Fluorescein angiographic findings and clinical features in Fuchs’ uveitis

Abstract

Fuchs' uveitis is very often diagnosed with substantial delay, which is at the origin of deleterious effects such as unnecessary treatment and its consequences. The aim of this study was to analyse the type and frequency of posterior inflammatory and fluorescein angiographic signs in Fuchs' uveitis in conjunction with other clinical signs. Patients seen at the Centre for Ophthalmic Specialised Care (COS) in Lausanne and the Memorial A. de Rothschild, Clinique Générale-Beaulieu in Geneva between 1995 and 2008 with the diagnosis of Fuchs' uveitis and who had undergone a fundus fluorescein angiography (FFA) were analysed. In addition to FFA signs, the data collected included age, gender, initial and final visual acuities, clinical findings at presentation, mean diagnostic delay and ocular complications. Between 1995 and 2008, 105 patients seen in our centres in Lausanne and Geneva were diagnosed with Fuchs' uveitis. Forty of them (38.1%) had undergone at least one FFA. One patient was excluded because of a concomittant diagnosis of multiple sclerosis. In 28 of 39 patients (71.2%) diagnosis was not reached at presentation with a mean diagnosis delay of 3.67 ± 4.86 years (range: 1 month-24 years). The original erroneous diagnosis was intermediate uveitis in 16 patients (57.1%), posterior uveitis in two patients (7.1%), panuveitis in four patients (14.3%) and anterior granulomatous uveitis in six patients (21.4%). Fluorescein angiography demonstrated the presence of disc hyperfluorescence in 43/44 eyes (97.7%), sectorial peripheral retinal vascular leaking in 6/44 eyes (13.6%) and cystoid macular oedema in 4/44 eyes (9.1%), all of which were seen in eyes having undergone cataract surgery. Fuchs' uveitis was bilateral in 5/39 patients (12.8%). The most frequent clinical signs were vitritis in 42/44 eyes (95.5%), stellate keratic precipitates in 41 eyes (93.2%), posterior subcapsular opacities or cataract in 19 eyes (43.2%), and heterochromia in 19 eyes (43.2%). Fuchs' uveitis is a largely underdiagnosed uveitis, probably because the predominant vitreous involvement is ignored by many ophthalmologists. In addition, the nearly constant inflammatory fluorescein angiography findings reported here such as disc hyperfluorescence and, more rarely, peripheral retinal vascular leaking, are not well known and are not usually associated with Fuchs' uveitis but represent an additional factor leading to misdiagnosis. These findings need to be recognised in order to reduce diagnostic delay.

Spectrum of Fuchs Uveitic Syndrome in a North Indian Population

“…It is important to consider FUS in uveitic eyes with prominent vitreous inflammation/debris with FA showing disc hyperfluorescence and absence of CME. 24 Bouchenaki et al 32 suggested that the high frequency of disc hyperfluorescence fundus fluorescein angiography could be due to an inflammatory breakdown of the blood-ocular barrier, or secondary to mechanical traction by a heavily infiltrated vitreous proximal to the optic disc. However this could not be found in the present series.…”

Viral anterior uveitis

“…The features described in these eyes include the presence of chronic persistent iritis, diffuse, fine, stellate keratic precipitates, diffuse iris atrophy and/or heterochromia, absence of posterior synechiae, posterior subcapsular cataract formation, vitritis, sectoral peripheral retinal vascular leakage, disc hyperfluorescence on fluorescein angiography and the development of cystoid macula oedema after cataract surgery [45 ]. The patients may be asymptomatic or present with floaters or visual loss from cataract formation or glaucoma.…”

Laser flare photometry and its use in uveitis

“…A relatively mild disruption of the blood-aqueous barrier has been shown in eyes with Fuchs' uveitis (FU), with mean flare values ranging from 6.4 to 12.1 ph/ms that were still significantly higher compared with fellow eyes or eyes of healthy controls [32][33][34][35][36][37]. It is noteworthy that flare levels do not change with anti-inflammatory Review CME treatment and remain stable over months or years in this entity [7,37,38].…”

“…It is noteworthy that flare levels do not change with anti-inflammatory Review CME treatment and remain stable over months or years in this entity [7,37,38]. A relatively mild and stable breakdown of the blood-aqueous barrier has been reported in FU even after cataract surgery [33,36,39,40].…”