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Atypical Bilateral Fuchs Uveitis: Diagnostic Challenges.

Couto C, Hurtado E, Faingold D, Demetrio C, Schlaen A, Zas M, Zarate J, Rosetti S, de Lima AP, Croxatto JO, Chiaradía P, Burnier MN - Case Rep Ophthalmol (2015)

Bottom Line: After extensive systemic workup, including vitrectomy, the case had no identifiable systemic etiology.IVCM of the cornea revealed the presence of dendritiform keratic precipitates.A high index of suspicion is key to an early diagnosis, especially in the cases with vitreous opacities and posterior segment manifestations.

View Article: PubMed Central - PubMed

Affiliation: Uveitis, Retina and Cornea Clinics, Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina.

ABSTRACT

Unlabelled: Bilateral Fuchs uveitis associated with vitreous infiltration and posterior segment involvement requires a thorough diagnostic evaluation. The lack of well-defined diagnostic criteria makes identification of this entity difficult. The aim of this case report was to present the characteristics of a patient with atypical Fuchs uveitis and the procedures needed to rule out the differential diagnosis with specific attention to the utility of in vivo confocal microscopy (IVCM).

Case report: One case of chronic bilateral uveitis with severe vitreous opacities is presented. After extensive systemic workup, including vitrectomy, the case had no identifiable systemic etiology. IVCM of the cornea revealed the presence of dendritiform keratic precipitates.

Conclusion: The diagnosis of Fuchs uveitis is based on clinical findings as no confirmatory laboratory tests are available. A high index of suspicion is key to an early diagnosis, especially in the cases with vitreous opacities and posterior segment manifestations. Auxiliary tests such as IVCM may aid the clinician in the diagnosis of Fuchs uveitis.

No MeSH data available.


Related in: MedlinePlus

Diffuse stellate medium, little KPs and vitreous haze in OU.
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Figure 1: Diffuse stellate medium, little KPs and vitreous haze in OU.

Mentions: A 67-year-old woman presented to the uveitis clinic with a 2-year history of decreased blurred vision in both eyes (OU) without pain or redness. She had had rheumatoid arthritis for 3 years and had been treated with methylprednisolone 30 mg/day and methotrexate 10 mg/week. Her ocular medical history was bilateral chronic anterior uveitis. On examination, the best corrected visual acuity was 20/30 in her right eye and 20/40 in her left eye (OS). IOP was 14 mm Hg in OU. A slit lamp examination of OU revealed diffuse stellate medium and little KPs (fig. 1), 1+ cells and no flare in the anterior chamber and smooth diffuse parenchymal iris atrophy without posterior synechiae. The fundus examination revealed 3+ of vitreous haze in OU in the absence of cataract (fig. 2). Optical coherence tomography could not asses the retina due to vitreous haze, and the fluorescein angiography did not show any posterior inflammatory signs. The workup for infectious uveitis was negative. Sarcoidosis was ruled out with chest imaging (chest CT scan) and laboratory tests (tuberculin skin test and serum angiotensin-converting enzyme).


Atypical Bilateral Fuchs Uveitis: Diagnostic Challenges.

Couto C, Hurtado E, Faingold D, Demetrio C, Schlaen A, Zas M, Zarate J, Rosetti S, de Lima AP, Croxatto JO, Chiaradía P, Burnier MN - Case Rep Ophthalmol (2015)

Diffuse stellate medium, little KPs and vitreous haze in OU.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608646&req=5

Figure 1: Diffuse stellate medium, little KPs and vitreous haze in OU.
Mentions: A 67-year-old woman presented to the uveitis clinic with a 2-year history of decreased blurred vision in both eyes (OU) without pain or redness. She had had rheumatoid arthritis for 3 years and had been treated with methylprednisolone 30 mg/day and methotrexate 10 mg/week. Her ocular medical history was bilateral chronic anterior uveitis. On examination, the best corrected visual acuity was 20/30 in her right eye and 20/40 in her left eye (OS). IOP was 14 mm Hg in OU. A slit lamp examination of OU revealed diffuse stellate medium and little KPs (fig. 1), 1+ cells and no flare in the anterior chamber and smooth diffuse parenchymal iris atrophy without posterior synechiae. The fundus examination revealed 3+ of vitreous haze in OU in the absence of cataract (fig. 2). Optical coherence tomography could not asses the retina due to vitreous haze, and the fluorescein angiography did not show any posterior inflammatory signs. The workup for infectious uveitis was negative. Sarcoidosis was ruled out with chest imaging (chest CT scan) and laboratory tests (tuberculin skin test and serum angiotensin-converting enzyme).

Bottom Line: After extensive systemic workup, including vitrectomy, the case had no identifiable systemic etiology.IVCM of the cornea revealed the presence of dendritiform keratic precipitates.A high index of suspicion is key to an early diagnosis, especially in the cases with vitreous opacities and posterior segment manifestations.

View Article: PubMed Central - PubMed

Affiliation: Uveitis, Retina and Cornea Clinics, Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina.

ABSTRACT

Unlabelled: Bilateral Fuchs uveitis associated with vitreous infiltration and posterior segment involvement requires a thorough diagnostic evaluation. The lack of well-defined diagnostic criteria makes identification of this entity difficult. The aim of this case report was to present the characteristics of a patient with atypical Fuchs uveitis and the procedures needed to rule out the differential diagnosis with specific attention to the utility of in vivo confocal microscopy (IVCM).

Case report: One case of chronic bilateral uveitis with severe vitreous opacities is presented. After extensive systemic workup, including vitrectomy, the case had no identifiable systemic etiology. IVCM of the cornea revealed the presence of dendritiform keratic precipitates.

Conclusion: The diagnosis of Fuchs uveitis is based on clinical findings as no confirmatory laboratory tests are available. A high index of suspicion is key to an early diagnosis, especially in the cases with vitreous opacities and posterior segment manifestations. Auxiliary tests such as IVCM may aid the clinician in the diagnosis of Fuchs uveitis.

No MeSH data available.


Related in: MedlinePlus