Prescription glucocorticoid medication and iridocyclitis are associated with an increased risk of senile cataract occurrence: a Mendelian randomization study.

Iridocyclitis and the use of glucocorticoid medication have been widely studied as susceptibility factors for cataracts. However, the causal relationship between them remains unclear. This study aimed to investigate the causal relationship between the development of iridocyclitis and the genetic liability of glucocorticoid medication use on the risk of senile cataracts occurrence by performing Two-sample Mendelian randomization (MR) analyses. Instrumental variables (IVs) significantly associated with exposure factors (P < 5 × 10-8) were identified using published genome-wide association data from the FinnGen database and UK Biobank. Reliability analyses were conducted using five approaches, including inverse-variance weighted (IVW), MR-Egger regression, simple median, weighted median, and weighted mode. A sensitivity analysis using the leave-one-out method was also performed. Genetic susceptibility to glucocorticoid use was associated with an increased risk of developing senile cataracts (OR, 1.10; 95% CI, 1.02-1.17; P < 0.05). Moreover, iridocyclitis was significantly associated with a higher risk of developing senile cataracts (OR, 1.03; 95% CI, 1.01-1.05; P < 0.05). Nonetheless, some heterogeneity in the IVs was observed, but the MR results remained consistent after penalizing for outliers. The estimates were consistent in multivariate analyses by adjusting for body mass index (BMI) and diabetes mellitus type 2 (T2DM). This study provides new insights into the prevention and management of senile cataracts by highlighting the increased risk associated with iridocyclitis and the use of glucocorticoids.

Changes in Etiology of Uveitis in a Single Center in Japan.

Purpose: We investigated the changes in etiology of uveitis at the Uveitis Clinic of Tokyo Medical University Hospital in recent years.Methods: Medical records of patients with uveitis diagnosed between 2011 and 2017 (Group A) and between 2001 and 2007 (Group B) were reviewed.Results: 1,587 patients in group A and 1,507 patients in group B were analyzed. For noninfectious uveitis, frequencies of Vogt-Koyanagi-Harada disease, intraocular lymphoma (IOL) and iridocyclitis in young girls increased, while those of sarcoidosis and Behçet's disease decreased in the recent era. For infectious uveitis, herpetic iridocyclitis, ocular toxoplasmosis, ocular syphilis, and bacterial endophthalmitis increased, while acute retinal necrosis and ocular toxocariasis decreased. Unclassified uveitis decreased, whereas infectious uveitis and IOL increased due to the availability of new diagnostic tests.Conclusion: Etiologies of uveitis have changed over the years. Further development of novel tests and diagnostic criteria would increase definitive diagnosis for unclassified uveitis. (147/150 words).

Incidence of Immune-Mediated Inflammatory Diseases Among Patients With Inflammatory Bowel Diseases in Denmark.

BACKGROUND & AIMS: It is not clear whether the co-occurrence of immune-mediated inflammatory diseases (IMIDs) affects the course of inflammatory bowel diseases (IBD). We investigated the occurrence of IMIDs in relation to onset of IBD and the effects of concurrent IMIDs on IBD outcomes in a nationwide study of the Danish population. METHODS: We used a nationwide cohort of all individuals diagnosed with IBD, including Crohn's disease (CD) or ulcerative colitis (UC), in Denmark from 2007 through 2016 (n = 14,377). Patients were match with individuals without IBD from the general population (controls, n = 71,885). All cohort members were followed from birth until 2016, their migration, or their death. The occurrence of IMIDs was assessed using the Danish national patient register and Registry of Medicinal Products Statistics. RESULTS: A total of 3,235 patients with a diagnosis of IBD (22.5%) has also received a diagnosis of an IMID; most IMIDs occurred before the onset of IBD (n = 2,600, 80.3%). The most common IMIDs observed were psoriasis, asthma, type 1 diabetes, and iridocyclitis. Patients with IBD treated with infliximab were at reduced risk of developing IMIDs (CD adjusted odds ratio [aOR], 0.52; 95% CI, 0.34-0.81 and UC aOR, 0.47; 95% CI, 0.29-0.76). Co-occurrence of IMIDs increased the risk of surgery in patients with CD that developed IMIDs after CD onset (aOR, 2.30; 95% CI, 1.46-4.20) but not in UC. CONCLUSIONS: In a nationwide study of the Danish population, 22.5% of patients with IBD also had at least 1 concurrent IMID. Co-occurrence of IMIDs increased the risk of surgery in patients with CD.

Posner-Schlossman syndrome in Wenzhou, China: a retrospective review study.

AIM: To describe the incidence of Posner-Schlossman syndrome (PSS) in Lucheng District, Wenzhou, China, over a 10-year period. METHODS: We reviewed retrospectively the medical records of all inpatient and outpatient patients diagnosed with PSS during the years 2005-2014 in the Eye Hospital of Wenzhou Medical University. The keywords of 'glaucomatocyclitic crisis', 'Posner-Schlossman syndrome' and 'PSS' were used for the retrieval. Only patients with registered residing address in Lucheng District where the hospital located were finally selected. The cumulative incidence and annual incidence of PSS were calculated based on the sum of household registered population and temporary resident population in Lucheng District. RESULTS: A total of 576 patients with PSS (339 men and 237 women) met the retrieval criteria. The mean age of these subjects at the first clinic visit was 40±15 years. Intraocular pressure (IOP) of the initial record was 31.91±15.37 mm Hg. The 10-year cumulative incidence of PSS in Lucheng District was 39.53 per 100 000 population, whereas the mean annual incidence of PSS in this area was 3.91 per 100 000 population. The majority of these patients were aged 20-59 years (83.9%). Men showed a significantly higher cumulative incidence of PSS than women (p=0.010). Higher rate of newly onset cases was found in spring (31%) than in other seasons (p=0.006). CONCLUSIONS: Our results suggest a relatively high incidence of PSS in Wenzhou, a southeastern city in China. Young, male adults are prone to be affected in spring. However, the aetiology and other risk factors are still waited to be clarified.

Epidemiology and Comorbidity in Children with Psoriasis and Atopic Eczema.

BACKGROUND: First studies have shown that juvenile psoriasis is associated with an increased prevalence of comorbidity. OBJECTIVES: We carried out a data analysis to characterise the profiles of comorbidity in children with psoriasis and atopic eczema. METHODS: Prevalence data were derived from the database of a German statutory health insurance company according to ICD-10 codes L40 (psoriasis) and L20 (atopic eczema) of children up to 18 years insured in 2009. RESULTS: Data sets included 1.64 million persons and 293,181 children. 1,313 children = 0.45% (0.42-0.47) had a diagnosis of psoriasis and 30,354 = 10.35% (10.24-10.47) had a diagnosis of atopic eczema. Obesity, hyperlipidaemia, arterial hypertension and diabetes were more often diagnosed in children with psoriasis in comparison to all children without psoriasis and to those with atopic eczema. CONCLUSION: Children with psoriasis and atopic eczema show different and specific patterns of comorbidity which should be detected early and treated adequately.

Polymorphisms in cytomegalovirus genotype in immunocompetent patients with corneal endotheliitis or iridocyclitis.

Cytomegalovirus (CMV) that caused corneal endotheliitis and iridocyclitis in immunocompetent patients was genotyped. The gB type1 was detected in seven endotheliitis samples (77.8%) and five iridocyclitis samples (100%), and the gB type 3 was detected in two endotheliitis samples (22.2%). The UL144 type 1 was found in five endotheliitis samples (45.5%) and five iridocyclitis samples (83.3%). The UL144 type 2 was found in two endotheliitis samples (18.2%) and one iridocyclitis sample (16.7%). The gB type 1 was predominant in endotheliitis and iridocyclitis, and the CMV genotypes in eyes with endotheliitis and iridocyclitis were similar.

Iridociclitis heterocrómica de Fuchs: una uveítis subdiagnosticada / Fuchs heterochromic iridocyclitis: an underdiagnosed uveitis

Objetivo: caracterizar clínicamente 20 de casos de Iridociclitis Heterocrómica de Fuchs subdiagnosticados por su cuadro clínico. Metodología: estudio observacional, descriptivo y retrospectivo de reporte de 20 casos con evaluación clínica y registro fotográfico. Resultados: fueron evaluados 20 casos referidos a la consulta de uveítis por oftalmología general, de los cuales 13 fueron mujeres (65%) con una edad promedio al momento de la evaluación de 52 años (R= 33-80 años). Diecisiete casos tuvieron compromiso unilateral (85%) y 3 bilateral (15%) para un total de 23 ojos comprometidos. La uveítis fue clasificada como anterior en 20 ojos (86,95%), crónica en 20 ojos (86,95%) y no granulomatosa en el 100% de los casos. El tiempo promedio de evolución de la enfermedad fue de 82 meses (R= 4 - 240 meses), y el tiempo promedio de diagnóstico por especialista en uveítis fue de 1,75 meses (R=0-18 meses). El 100% de los pacientes consultaron por cambios en la agudeza visual, sin manifestación de ojo rojo o dolor. La agudeza visual inicial promedio fue de 20/40 (rango 20/1000-20/20), con una reacción inflamatoria de bajo grado con promedios por debajo de 1+ en todos los signos inflamatorios. La evidencia de precipitados queráticos estrellados difusos típicos se presentó en el 100% de los casos y en el iris se encontró heterocromía en un 50% (10 casos), atrofia del iris en 80% (18 casos) y nódulos (Koeppe y Busacca) en 8 ojos (34,78%). Como complicaciones asociadas se encontró catarata en 10 ojos (43.47%) y glaucoma en 8 ojos (34.78%). Conclusión: las características clínicas de la Iridociclitis Heterocrómica de Fuchs, especialmente lo discreto de sus síntomas y lo sutil de sus cambios biomicroscópicos, específicamente la heterocromía del iris que se sugiere como un marcador clínico importante de esta condición, han llevado a un subdiagnóstico o a un diagnóstico retardado de esta patología, siendo identificada en muchas ocasiones como cuadros de uveítis anterior sin etiología esclarecida y generando tratamientos crónicos con corticoesteroides que a la larga se convierten en factor de riesgo para complicaciones tales como catarata de presentación temprana y glaucoma.

Objetive: clinical characterization of 20 underdiagnosed cases of Fuchs Heterochromic Irido cyclitis. Methods: observational, descriptive and retrospective study report of 20 cases with clinical evaluation and photographic record. Results: a total of 20 cases referred to uveal specialist from general ophthalmology were evaluated. It was found that the group of women with 13 cases (65%) predominated with respect to men 7 cases (35%), the average age at evaluation was 52 years (range 33-80). Twenty three eyes were diagnosed, 17 cases were unilateral (85%) and 3 cases were bilateral (15%). 100% of patients complaint for changes in AV, without red eye or pain. Uveitis was classifi ed as anterior in 20 eyes (86,95%), chronic in 20 eyes (86,95%) and non-granulomatous in 23 eyes (100%). The average time evolution was found in 82 months (R 4-240 months), and the time of diagnosis by uveitis specialist was 1,75 months (0-18 months). Initial AV average found was 0.48 (0,02-1), with a low mean anterior chamber reaction cellularity of 0,80+ cells; fl are 0,69+, average cellularity at anterior vitreous of 0,26+ cells and vitreous opacity was 0,45+. Typical diffuse stellate keratic precipitates were present in 100% cases and heterochromia was found in 10 of cases (50%), iris atrophy in 18 cases (80%) and nodules (Koeppe and Busacca) in 8 eyes (34.78%). Th e average intraocular pressure was found in 15.74 mmHg. Cataract associated complications found in 10 eyes (43.47%) and glaucoma in 8 eyes (34.78%). Conclusión: clinical features in Fuchs Heterochromic Iridocyclitis, has discrete symptoms and subtle biomicroscopic changes; heterochromia is an important clinical marker of this condition, lack of identifi cation of this signs may delay the timely and proper diagnosis. This entity has been confused as anterior uveitis without known etiology and for this reason many ophthalmologists treat these cases with corticosteroids that eventually become a risk factor for complications such as early cataract and glaucoma.

Spectrum of Fuchs uveitic syndrome in a North Indian population.

PURPOSE: To describe patients with Fuchs uveitis syndrome (FUS) in North India. DESIGN: Retrospective case series. METHODS: One hundred ninety-eight eyes of 183 patients with FUS were reviewed at the Post Graduate Institute of Medical Education and Research, Advanced Eye Centre, Department of Ophthalmology, between December 1996 and September 2011. Demographic profile, clinical findings at presentation, risk of new complications, and rate of decreased vision were the main outcome measures. RESULTS: The mean age at presentation was 30.1 ± 9.4 years. Male-to-female ratio was 1.1:1. Fifteen patients (8.1%) had bilateral involvement. Clinical findings at presentation included diffuse keratic precipitates (92.4%), anterior chamber cells (54.5%), diffuse iris atrophy without hypochromia (29.3%), heterochromia (24.7%), iris nodules (16.1%), cataract/pseudophakia (79.3%), vitreous cells (61.1%), elevated intraocular pressure (13.6%), and chorioretinal scars (2%). On fluorescein angiography, hyperfluorescence of the optic disc was detected in 28 of 51 eyes (55%), peripheral vasculitis in 1 (2%) and both in 8 eyes (15.7%). OCT showed traction papillopathy in 6 of 34 eyes (17.6%). None of the eyes showed cystoid macular edema. CONCLUSION: Heterochromia is seen only in 25% of patients with Fuchsheterochromic uveitis in brown irides. Diffuse stellate keratic precipitates, low cellular reaction, vitritis, vitreous opacities, diffuse iris stromal atrophy in the absence of posterior synechia, and macular edema are other parameters helpful in diagnosing FUS.

[Incidence of uveitis in the northern Kyushu region of Japan --comparison between the periods of 1996-2001 and 2003-2008].

PURPOSE: To report the clinical statistical analysis of patients with uveitis in the northern Kyushu region of Japan. SUBJECTS AND METHODS: This retrospective study involved 735 new patients with uveitis who visited the Kyushu university hospital from January 2003 to December 2008. The subjects were classified into four groups; adolescent (0-19 years), young (20-39 years), middle-aged (40-59 years) and old (60 years or older) and were compared with the results of our previous studies. RESULT: This study comprised 343 men and 392 women. The age averaged 47.2 years. Definitive diagnosis was made in 385 cases (52.4%). The most frequent clinical entity was sarcoidosis (9.8%), followed by Vogt-Koyanagi-Harada disease (7.9%), Behçet's disease (7.6%), acute anterior uveitis associated with human leukocyte antigen (HLA)-B27 (4.5%), herpetic iridocyclitis (3.1%), human T-lymphotropic virus type I associated uveitis (HU) (2.7%), and intraocular lymphoma (2.3%). The proportion of unclassified uveitis was large among females in general, and among adolescents in the four groups. The incidence of secondary glaucoma in the whole group of 735 patients with uveitis was 22.2%. Among the patients with ocular hypertension, the proportion of steroid responders was large in the adolescent group. CONCLUSION: Compared with our previous report, this study shows increasing frequency of sarcoidosis and decreasing frequency of Behçet's disease except in the young group. HU showed a decreasing incidence.

Frequency of iridocyclitis in patients with early psoriatic arthritis: a prospective, follow up study.

OBJECTIVE: The occurrence of iridocyclitis (IC) in early psoriatic arthritis (PsA) has been rarely assessed. The primary end-point of this study was to evaluate the frequency of IC at onset in patients with early PsA. METHODS: We evaluated the frequency of IC in a clinical series of consecutive, new outpatients with early PsA observed between January 2000 and December 2009. All patients met the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria for PsA and had a disease duration ≤12 months. The following clinical patterns were considered: peripheral PsA (oligoarthritis ≤4 and polyarthritis ≥5 involved joints), axial PsA and mixed. IC diagnosis was made by the ophthalmologist. Follow-up visits were scheduled at baseline and every 4 months with interval shortening in the case of urgent clinical problems. RESULTS: Two hundred and forty-two patients, 137 (57%) women and 105 (43%) men (mean age 50.33 ± 11.7 years; mean symptom duration 9.38 ± 3.1 months) were studied. One hundred and thirty-two (51%) patients had peripheral PsA, 41 (17%) axial and 69 (28%) mixed. Twenty-six episodes of IC were recorded at diagnosis in 22 (9%) patients, 17 (77.3%) female and five (22.7%) male; 11 (50%) patients had peripheral PsA, two (9.1%) axial, and nine (40.9%) mixed; 5/22 (22.7%) patients were B27-positive. IC recurred in 2/22 (9%) patients over the follow-up period. Mean follow-up duration was 51 ± 23.2 months. Dactylitis was significantly more frequent in patients with IC compared to those without this feature (P = 0.032). CONCLUSION: IC occurred in 9% of 242 patients with early PsA with no association with the clinical pattern and B27 positivity. This frequency is higher than previously reported.

Cataract surgery in camp patients: a study on visual outcomes.

AIM: To assess the complications and visual outcomes associated with cataract surgery in camp patients operated at a tertiary centre. MATERIALS AND METHODS: In a retrospective study, 206 outreach camp patients had undergone cataract surgeries with posterior chamber intraocular lens implantation under peribulbar anesthesia over a period of 6 months. Post-operative complications on Day 1 were graded as per Oxford Cataract Treatment and Evaluation Team (OCTET) definitions. One month postoperative complications, best corrected visual acuity and refractive errors were assessed. RESULTS: 206 eyes underwent cataract extraction with PCIOL implantation. Small incision cataract surgery (SICS) was the commonest method (78.6%) used. The most common first post-operative day complication was mild iridocyclitis (26.2%). The complications were based on OCTET definitions, and showed that 33 % had Grade I and 3.4 % had Grade II complications. The major post-operative complication after 4 weeks of surgery was posterior capsular opacity. 89.8 % of the eyes had a 4 week-post-operative best corrected visual acuity of e± 6/24. The commonest refractive error was myopia with against the rule astigmatism, seen in 86 out of 150 cases. CONCLUSION: High quality cataract surgery with a low rate of intra-operative complications and good visual outcome can be attained in camp patients operated in the base hospitals, thus justifying more similar screening camps to clear the vast cataract backlog.

Incidence and long-term outcomes of toxic anterior segment syndrome at Aravind Eye Hospital.

PURPOSE: To determine the incidence and long-term outcomes of toxic anterior segment syndrome (TASS) at a single institution. SETTING: Aravind Eye Hospital, Pondicherry, India. DESIGN: Case series. METHODS: The records of all eyes developing TASS during a 1-year period after cataract surgery were retrospectively reviewed. Clinical outcomes, including corrected distance visual acuity (CDVA), intraocular pressure, and complications, were recorded at the 1-month and 6-month follow-up visits. RESULTS: Toxic anterior segment syndrome occurred in 60 eyes (0.22%) in 26 408 consecutive cataract surgeries. Although there were 2 identifiable clusters of TASS, 52% of cases were sporadic. The mean duration until resolution of severe iridocyclitis was 6.11 days ± 2.19 (SD). Of the 24 eyes (40%) with a follow-up of at least 6 months (mean 11.24 ± 2.3 months), 6 (24%) had atrophic iris changes, 1 (4%) had cystoid macular edema, 3 (12.5%) developed anterior capsule phimosis, and 4 (16%) had posterior capsule opacification (PCO). There was no statistically significant difference between the mean CDVA at 1 month (0.08 ± 0.06 logMAR) (n = 60) and the mean final CDVA (0.11 ± 0.1 logMAR, minimum 6 months; n = 24) (P=.42). CONCLUSIONS: Although it is impossible to generalize for all etiologies, this study found that TASS is uncommon but not rare, responded to intensive topical antiinflammatory medication, and was usually associated with a good visual outcome. Anterior capsule contraction and PCO were the principal delayed-onset complications beyond those present 1 month postoperatively.

Etiologies of chronic anterior uveitis at a tertiary referral center over 35 years.

PURPOSE: To describe the epidemiology of chronic anterior uveitis (CAU) at a tertiary center over 35 years. METHODS: Data regarding etiology of CAU was collected from medical records of patients evaluated between 1973-2007. Relative frequencies of each diagnosis of CAU were calculated. Linear regression analyses were performed on the common types of CAU. RESULTS: 5970 patients were evaluated between 1973-2007; 31% carried a diagnosis of CAU. Idiopathic disease was diagnosed in 54% of patients (39 to 72% annually), ocular sarcoidosis in 14% of patients (2 to 20% annually), Fuchs heterochromic iridocyclitis (FHI) in 12% of patients (4 to 22% annually), and juvenile idiopathic arthritis (JIA) in 6% of patients (2 to 13% annually). The frequency of diagnosis of idiopathic CAU decreased over time, with no significant change for sarcoidosis, FHI or JIA. An increase in frequency of diagnosis was observed for HLA-B27-related disease and uveitis related to multiple sclerosis and inflammatory bowel disease. CONCLUSIONS: The relative frequency of idiopathic disease has decreased over the past 35 years at our center. This may be related to an increase in the diagnosis of CAU associated with HLA-B27 positivity, inflammatory bowel disease (including family history) and multiple sclerosis. Despite the advances over the last 35 years, idiopathic disease still comprises at least 39% of our patients with CAU each year.

A cross-sectional and longitudinal study of Fuchs uveitis syndrome in Turkish patients.

PURPOSE: To describe Turkish patients with Fuchs uveitis syndrome (FUS). DESIGN: Retrospective observational case series. METHODS: We reviewed the records of 172 patients with FUS seen at Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, between January 1995 and July 2007. The main outcome measures were demographic features, clinical findings at presentation, laser flare photometry values, risk of new complications, and rate of decreased vision. RESULTS: The mean age was 29.5 + 8.4 years. Male-to-female ratio was 1:1.3. Nine patients (5.2%) had bilateral involvement. The diagnosis of FUS had been made in only 10 of 115 (8.7%) referrals. Clinical findings at presentation included diffuse keratic precipitates (medium-sized round in 74.6%, fine-stellate in 22.1%), anterior chamber cells (74%), diffuse iris atrophy without hypochromia (48.6%), heterochromia (39.8%), iris nodules (32%), cataract/pseudophakia (69.1%), vitreous cells (71.8%), elevated intraocular pressure (12.7%), and chorioretinal scars (7.7%). The mean flare was 8.4 + 3.1 photons/ms in eyes with FUS and 3.7 + 0.8 photons/ms in the fellow eyes (P < .001). Hyperfluorescence of the optic disc was the only fluorescein angiographic finding, detected in 7 of 32 eyes (22%). Kaplan-Meier analysis estimated risks of cataract formation and intraocular pressure elevation as 42% and 17%, respectively, at 4 years. The rate of decreased visual acuity by 2 lines or more was 0.06/eye-year. CONCLUSIONS: The referral patterns suggest that FUS is frequently misdiagnosed in Turkish patients. Diffuse medium-sized round keratic precipitates, low flare readings, iris stromal atrophy without hypochromia, and vitreous opacities in the absence of macular edema are more often helpful clues to the diagnosis than heterochromia.

Ocular involvement in Adamantiades-Behçet's disease in Berlin, Germany.

BACKGROUND: Epidemiological studies demonstrate a prevalence of Adamantiades-Behçet's disease (ABD) in the range of 0.12-420 per 100,000 inhabitants, with the highest rates in Istanbul, Turkey, and the lowest rates in the USA. Ophthalmological data on the prevalence of ocular involvement are limited for ABD in Germany, because most epidemiological studies are based on rheumatological or dermatological data. Berlin is the city with the highest number of non-native German inhabitants, and its multi-ethnic character renders it uniquely appropriate for epidemiological studies on ABD. METHODS: We retrospectively analyzed all ABD patients seen in our department since 1982. All patients fulfilled the criteria of the International Study Group for Behçet's Disease. We found 140 patients (63 female, 77 male), with a mean follow-up of 6.4 years (0.5-22 years). RESULTS: The mean age was 23 at the first manifestation and 32 when the full-blown disease was noted. The mean age at onset of ocular involvement was 30. Most of the patients were of Turkish (n = 73) or German (n = 34) origin. Fifty-six percent developed ocular involvement, which was the first manifestation in 8.6% and the second manifestation in 19.3% of cases. CONCLUSIONS: More than half the patients developed ocular involvement. The calculated prevalence of ocular involvement in ABD is 1.77/100,000 inhabitants for the municipality of Berlin.

The antitoxoplasma gondii antibodies incidence to the different ocular diseases patients cases of human ocular toxoplasmosis infections in Romania.

Toxoplasmosis is an anthropo-zoonosis widely spread around the earth, whose ocular complications are very frequent and are often a first sign of infestation. This is a retrospective statistic research based on the clinical survey and periodic control of a lot of 135 patients with toxoplasmosis, out of which 90 presented ocular toxoplasmosis.

Epidemiologic relationship between fuchs heterochromic iridocyclitis and the United States rubella vaccination program.

PURPOSE: To investigate an epidemiologic association between Fuchs heterochromic iridocyclitis (FHI) and the rubella vaccination program in the United States. DESIGN: Observational case series. METHODS: The percentages of patients with FHI, idiopathic chronic iridocyclitis, and idiopathic chronic granulomatous iridocyclitis at the University of Illinois were compared over time. Analysis of country of origin (United States vs foreign-born) was also performed. Findings were correlated with implementation of the rubella vaccination program in the United States in 1969. RESULTS: A total of 3,856 patients were seen between 1985 and 2005. Percentages of patients with FHI and idiopathic chronic granulomatous iridocyclitis born between 1919 and 1958 were similar (FHI 3.51% to 5.19%; idiopathic chronic granulomatous iridocyclitis 3.51% to 4.72%), with more variability in the idiopathic chronic iridocyclitis group (6.63% to 11.32%). A 64.8% reduction in FHI subjects was seen for those born the following decade (1959 to 1968). An additional 39.7% drop in FHI occurred in patients born between 1969 and 1978. Only one patient with FHI was born during the decade 1979 to 1988. The trend over time for FHI differed significantly from idiopathic chronic iridocyclitis (P = .0007) and idiopathic chronic granulomatous iridocyclitis (P = .0002), with no difference between the controls (P = .5437). The percentage of foreign-born patients with FHI increased after the institution of the rubella vaccination program (42% to 55%) compared with those born in previous decades (24% to 25%). This was not observed in the controls. CONCLUSION: FHI is less common in patients born since the introduction of the US rubella vaccination program, with a corresponding increase in percentage of foreign-born cases. This epidemiologic study supports a relationship between the rubella virus and FHI.

Aproximación diagnóstica a la ciclitis heterocrómica de Fuchs en ausencia de heterocromía / Fuchs´heterochronic cyclits without heterochromia: a diagnostic approach

Objetivo: Obtener pautas de diagnóstico de la ciclitis heterocrómica de Fuchs (CHF) en ausencia de heterocromía utilizando metodología bayesiana. Métodos: Se obtienen las probabilidades pre-test y post-test de que un determinado paciente sin heterocromía pero con otros síntomas característicos de la enfermedad, tales como nódulos iridianos, cataratas, glaucoma o vitritis anterior, tenga CHF. Para ello se utiliza el teorema de Bayes para la probabilidad condicionada. Los valores de la prevalencia de la CHF y de la frecuencia de presentación de los síntomas en la CHF y en el total de las uveitis anteriores se obtienen de los datos de la literatura publicada. Resultados: En ausencia de heterocromía, la combinación de nódulos iridianos junto con cataratas, vitritis o glaucoma, así como la asociación de estos tres últimos síntomas aún sin nódulos supone una probabilidad acumulada de más del 50% de tener la enfermedad. Conclusiones: La coincidencia en un paciente de varios síntomas indicativos aún en ausencia de heterocromía puede hacer que la CHF sea una opción diagnóstica probable

Objective: To obtain diagnostic guidelines of Fuchs’ heterochromic cyclitis (FHC) in the absence of heterochromia using Bayesian methods. Methods: The pre-test and post-test likelihood that a certain patient without heterochromia (but with other characteristic symptoms of the disease such as iris nodules, cataracts, glaucoma or vitritis) has FCH, was assessed by the Bayes’ theorem for conditioned likelihood. The prevalence values of FCH and the presentation rate of symptoms in FCH and in other forms of anterior uveitis were obtained from published literature data. Results: In the absence of heterochromia, the combination of iris nodules together with cataracts, vitritis or glaucoma, and the association of the last three symptoms in the absence of nodules, resulted in an accumulated likelihood of more than 50% of subjects having the disease. Conclusions: The coincidence in one patient of several indicative symptoms, even in the absence of heterochromia, may make FCH a likely diagnostic option