Fuchs syndrome in ophthalmology is a non-granulomatous uveitis, present in a chronic form, which is indicated by the smooth formation of the disease. In the early stages, as a rule, only one eye is affected. The disease is noticed at any age, it is extremely rarely bilateral. Fuchs syndrome occurs in 4% of absolutely all uveitis, and is very often misdiagnosed. The change in eye color may not occur or be difficult to detect, especially in those with brown eyes, if the patient is not examined in normal light. Learn more about the symptoms and treatment of eye uveitis next.
Causes of occurrence
The prerequisites leading to the appearance of the syndrome remain unclear today. There is an assumption that there is a connection between the disease and toxoplasmosis, in its ocular form, but there is still no concrete evidence for this hypothesis. Histological studies reveal lymphocytes and plasma cells, which indicates the inflammatory nature of this pathology. Of courseit remains unclear whether Fuchs syndrome can be called an independent disease, or whether it involves only a counter reaction of eye structures to certain conditions.
Symptoms
Corneal precipitates are considered the main characteristic pathognomonic indicator of the disease. They are rather small, have a rounded or star-shaped shape, gray-white tone and cover the entire corneal layer. Precipitates come and go, but are not pigmented and do not coalesce. Among the corneal formations, it is possible to identify soft fibrin fibers. An equally important sign is the fog before the eyes.
The detectable amount of aqueous humor opalescence is low, with cell numbers up to +2. The main symptom of the disease can be considered cellular infiltration of the glassy body.
When gonioscopy changes are not detected or the following are formed:
- Small arteries placed radially in the corners of the eye in front, resembling twigs. They activate the occurrence of hemorrhages in this place on the reverse side of the puncture.
- Transillumination of the eye.
- Membranes in the foreground.
- Anterior synechia of small volume and uneven shape.
Change in color of the iris
The following changes stand out:
- After cataract extraction, posterior synechiae form.
- Hemiatrophy of the stroma of the iris of a scattered nature.
- No iris crypts (is an earlyindicator). With the subsequent formation of stromal atrophy, the iris fades and turns white, especially in the pupil area. There is a protrusion of the radial vessels of the iris due to the loss of the underlying tissue.
- When retroillumination is caused by spotted atrophy of the posterior pigment cover.
- Iris nodules.
- Rubeosis of the iris is quite common, characterized by the appearance of an irregular shape, gentle neovascularization.
- Due to atrophy of the sphincter of the pupil, mydriasis is formed.
- Sometimes there are crystalline deposits in the iris.
- A significant and often common criterion is heterochromia of the iris.
Other signs
Iris hypochromia is especially common. Very rarely, this disease is considered congenital.
The appearance of heterochromia of the iris is determined by the correspondence of stromal atrophy and the level of pigmentation of the posterior endothelium, the occurrence at the gene level of a certain color of the iris.
Predominant stromal atrophy allows translucence of the posterior pigment layer of the endothelium and the formation of a hyperchromic iris.
Dark irises become clearer, blue irises become more saturated.
Diagnosis
Eye examination is based on external examination data as well as the results of various procedures. When conducting an external examination, the level of heterochromia of the iris is assessed, the degree can be qualified from doubtful to clearly manifested. Questionable resultsor lack of heterochromia are seen in patients with binocular lesions. Biomicroscopy technology makes it possible to detect corneal precipitates, the volume of which depends on the severity of the Fuchs syndrome.
The appearance of delicate translucent formations, which in the rarest cases include pigment inclusions, matters. In 20-30% of patients, mesodermal Boussac's nodules are formed on the surface of the iris, and Keppe's nodules are formed along the edge of the pupil. Performing an ultrasound of the eye in B-mode can indicate a focal or scattered change in the texture of the iris. Precipitates in Fuchs syndrome are visualized as hypoechoic formations.
Keratoesthesiometry diagnoses the degree of reduction in corneal receptivity. When diagnosing the anterior part of the eye using the gonioscopy method, it can be determined that the eye chamber is accessible for inspection and has an average width. The formation of secondary glaucoma in this disease leads to a gradual narrowing of its lumen with subsequent closure. During the diagnosis, the ophthalmologist in St. Petersburg will determine that the intraocular pressure is normal or slightly increased.
The secondary form of the disease is accompanied by an IOP above 20 millimeters of mercury. The implementation of invasive interventions is accompanied by the formation of filiform hemorrhage. This is due to a sudden decrease in IOP. The appearance of complications in Fuchs syndrome leads to a decrease in visual acuity, which is detected in the process of visometry.
Treatment
The strategy for the prevention and treatment of Fuchs syndrome is determined depending on the stage of the disease and the severity of secondary complications. At the first stages, specific therapy is not carried out. Color correction occurs when using cosmetic colored lenses. But already at the later stages of the disease, local and systemic therapy is recommended, aimed at correcting trophic processes.
Angioprotectors, nootropics, vasodilators and vitamins have been introduced into the Fuchs syndrome treatment complex. In case of formation of a significant number of precipitates, the course of treatment procedures should be extended with corticosteroids for local use in the form of drops and enzyme therapy should be carried out.
Medicated treatment
When forming a secondary posterior subcapsular cataract in the initial stages of the development of Fuchs syndrome, drug therapy is recommended. In the absence of a result, microsurgical intervention is practiced, which implies fragmentation of the lens nucleus with simultaneous installation of an intraocular lens implant. The appearance of secondary glaucoma is regarded as a sign of the need for local antihypertensive therapy simultaneously with the main course of treatment of the disease.
Forecast and prevention
As such, no means and methods for the prevention of Fuchs syndrome have been found. Patients with this pathology should visit an ophthalmologist every six months to carry out all the necessary diagnostic methods in order to early identify subsequent complications incataract and glaucoma. In addition, it is recommended to adjust the diet with the inclusion of a significant number of vitamins, the organization of sleep and rest.
The prognosis for this disease to continue a full life and the ability to work more often is positive. For a long time, the disease is latent, but, in the event of the subsequent development of cataracts or glaucoma, complete loss of vision is likely with a long period of time, the disease has a latent course, however, in the case of secondary cataract or glaucoma, absolute loss of vision is likely with assignment of a disability group.
