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Editorial
Intraocular crystals: A clinic sign of Fuchs' heterochromic cyclitis
Cristales intraoculares: un signo clínico de ciclitis heterocrómica de Fuchs
G. Rebolleda, F.J. Muñoz Negrete
Corresponding author
francisco.munoz@uah.es

Corresponding author.
Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The first case of crystals in iris was published 50 years ago in a report about a patient with chronic anterior uveitis&#44; with a histological study revealing immunoglobulin &#40;Ig&#41; deposits&#47;Russell bodies&#44; indicating active intraocular secretion thereof&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> A review on iris crystals demonstrated that 70&#37; of cases were patients with Fuchs&#8217; heterochromic uveitis&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> being therefore described as typical of said disease&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Even though said entity can be observed in other chronic uveitis&#44; its higher prevalence is attributed to the fact that oligoclonal Ig secretion &#40;mainly Ig G&#41; is present in over 50&#37; of eyes with Fuchs&#8217; cyclitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#8211;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Even though the etiology of said disease is not known&#44; studies suggest a viral infection due to the high prevalence of anti-rubella antibodies in the aqueous humor of these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Iris crystals are characterized by being shiny&#44; refractive and very small&#44; which could make them easily unnoticeable&#46; They can be observed on their own or in groups between the pupil margen and the root of the iris&#46; In addition&#44; crystals have been reported over the retina in rare cases &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Medical therapy or the degree of ocular inflammation seem able to modify their appearance&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Even though longitudinal studies have not been published&#44; it has been described that said crystals could remain unchanged for over one year&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> However&#44; 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&#46; Spectral domain optical coherence tomography &#40;SD-OCT&#41; shows said crystals as nodular hyper-reflective lesions over the retinal surface&#44; without producing lesions in the underlying tissue &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The diagnostic of Fuchs&#8217; heterochromic uveitis is purely clinic&#46; Generally&#44; patients remain asymptomatic for years&#46; In contrast with other types of uveitis&#44; pain or ocular reddening is not typical&#44; leading to frequent infradiagnostics&#46; In addition&#44; even though the heterochromia gives the disease its name&#44; it is not an indispensable requirement for diagnosis &#40;up to 10&#37; of cases can be bilateral&#41;&#46; For the above reasons&#44; diagnosing this disease is a complex and frequently incidental occurrence&#46; In fact&#44; in 80&#37; of cases an average of 3&#46;7 years go by before the appearance of typical clinic signs&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Optic disc hyper-fluorescence is also frequent in said entity&#44; with percentages between 70 and 90&#37;&#44; which increases the difficulty of differential diagnoses&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In this editorial we would like to emphasize that the clinic sign of intraocular crystals&#44; although relatively unknown and infrequent&#44; should alert us towards said diagnostic when observed&#44; even more so when associated to some of the typical clinic signs including non-confluent keratic precipitates&#44; low grade anterior chronic uveitis&#44; iris atrophy&#44; heterochromia&#44; absence of synechiae&#44; vitritis&#44; cataract and glaucoma&#44; among others&#46;</p></span>"
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