Intraocular crystals: A clinic sign of Fuchs' heterochromic cyclitis

Rebolleda, G.; Muñoz Negrete, F.J.

doi:10.1016/j.oftale.2019.03.001

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Se aprecia un cambio en el número y la localización desde enero 2015 (hilera superior), a diciembre 2017 (hilera central) y enero 2019 (hilera inferior). La OCT macular demuestra la naturaleza hiperrreflectiva y nodular del cristal apoyado sobre la superficie de la retina." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Rebolleda, F.J. Muñoz Negrete" "autores" => array:2 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Rebolleda" ] 1 => array:2 [ "nombre" => "F.J." 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Vertical axis refers to the number of consultations." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.B. Domínguez-Serrano, P. Molina-Solana, M. Infante-Cossío, J. Sala-Turrens, N. Seva-Silva, E. Rodríguez-de-la-Rúa-Franch" "autores" => array:6 [ 0 => array:2 [ "nombre" => "F.B." "apellidos" => "Domínguez-Serrano" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Molina-Solana" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Infante-Cossío" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Sala-Turrens" ] 4 => array:2 [ "nombre" => "N." "apellidos" => "Seva-Silva" ] 5 => array:2 [ "nombre" => "E." 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Rebolleda, F.J. Muñoz Negrete" "autores" => array:2 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Rebolleda" ] 1 => array:4 [ "nombre" => "F.J." "apellidos" => "Muñoz Negrete" "email" => array:1 [ 0 => "francisco.munoz@uah.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cristales intraoculares: un signo clínico de ciclitis heterocrómica de Fuchs" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1553 "Ancho" => 1500 "Tamanyo" => 222738 ] ] "descripcion" => array:1 [ "en" => "Female, 48, with Fuchs’ cyclitis in OS, showing characteristic crystals over the iris and retina, as well as evolution thereof through 2 years follow-up. Changes in the number and location can be observed from January 2015 (upper row) to December 2017 (central row) and January 2019 (lower row). Macular OCT shows the hyper-reflective and nodular nature of the crystal on the retinal surface." ] ] ] "textoCompleto" => "The first case of crystals in iris was published 50 years ago in a report about a patient with chronic anterior uveitis, with a histological study revealing immunoglobulin (Ig) deposits/Russell bodies, indicating active intraocular secretion thereof.<a class="elsevierStyleCrossRef" href="#bib0050">1</a> A review on iris crystals demonstrated that 70% of cases were patients with Fuchs’ heterochromic uveitis,<a class="elsevierStyleCrossRef" href="#bib0055">2</a> being therefore described as typical of said disease.<a class="elsevierStyleCrossRef" href="#bib0060">3</a> Even though said entity can be observed in other chronic uveitis, its higher prevalence is attributed to the fact that oligoclonal Ig secretion (mainly Ig G) is present in over 50% of eyes with Fuchs’ cyclitis.<a class="elsevierStyleCrossRefs" href="#bib0060">3–7</a>Even though the etiology of said disease is not known, studies suggest a viral infection due to the high prevalence of anti-rubella antibodies in the aqueous humor of these patients.<a class="elsevierStyleCrossRefs" href="#bib0075">6,7</a>Iris crystals are characterized by being shiny, refractive and very small, which could make them easily unnoticeable. They can be observed on their own or in groups between the pupil margen and the root of the iris. In addition, crystals have been reported over the retina in rare cases (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Medical therapy or the degree of ocular inflammation seem able to modify their appearance.<a class="elsevierStyleCrossRef" href="#bib0075">6</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>Even though longitudinal studies have not been published, it has been described that said crystals could remain unchanged for over one year.<a class="elsevierStyleCrossRef" href="#bib0055">2</a> However, in our experience the number of crystals diminish in time and migrate over different areas of the retinal and iris surface in the course of years. Spectral domain optical coherence tomography (SD-OCT) shows said crystals as nodular hyper-reflective lesions over the retinal surface, without producing lesions in the underlying tissue (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).The diagnostic of Fuchs’ heterochromic uveitis is purely clinic. Generally, patients remain asymptomatic for years. In contrast with other types of uveitis, pain or ocular reddening is not typical, leading to frequent infradiagnostics. In addition, even though the heterochromia gives the disease its name, it is not an indispensable requirement for diagnosis (up to 10% of cases can be bilateral). For the above reasons, diagnosing this disease is a complex and frequently incidental occurrence. In fact, in 80% of cases an average of 3.7 years go by before the appearance of typical clinic signs.<a class="elsevierStyleCrossRef" href="#bib0060">3</a> Optic disc hyper-fluorescence is also frequent in said entity, with percentages between 70 and 90%, which increases the difficulty of differential diagnoses.<a class="elsevierStyleCrossRefs" href="#bib0085">8,9</a>In this editorial we would like to emphasize that the clinic sign of intraocular crystals, although relatively unknown and infrequent, should alert us towards said diagnostic when observed, even more so when associated to some of the typical clinic signs including non-confluent keratic precipitates, low grade anterior chronic uveitis, iris atrophy, heterochromia, absence of synechiae, vitritis, cataract and glaucoma, among others." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Rebolleda G, Muñoz Negrete FJ. Cristales intraoculares: un signo clínico de ciclitis heterocrómica de Fuchs. Arch Soc Esp Oftalmol. 2019;94:209–210." ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1553 "Ancho" => 1500 "Tamanyo" => 222738 ] ] "descripcion" => array:1 [ "en" => "Female, 48, with Fuchs’ cyclitis in OS, showing characteristic crystals over the iris and retina, as well as evolution thereof through 2 years follow-up. Changes in the number and location can be observed from January 2015 (upper row) to December 2017 (central row) and January 2019 (lower row). Macular OCT shows the hyper-reflective and nodular nature of the crystal on the retinal surface." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Light and electron microscopy on plasma cells and Russell bodies in the iris of a chronic uveitis patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Iwamoto" 1 => "R. 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Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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Vol. 94. Issue 5.