|Year : 1982 | Volume
| Issue : 5 | Page : 473-474
Fuch's heterochromic cyclitis
IS Jain, Amod Gupta, DN Gangwar, SP Dhir, RL Kaul
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
I S Jain
Prof. of Ophthalmology, PGI, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain I S, Gupta A, Gangwar D N, Dhir S P, Kaul R L. Fuch's heterochromic cyclitis. Indian J Ophthalmol 1982;30:473-4
The Syndrome of heterochromic cyclitis first described by Fuchs 1 is characterised by a triad of heterochromia, it is atrophy and keratis precipitates (KPs). This study which is the first report of heterochromic cyclitis from India. It was carried out to review the clinical picture, histopathology and results of cataract surgery in a series of such cases.
This study comprises of 29 cases of beterochromic cyclitis which presented to the Eye Department of PGI Chandigarh from the year 1961 to 1980. Heterochromic cyclitis was diagnosed according to the criteria laid down by Kimura 2 All cases were personally examined and kept under observation by the senior author. Iridectomy specimens of some of the patients undergoing cataract extraction were subjected to histopathology examination by the Armed Forces Institute of Pathology, Washington, DC, USA. Operative and postoperative complications in patients who underwent cataract surgery were recorded.
| Materials and methods|| |
| Observations and discussion|| |
Of the 28 cases were studied clinically, there were 22 males and 6 females. Age at the time of presentation varied from 18 to 57 years with a mean age of 33.6 years in males and 28.3 years in females. Duration of symptoms varied from 6 weeks to 10 years (Mean duration 2.10 years) prior to the diagnosis of heterochromic cyclitis. Of the 28 cases, uniocular involvement were seen in 27 cases and binocular involvement in one case (3.56%). Visual acuity was only perception of light in the majority (14 eyes). It was less than 6/60 in 5, 6/60 to 6/24 in 7 eyes. Only 3 eyes had better than 6/18 visual acuity.
Keratic precipitates were generally white, small to medium size in 26 eyes. Few patients also showed stringy KPs.
All the 29 involved eyes showed hypochromia of iris with diffuse stromal iris atrophy giving it a moth eaten, felt like appearance. In addition, 6 eyes also showed presence of peculiar as yet unreported gelatinous elevations over the surface of the iris or at the pupillary border. Histopathologically these are aggregation of plasma cells.
Pupil size and reaction were normal in 13 eyes. It was dilated and sluggishly reactioning in 4 showed pupillary border atrophy in 9 and had persistent pupillary membrane in 3 eyes. All the 29 affected showed cataractous changes. Soft mature cataract was seen in 14 eyes, posterior subcap sular cataract with polychromatic lustrue in 5 and had immature cataract in 9 eyes. We saw an unusual case where a female patient presented with a posterior subcapsular cataract and nine years later developed other signs of heterochromic cyclitis viz; iris atrophy, hypochromia and keratis precipitates. Thus it appears that development of cataract may be a part of the syndrome itself rather than complication of a low grade uveitis. One patient had already undergone cataract surgery in the affected eye. Pseudo-exfoliation at the pupillary border and over the lens surface was seen in 3 eyes an unusual finding. Three out of 28 cases were complicated by raised lOP in the affected eye. At the time of presentation, IOP in one case was 30 mm and in the ether 42mm (Schiotz). Gonioscopy in both cases showed op .-n angle and heavy deposits of pigments. Third patient had open angle glaucoma controlled with miotics. Abnormal vascularisation of the anterior chamber angle was noticed only in 3 of the 29 eyes.
19 eyes were subjected to cataract surgery, at an age varying from 20 to 53 yeas s. Planned extracapsular lens extraction was carried out in 15, accidental extracapsular extraction, in 3 and only one had intra capsular cataract extration.
| Complications|| |
Filiform haemorrhage in the anterior chamber from 6 O'clock area encountered in 3 eyes. Vitreous loss on the table occurred in one patient who had associated secondary glaucoma (IOP 30mm).
Hyphaema slight to moderate occurred in 5 eyes (26.3 %) from 2nd to 5th post operative days and resolved spontaneously without sequalae. P.O uveitis occurred in one eye that had vitreous loss already referred to Phacoanaphylactic uveitis developed in two eyes. Both cases resolved with systemic steroid therapy. P.O. shallow A.C. developed in one eye, however, the chamber formed spontaneously. After cataract developed in 4 eyes and necessitated capsulotomy in 2 eyes. The eye which had vitreous loss developed ectropion uvea, rubeosis iridis and dense after cataract. Occlusion pupillae resulted in one eye that suffered from phacoanaphylactic uveitis.
Visual results after cataract surgery
6/6 or better VA was achieved in 4 eyes, 15 eyes 79%) showed 6/12 or better VA.
Histopathology of iris
Histopathology of iridectomy specimens showed stromal atrophy and infiltration by Plasma cells and mononuclear cells. Few clumps of plasma cells were seen at the anterior iris surface. No epithelioid cells were seen. This picture is consistent with chronic non-granulomatous uveitis.
| Summary|| |
This study has been based on 2R cases of heterochromic cyclits. Apart from the usual triad of heterochromia, iris atrophy and keratic precipitates, some very unusual features like gelatinous nodules at the pupillary border or over the surface of iris stroma and pseudoexfoliation of lens capsule with bilateral heterochromic cyclitis were noted. Experience in 19 eyes cataract surgery has been reported.