Fuchs uveitis syndrome is a chronic non-granulomatous uveitis characterized by iris depigmentation, with approximately 90% of cases being unilateral. This condition is also known as Fuchs heterochromatic iridocyclitis or Fuchs heterochromic uveitis, among other names.
Clinical Manifestations
Symptoms may include blurred vision, floaters, and significant vision loss if complicated by cataracts or secondary glaucoma. On examination, medium-sized keratic precipitates (KPs) or stellate KPs with a diffuse distribution may be observed, accompanied by mild anterior chamber flare and a small number of cells. Diffuse depigmentation of the iris is present; however, due to the dense iris pigmentation in Chinese patients, this typically does not result in heterochromia. Koeppe nodules may appear, but posterior synechiae do not develop. Subcapsular opacities of the posterior lens and increased intraocular pressure may occur, with opacity and cellular infiltration often seen in the anterior vitreous.
Diagnosis
Diagnostic criteria include required signs and ancillary signs. The required signs are as follows:
- Diffuse iris depigmentation.
- Absence of posterior synechiae.
- Mild anterior chamber inflammatory response.
Ancillary signs may include unilateral involvement, cataracts, vitreous opacities, absence of signs of acute inflammation, and characteristic iris nodules. A diagnosis can be established based on the presence of all three required signs, with the ancillary signs serving as supportive evidence in certain cases.
Treatment
Treatment generally does not require corticosteroid eye drops or systemic therapy. For cases with significant anterior chamber inflammation, short-term topical therapy may be utilized. Complicated cataracts can be managed through phacoemulsification and intraocular lens implantation, with most cases achieving favorable outcomes. Elevated intraocular pressure can be addressed with ocular hypotensive medications, and in rare cases, glaucoma surgeries may be necessary.