Delay in the Diagnosis of Fuchs' Uveitis and its Deleterious Consequences

Abstract

Abstract: : Purpose. Fuchs’ uveitis is very often diagnosed with substantial delay at the origin of deleterious effects such as unnecessary treatment and its consequences. The aim of the study was to analyse the proportion of undiagnosed Fuchs cases seen in a secondary referral centre, the mean delay of diagnosis, the reasons for such a delay and its consequences. Patients and Methods: Patients seen at the Uveitis Clinic at la Source Eye Centre between 1995 and 2002 with the diagnosis of Fuchs’ uveitis were analysed. The proportion of cases with a delayed diagnosis, the mean diagnostic delay, the original erroneous diagnosis, the disease characteristics and the severe deleterious effects were recorded.Results: Between 1995 and 2002, 62/742 new patients seen (8.35%)seen at La Source Eye Centre were diagnosed with Fuchs’ uveitis. In 49/62 cases (79%) diagnosis was delayed for a mean of 3.67+/- 4.34 years (range 1 month to 20 years). The original erroneous diagnosis was intermediate uveitis in 27/49 cases (55%), posterior uveitis in 6 (12%), panuveitis in 5 (10%) and granulomatous uveitis in 5 patients (10%). Fuchs’ uveitis was bilateral in 6/62 cases (12%). The most frequent signs were vitritis in 66/68 eyes (97%), stellate keratic precipitates in 64 (94%), posterior subcapsular opacities or cataract in 41 (60%), heterochromia in 23 (42.6%),Koeppe nodules in 9 (13%), abnormal vessels in the iridocorneal angle in 9 (13%). The mean initial flare and flare at final follow-up measured by laser flare photometry was 8.62±4.2 photons/ms and 8.45±4.3 ph/ms and the mean initial and final intraocular pressures were 12.61±4.2 and 12.87±4.2 mmHg. Eighteen patients were treated with systemic steroids and 5 patients with additional immunosuppressive drugs. In one case this therapy was nearly lethal because of a subsequent missed Toxoplasma Gondii primoinfection. Conclusions: Fuchs’ uveitis is a largely undiagnosed uveitis probably because the predominant vitreous involvement is ignored by many ophthalmologists. This situation needs to be publicised in order to avoid possibly severe deleterious effects following erroneous systemic corticosteroid and/or immunosuppressive therapy.

Keywords: uvea • inflammation • clinical (human) or epidemiologic studies: pre