bThere is growing evidence for the role of rubella virus in Fuchs' uveitis syndrome (FUS). This report is the first to show persistent intraocular rubella virus in a 28-year-old man with congenital rubella syndrome (CRS), who presented with blurred vision and was diagnosed with FUS. CASE REPORTA 28-year-old man of Afro-Caribbean descent was referred to a tertiary hospital in 2006 with progressively worsening vision in both eyes. There was no history of pain, conjunctival injection discharge, photophobia, photopsia, or floaters. He had been diagnosed at birth with congenital rubella syndrome (CRS), following a clinical diagnosis of maternal rubella in pregnancy and presentation with profound deafness and cataracts. He did not have any cardiac defects. His visual acuities on presentation in 2006 were 6/36 and 6/12 in the right and left eye, respectively. Examination revealed bilateral anterior uveitis with stellate keratic precipitates as well as bilateral posterior subcapsular lens opacities. Intraocular pressures were within normal limits in both eyes. Dilated fundus examination was normal.The clinical diagnosis of Fuchs' uveitis syndrome (FUS) was made based on the presence of a bilateral low-grade anterior uveitis with typical keratic precipitates and the absence of posterior synechiae or acute symptoms of pain, redness, and photophobia. Investigations for other causes of uveitis were carried out, including serum angiotensinogen-converting enzyme, syphilis serology, and antinuclear antibody titers, which were all negative. The full blood count, renal and liver function tests, and erythrocyte sedimentation rate (ESR) were normal, and the sickle cell screen was negative. The serum rubella IgM was negative, and the rubella IgG was positive.His reduced visual acuity was attributed to his bilateral lens opacities, which is a common feature of FUS. Right followed by left eye phacoemulsification cataract extraction and intraocular lens implantation were performed under general anesthesia to improve vision. One-hundred-microliter samples of aqueous humor (AH) were aspirated through a paracentesis prior to both cataract surgeries. The rest of the operations were performed in a standard manner and without complications. The postoperative treatment regimen consisted of hourly dexamethasone as 0.1% drops that were tapered over 6 weeks and with chloramphenicol as 0.5% drops 4 times a day (q.d.s.) for 1 week.A venous blood sample, urine sample, and throat swabs were collected for serological and microbiological investigations. The serum sample confirmed serological evidence of past rubella infection with an unusually high titer (Table 1). Samples of aqueous fluid were sent to the national rubella reference laboratory at Colindale, United Kingdom, for detection of rubella RNA and intraocular antibody production, by calculating the rubella-specific antibody index (AI Rub ) based upon the Goldmann-Witmer index (GW-I) (1). This compares the relative levels of specific antibody in aqueous and serum samples and compares them with...