactive nature of anterior uveitis, heterochromia, the absence of synechia and meager eye symptoms.
Treatment of heterochromic iridocyclitis Fuchs
Despite chronic anterior uveitis, it is not recommended to use active local therapy with glucocorticoids or systemic immunosuppressive therapy because of their low efficacy in the case of heterochromic Fuchs iridocyclitis. The use of local glucocorticoids can even be contraindicated because they accelerate the development of cataracts and glaucoma. It is recommended to conduct medical treatment of glaucoma, but in 66% of cases, surgical treatment is necessary. The best surgical procedure for treating patients suffering from the heterochromic Fuchs iridocyclitis is unknown. Argon-laser trabeculoplasty is ineffective in these patients because of the formation of the hyaline membrane over the trabecular network, so this method of treatment should not be used.