Intraocular rubella virus detection as a diagnostic tool for atypical forms of Fuchs cyclitis

Purpose Since 2004, different studies have reported on the pathophysiology of Fuchs cyclitis, which may be due to rubella virus infection. The purpose of this study is to investigate clinical profile and prognosis of rubella virus associated uveitis. Retrospective, observational, bicentric study. Methods All patients managed between January 2009 & march 2013 for an atypical form of Fuchs cyclitis were included. Clinical features for these patients were assessed. An extensive work‐up of anterior or intermediate uveitis was performed in all cases. An anterior chamber tap was done for molecular detection of herpesviruses and intraocular anti‐rubella virus antibody synthesis. Treatment was adapted to the results of ocular fluids analysis. Results The series included 17 patients (M/F : 11/6) with a proven diagnosis of rubella virus‐associated uveitis. The mean age was 43.3years (27‐70)). All patients had a positive outcome for intraocular antibody production against rubella virus with a Goldmann‐Witmer coefficient > 3. Only 3 patients (15%) fulfilled the classical Fuchs cyclitis criteria with stellar keratic precipitates + heterochromia/iris atrophy + cataract + vitritis. Uveitis was bilateral in 3 patients (20%) and 7 patients (35%) had an uncontrolled IOP requiring glaucoma surgery. Conclusion For most of these patients, intraocular rubella virus serology allowed the final diagnosis of Fuchs cyclitis despite incomplete clinical criteria. Intraocular rubella virus detection can help for the diagnosis of atypical forms of Fuchs cyclitis. This avoids unnecessary additional tests and prescription of local or systemic corticosteroids. Secondary glaucoma remains a major complication and needs a close monitoring.