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Fuchs' Heterochromic Iridocyclitis

FHI


Presentation

  • We present the clinical features observed in 77 patients (89 eyes) seen in the Uveitis Clinic at Leicester Royal Infirmary over a 2-year period. The most common presenting symptom was visual deterioration (96.1%) rather than pain (18.2%).[ncbi.nlm.nih.gov]
  • Diagnosis [ edit ] Diagnosis is made by an ophthalmologist or optometrist based on the clinical presentation.[en.wikipedia.org]
Mediastinal Lymphadenopathy
  • Chest X-ray showed mediastinal lymphadenopathy in two cases. Biopsy diagnosis of sarcoidosis was made in one case, while in the second case, the diagnosis of sarcoid was made on the basis of the ancillary laboratory investigations.[joii-journal.springeropen.com]
Recurrent Inflammation
  • The eye that tested positive for HSV (Figure 1 ) had a history of recurrent inflammation, increase in IOP, pigmented KPs, and irregular iris stromal atrophic areas.[joii-journal.springeropen.com]
Camping
  • SICS in complicated cataracts can be performed in rural settings and eye camps with minimal instrumentation, obviating the need for referral to tertiary care centers.[nepjol.info]
Muscular Atrophy
  • The ciliary body shows stromal fibrosis with muscular atrophy. Pathophysiology Add text here Primary prevention Add text here Clinical diagnosis of exclusion based on history and physical findings. Laboratory testing is of no value.[eyewiki.org]
Confusion
  • Fuchs originally referred to it as dystrophia epithelialis … Wikipedia Heterochromia iridum — Not to be confused with Heterochromatin or dichromatic (disambiguation).[medicine.academic.ru]

Workup

  • Workup should be performed to rule out other causes of uveitis.[eyewiki.aao.org]
  • The possible causes are quite numerous and a medical workup will likely be undertaken. A definitive cause can only be found about half of the time or less.[medhelp.org]
Helicobacter Pylori

Treatment

  • 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.[ncbi.nlm.nih.gov]
  • Surgical treatment, other than what is necessary for removal of glaucoma or cataracts, is not usually possible.[wisegeek.com]
  • Beginning with the basic principles of the disease, its diagnosis and management, the following sections discuss the treatment of numerous different infectious, non infectious, masquerade and autoimmune syndromes.[books.google.com]

Prognosis

  • Abstract After reviewing the records of 111 patients with Fuchs' heterochromic iridocyclitis, we studied the therapy and prognosis of secondary glaucoma in 30 of these 111 patients (27%) who had glaucoma or could be considered glaucoma suspects.[ncbi.nlm.nih.gov]
  • Fuchs' heterochromic iridocyclitis (FHI) is a chronic, low grade, usually unilateral, ocular inflammatory disease with a good visual prognosis.[eyewiki.org]
  • Treatment and prognosis of secondary glaucoma in Fuchs’ heterochromic iridocyclitis. Am J Ophthalmol. 1993;116:327–40. CrossRef PubMed Google Scholar 26. Da Mata A, Burk SE, Netland PA, et al.[link.springer.com]
  • Inflammation: most cases do not require therapy, with patients generally having a good prognosis despite the persistent inflammation.[eyewiki.aao.org]
  • Clinical features and prognosis in Fuchs' uveitis syndrome. Arch Ophthalmol 1982;100:1622–1626. 22. Alanko HI, Vuorre I, Saari KM. Characteristics of corneal endothelial cells in Fuchs' heterochromic cyclitis.[synapse.koreamed.org]

Etiology

  • A role of embryologic factors in neural crest cells in the etiology of both diseases cannot be excluded.[ncbi.nlm.nih.gov]
  • Etiology Historical etiological theories for FHI included sympathetic denervation, which could account for iris hypochromia, and infectious etiologies such as herpes simplex virus, toxoplasma, and cytomegalovirus (CMV).[glaucomatoday.com]
  • Etiology While the exact etiology of FHI remains unknown, several associations have been proposed, suggesting a multi-factorial disease process.[eyewiki.aao.org]
  • While the etiology is unknown, there are several hypotheses linking the disorder to an infectious etiology, such as rubella or toxoplasmosis. Patients typically do not require treatment for their uveitis.[link.springer.com]

Epidemiology

  • Epidemiologic relationship between Fuchs’ heterochromic iridocyclitis and the United States rubella vaccination program. Am J Ophthalmol. 2007;144(3):424–8. CrossRef PubMed Google Scholar 13. Norrsell K, Sjodell L.[link.springer.com]
  • Epidemiology of uveitis. Int Ophthalmol Clin. 2005; 45(2):1-13. Quentin CD, Reiber H. Fuchs heterochromic cyclitis: rubella virus antibodies and genome in aqueous humor. Am J Ophthalmol. 2004;138(1):46-54. Gordon L.[glaucomatoday.com]
  • The epidemiologic association of Fuchs’ heterochromic Iridocyclitis and ocular toxoplasmosis. Am J Ophthalmol 1991; 111:356-62. Arffa RC, Schlaegel TF. Chorioretinal scars in Fuchs’ heterochromic Iridocyclitis. Arch Ophthalmol 1984; 102:1153-5.[eyewiki.aao.org]
  • Br J Ophthalmol 1995, 79 (11):1021–1023. 10.1136/bjo.79.11.1021 PubMed Central PubMed View Article Google Scholar Birnbaum AD, Tessler HH, Schultz KL, Farber MD, Gao W, Lin P, Oh F, Goldstein DA: Epidemiologic relationship between Fuchs heterochromic[joii-journal.springeropen.com]
  • Epidemiological characteristics of uveitis in Switzerland. Int Ophthalmol 1994-95;18(5):293-8. Quentin CD, Reiber H. Fuchs heterochromic cyclitis: rubella virus antibodies and genome in aqueous humor. Am J Ophthalmol 2004 Jul;138(1):46-54. Vol.[reviewofoptometry.com]
Sex distribution
Age distribution

Pathophysiology

  • The appearance of a hyphema after peribulbar anesthesia in Fuchs' heterochromic iridocyclitis is an unusual sign that may have the same pathophysiology as the Amsler-Verrey sign.[ncbi.nlm.nih.gov]
  • Pathophysiology Add text here Primary prevention Add text here Clinical diagnosis of exclusion based on history and physical findings. Laboratory testing is of no value. History Floaters and visual deterioration.[eyewiki.org]
  • We are unaware of any other cases presenting with both Horner and Waardenburg syndromes and believe that this case serves as an excellent opportunity to briefly review the pathophysiology involved with these disorders.”[neuro-ophthalmology.stanford.edu]

Prevention

  • We believe that finding the way these entities connect can shed some light into their complex pathogenesis and help find ways to foresee and prevent the appearance of complications such as cataract and macular edema.[journalretinavitreous.biomedcentral.com]
  • Pathophysiology Add text here Primary prevention Add text here Clinical diagnosis of exclusion based on history and physical findings. Laboratory testing is of no value. History Floaters and visual deterioration.[eyewiki.org]
  • Filtering surgery is successful in preventing IOP spikes and for long-term IOP control. 17 We start with medical therapy, which includes prednisolone 1% and topical drops to lower IOP and reserve incisional surgery for refractory cases.[glaucomatoday.com]
  • Early detection and treatment could prevent vision loss. See an eye care professional right away if you have a sudden change in vision, if everything looks dim, or if you see flashes of light.[icdlist.com]
  • The position of the Argon iridotomy in this case is preferably supero-nasal to prevent injury to the macula.[intechopen.com]

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