2. Fuch,s Heterachromic Uvitis
K.Nasrollahi MD
Feiz Hospital 1390

3. -Accounting for up to 5% of uveitis in some populations
-First time was described in 1906 in a group of 38 patients by Dr.Ernest fuchs,
-Accounting for up to 5% of uveitis in some populations
- Its cause remain unknown

4. - The epidemiology suggests that this is a purely ocular disorder
- But occasional is associated with parry romberg syndrome of hemifacial atrophy
- It has been suggested that toxoplasmosis maybe linked to some cases of F.H.U

5. - F.H.U is characteristically unilateral - The incidence of Bil disease is 8% - Most cases present in early adulthood but congenital heterochromia & childhood onset also reported .

6. - The most common reason for presentation is floaters (because of vit opacification) - Heterochromia - Ocular discomfort - Chronic intermitent periocular pain & headache

7. - Cilliary injection and ant
- Cilliary injection and ant.uveitis usually are not present but may by seen occasionally - Mild presence of cell & flare in AC - KP are typically numeroces -Moderate in size , transluscent and greyish - Scattered over the whole corneal endothelium

8. - Mutton fat kps , finekps – inferior spindle are not features of F. H
- Mutton fat kps , finekps – inferior spindle are not features of F.H.U and should suggest another diagnosis.

9. - Iris nodules are an important feature - F. H
- Iris nodules are an important feature - F.H.U is probably the most common cause of iris nodules - They are most prominent on the pupillary side of the colarete - Small , domed and Traslucent .

10. - Heterochromia being only end – stag manifestation of F.H.U
- The Heterochromia is the most well-known feature of F.H.U
- Heterochromia being only end – stag manifestation of F.H.U
- Is due to atrophic changes & depigmentation of ant surface & stroma of iris

11. - In some cases stromal atrophy becomes profound allowing visualization of the brown pigmented epitheliun from the ant aspect which is called inverse heterochromia

12. - Post synechia are not seen in F. H
- Post synechia are not seen in F.H.U (rares) - Sometimes dilation of the pupil will reveal radial smears of iris pigment on the anterior lense surface.

14. An abnormality of antrior segment vasculature is an important feature
- Vascular fragibility and an increased tendency to bleed - Minor bleeding in to the AC angle (Amsler,s sign) is a constant accompaniment to intraoculr surgery. - Recurrent hyphema is occasionally recorded

15. - Occasionally minor trauma such as eye rubbing may cause microscopic hyphema - More rarely significant vitreons hemorrhage has been observed.

16. - Rarely iris neovascularization is seen -AC angle rubeosis may be seen that should be diagnosed from normal iris vessel after iris atrophy. - A few eyes have been enucleated because of neovascular glaucoma in F.H.U - It is interesting that no evidence of post – segment ischemia seems to accompany such chenges

17. Glaucoma
- Is the most problematic feature of F.H.U - It is common = ¼ of cases. - It is usually present when the pt . Presents to ophthalmologist. - The most likely percipitant being cataract surgery - Is responsive to mepdical TX - Only a minority require surgical drainage

18. Cataract
P.S.C can be expected in great majority of patient with F.H.U

19. Vitreous opacification
- It can be highly significant - Opacities are usually wide spread & fibrillary - Small inferier snow balls may be seen - Parsplana exudate is not seen - In some pts vitrectomy may be necessary after cat ext.

20. Macular Edema
- Is rare in F.H.U ever after cat,xt
- In some cases its presence serves to diffrentiate F.H.U from intermediate uveites

21. - It has been suggested that toxo may be the cause in some cases
- Focal choryoretinal scarring or macular scar suggest previous toxoplasma infection
- It has been suggested that toxo may be the cause in some cases

23. Dingnosis
-The etiology of F.H.U is unknown - There is no diagnostic test - Diagnosis is mostly clinical - Bilateral cases requires a more careful observation

24. Diff Dingnosis
- Posner – schlossman syndrome causing heterochromia and glaucoma with mild uveitis - Unilateral intermediate uveitis may cause heterochromia

25. Management
- The frequent misdiagnosis of F.H.U lead to the automatic use of topical steroid XT
- This may lead to cat & glaucoma formation
- It is better to use topical steroids only in specific situations such as:
1- Dense accumulation of KPS
2- Percipitates on the post lense surface
3- In the cases with flare – unps of inflamation
4- At the time of intraocular surgery

26. Management of cataract
-The majority of pts with F.H.U require cat ext - Most often in 4th to 5th decade - Phaco IOL ( intra bag ) is the best method

27. - Topical steroids from 2 weeks preop Q6h - After operation Q2h for first few dayes - Periocular steroid injection at the time of surgery - Continue topical steroid at least 3 wks postop Q6h

28. Management of glaucoma
- Medical TX of glaucoma is the first choice - Some pts reuire drainage surgery - It is better to combine surgery with antimetabolites