Intraocular rubella virus antibody detection as a diagnostic tool for atypical forms of Fuchs uveitis

Abstract

Purpose: To analyze the clinical profile and prognosis of rubella virus-associated uveitis.

Methods: All patients managed between January 2009 and August 2013 for an atypical form of Fuchs uveitis were included in this study. Clinical features for these patients were assessed. An extensive work-up of anterior or intermediate uveitis was performed in all cases. An anterior chamber tap was performed for molecular detection of herpesviruses and intraocular anti-rubella virus antibody synthesis. Treatment was adapted to the results of ocular fluids analysis.

Results: The series included 27 patients (M/F : 14/13) with a proven diagnosis of rubella virus-associated uveitis. The mean age was 39.6 years (23-67). All patients had an intraocular antibody production against rubella virus with a Goldmann-Witmer coefficient > 3. Only 7 patients (23%) fulfilled the classical criteria of Fuchs cyclitis with stellar keratic precipitates, heterochromia/iris atrophy, cataract and vitritis. 15 patients (48%) had a posterior subcapsular cataract requiring surgery. Mean laser flare meter values were 13.8 ph/ms. 18 patients (58%) had vitritis. Uveitis was bilateral in 4 patients (15%) and 10 patients (32%) had an uncontrolled IOP requiring filtering surgery.

Conclusions: For most of these patients, intraocular rubella virus antibody production allowed the final diagnosis of Fuchs uveitis despite incomplete clinical criteria. Intraocular rubella virus detection can help to establish the diagnosis of atypical forms of Fuchs cyclitis. This avoids unnecessary additional tests and prescription of local or systemic corticosteroids. Secondary glaucoma remains a major complication and needs an appropriate management in order to avoid a poor visual outcome.

Keywords: 746 uveitis-clinical/animal model • 557 inflammation • 568 intraocular pressure