title: Fuchs' Uveitis: Failure to Associate Vitritis and Disc Hyperfluorescence with the Disease is the Major Factor for Misdiagnosis and Diagnostic Delay.
abstract: OBJECTIVE
  Fuchs' uveitis is often diagnosed with substantial delay at the origin of deleterious consequences such as unnecessary treatment. The aim of the study was to analyse the type and frequency of posterior inflammatory and fluorescein angiographic signs in Fuchs' uveitis in conjunction with the other clinical signs and evaluate their respective importance in the diagnosis of the disease. In particular, diagnostic delay and erroneous diagnoses were investigated.
  
  
  METHODS
  Patients seen in our centers between 1995 and 2008 with the diagnosis of Fuchs' uveitis were analysed. The data collected included age, initial and final visual acuities, clinical findings at presentation, mean diagnostic delay, erroneous diagnoses, laser flare photometry values, fundus and fluorescein angiography manifestations and ocular complications.
  
  
  RESULTS
  One hundred and five patients were included. The mean age at diagnosis was 34 years. Twelve patients (11.4%) had bilateral involvement. The mean diagnostic delay was 3.04 +/- 4.30 years. The most frequent clinical signs were vitreous infiltration (97.40%), typical Fuchs' keratic precipitates (94.90%), crystalline lens opacities or cataract (47%), heterochromia (42.60%), ocular hypertension or glaucoma (12.80%). The mean laser flare photometry value at presentation was 9.85 +/- 6.28 ph/ms. Thirty-nine patients (37.14%) had undergone fluorescein angiography showing disc hyperfluorescence in 97.7% and peripheral retinal vascular leakage in 13.6%.
  
  
  CONCLUSIONS
  Fuchs' uveitis is significantly underdiagnosed likely because vitreous involvement was previously described but not commonly recognized as an association with Fuchs' uveitis in the clinician's mind and therefore has often been given a different diagnostic label. Moreover, the very frequent inflammatory signs on fluorescein angiography such as disc hyperfluorescence and more rarely peripheral retinal vascular leakage, which has not been typically associated with Fuchs' uveitis, appear to represent an additional factor leading to misdiagnosis. Such clinical findings need to be publicised in order to reduce misdiagnosis, and diagnostic delay.
authors.affiliation: Inflammatory and Retinal Eye Diseases, Center for Ophthalmic Specialized Care (COS); Lausanne, Switzerland.
authors.forename: Nadia
authors.initials: N
authors.lastname: Bouchenaki
authors.forename: Carl P
authors.initials: CP
authors.lastname: Herbort
references.citation: Ocul Immunol Inflamm. 1994;2(3):169-76
references.pmid: 22823117
references.citation: Ocul Immunol Inflamm. 2002 Jun;10(2):125-31
references.pmid: 12778348
references.citation: Ophthalmic Epidemiol. 2002 Oct;9(4):239-49
references.pmid: 12187422
references.citation: Eye (Lond). 1991;5 ( Pt 6):649-61
references.pmid: 1800162
references.citation: Eye (Lond). 2009 Jan;23(1):79-84
references.pmid: 17962825
references.citation: Ocul Immunol Inflamm. 2001 Sep;9(3):169-75
references.pmid: 11815885
references.citation: Int Ophthalmol. 2010 Oct;30(5):511-9
references.pmid: 20401514
references.citation: Eye (Lond). 1991;5 ( Pt 6):662-7
references.pmid: 1800163
references.citation: Am J Ophthalmol. 2008 May;145(5):834-40
references.pmid: 18255045
references.citation: Am J Ophthalmol. 2000 May;129(5):672-3
references.pmid: 10844066
references.citation: Am J Ophthalmol. 2004 Jul;138(1):46-54
references.pmid: 15234281
references.citation: Surv Ophthalmol. 1993 Jan-Feb;37(4):253-72
references.pmid: 8441952
references.citation: Ophthalmologica. 1996;210(4):234-8
references.pmid: 8841072
references.citation: Am J Ophthalmol. 2009 Oct;148(4):510-515.e1
references.pmid: 19477709
references.citation: Arch Ophthalmol. 1988 Dec;106(12):1688-90
references.pmid: 3196209
references.citation: Arch Ophthalmol. 1982 Oct;100(10):1622-6
references.pmid: 6890339
references.citation: Curr Opin Ophthalmol. 2005 Dec;16(6):356-63
references.pmid: 16264346
references.citation: Ophthalmology. 2006 Mar;113(3):473-80
references.pmid: 16458965
references.citation: Acta Ophthalmol Scand. 1995 Apr;73(2):166-70
references.pmid: 7656148
references.citation: Curr Eye Res. 1990;9 Suppl:31-4
references.pmid: 2384011
references.citation: Ophthalmologica. 2005 Jan-Feb;219(1):21-5
references.pmid: 15627823
references.citation: Acta Ophthalmol. 2008 Feb;86(1):58-64
references.pmid: 17986291
references.citation: Doc Ophthalmol. 1991;78(3-4):225-35
references.pmid: 1790745
references.citation: Am J Ophthalmol. 2006 Jan;141(1):212-214
references.pmid: 16387009
references.citation: Ocul Immunol Inflamm. 2004 Dec;12(4):297-310
references.pmid: 15621869
references.citation: Acta Ophthalmol Scand. 1998 Aug;76(4):405-12
references.pmid: 9716325