Fuchs syndrome in ophthalmology is non-granulomatous uveitis, present in a chronic form, which is indicated by the smooth formation of the disease. In the first stages, in this case, as a rule, only one eye is affected. The disease is noticed at any age, it is rarely bilateral. Fuchs syndrome occurs in 4% of absolutely all uveitis, and very often is misdiagnosed. A change in eye color may not occur, or may be difficult to determine, especially for those who have brown eyes, if the patient is not examined in normal light. In more detail about the symptoms and treatment of uveitis of the eye on.
Causes of occurrence
The prerequisites leading to the appearance of the syndrome remain incomprehensible 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 of this hypothesis. Histological studies detect lymphocytes and plasma cells, which indicates the inflammatory nature of this pathology. Of course, it remains unclear whether Fuchs syndrome can be called an independent disease, or whether it involves only a counter reaction of the eye structures to certain conditions.
Symptoms
The main characteristic pathognomonic indicator of the disease are considered corneal precipitates. They are quite small, have a rounded or star-shaped shape, the tone is gray-white and cover the entire layer of the cornea. Precipitates arise and disappear, but are not pigmented or combined. From among the corneal formations, it is possible to identify soft fibrin fibers. No less important sign is fog before the eyes.
The determined amount of opalescence of aqueous humor is low, with the number of cells up to +2. The main symptom of the disease can be considered cell infiltration of the vitreous.
With gonioscopy, changes are not detected or the following are formed:
- Small radially placed arteries in the corners of the eye in front, resembling twigs. They activate the occurrence of hemorrhages in this place on the back of the puncture.
- Transillumination of the eye.
- Membranes in the foreground.
- Anterior synechiae of small volume and irregular shape.
Change in iris color
The following changes are distinguished:
- After cataract extraction, posterior synechiae form.
- Hemiatrophy of the stroma of the iris of a diffuse nature.
- No crypts of the iris (an early indicator). With the subsequent formation of stromal atrophy, the iris fades and whitens, especially in the pupil. There is a protrusion of the radial vessels of the iris due to the loss of the underlying tissue.
- With retroillumination, spotty atrophy of the posterior pigmentosa is caused.
- Nodules on the iris.
- Quite often there is iris rubeosis, 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 symptoms
Especially often observed hypochromia of the iris. Very rarely, this disease is considered congenital.
The appearance of iris heterochromia is due to the correspondence of stromal atrophy and the level of pigmentation of the posterior endothelium, the appearance of a certain color of the iris at the gene level.
The predominant stromal atrophy allows transmission of the posterior pigment layer of the endothelium and the formation of hyperchromic iris.
The iris of dark color becomes clearer, blue acquires a tone more saturated.
Diagnostics
Eye examination is based on data from an external examination, 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 qualify from dubious to clearly manifested. Doubtful results or a lack of heterochromia can be 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 gentle translucent formations, which in rare cases include pigment inclusions, matters. In 20-30% of patients on the surface of the iris, mesodermal nodules of Busssak form, and on the edge of the pupil - Keppe nodules. Performing an ultrasound of the eye in B-mode can indicate a focal or diffuse change in the texture of the iris. Precipitates in Fuchs syndrome are visualized in the form of hypoechoic formations.
With keratoesthesiometry, a degree of reduction in corneal susceptibility is diagnosed. When diagnosing the front of the eye using the gonioscopy method, it can be determined that the camera of the eye is accessible for examination and has an average width. The formation of secondary glaucoma in this disease leads to a gradual narrowing of its lumen with subsequent closure. When diagnosing, an ophthalmologist in St. Petersburg will determine that intraocular pressure is normal or slightly increased.
The secondary form of the disease is accompanied by an IOP indicator 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 with 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 minor complications. In the first stages, specific therapy is not performed. Color correction occurs when using cosmetic colored lenses. But already at the later stages of the disease, local and systemic therapy, aimed at correcting trophic processes, is recommended.
Angioprotectors, nootropics, vasodilators and vitamins are introduced into the complex for treating Fuchs syndrome. In the case of the formation of a significant number of precipitates, the course of medical procedures should be expanded with corticosteroids for topical use in the form of drops and enzyme therapy should be carried out.
Drug treatment
With the formation of 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 the simultaneous installation of an implant of an intraocular lens. 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, funds and methods for the prevention of Fuchs syndrome were not found. Patients with this pathology should visit an ophthalmologist once every six months to conduct all the necessary diagnostic methods with the aim of early detection of subsequent complications in the form of cataracts and glaucoma. In addition, recommended dietary adjustment 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 is often positive. For a long time, the disease proceeds secretly, but in the event of the subsequent development of cataracts or glaucoma, complete loss of vision is likely to occur.