Clinical Features of Chinese Patients with

Fuchs’ Syndrome
Peizeng Yang, MD, PhD,1,2 Wang Fang, MD,1,2 Haoli Jin, PhD,1 Bing Li, PhD,1,2 Xuan Chen, PhD,1,2
Aize Kijlstra, PhD3,4,5

Purpose: To characterize the clinical features of Chinese patients with Fuchs’ syndrome.
Design: Retrospective noncomparative case series.
Participants: One hundred eighteen eyes of 104 consecutive patients with Fuchs’ syndrome initially exam-
ined between January 1999 and March 2005.
Methods: The history and clinical findings of all consecutive Fuchs’ patients attending the Zhongshan
Ophthalmic Center were reviewed. Auxiliary examinations, including laser flare-cell photometry, ultrasound
biomicroscopy (UBM), fundus fluorescein angiography (FFA), and serologic tests for Toxoplasma gondii, were
performed in certain cases.
Main Outcome Measures: Patients’ demographics, clinical presentation, and auxiliary examination
findings.
Results: One hundred four patients (49 male, 55 female) were included in this study. Unilateral involvement
was noted in 90 patients (86.5%). The most common symptom was blurred or decreased vision (86%). Stellate
and medium-sized keratic precipitates (KPs) were noted in 108 eyes (91.5%). A mild anterior chamber (AC)
reaction was observed in all the affected eyes. Heterochromia was observed in only 15 affected eyes, although
there were varying degrees of iris depigmentation in all patients. Iris nodules, mostly Koeppe, were present in
28.0% of the affected eyes. Complicated cataract, vitreous opacity, and secondary glaucoma were observed in
84 of 118 eyes (70.7%), 31 eyes of 42 eyes (73.8%), and 24 of 118 eyes (23.1%), respectively. The mean laser
flare photometry value (6.4⫾2.3 photon counts per millisecond) and the cell number in the AC (1.5⫾1.2 cells per
0.5 mm3) in 25 patients were both significantly higher than those in 25 healthy controls (5.3⫾2.3 photon counts
per millisecond and 0.8⫾0.6 cells per 0.5 mm3) (P⬍0.05). Ultrasound biomicroscopy revealed exudates adjacent
to the ciliary body in 18 of 24 patients (75%). Serological tests failed to confirm an association of Fuchs’
syndrome with toxoplasmosis. Retinal capillary leakage in the midperipheral fundus and disc staining at the late
stage were observed in most of the eyes examined by FFA.
Conclusion: Fuchs’ syndrome in Chinese patients is characterized by a mild uveitis with characteristic KPs,
varying degrees of iris depigmentation, and, occasionally, heterochromia. Exudates adjacent to the ciliary body
and subclinical retinal and optic nerve involvement were common in the patients who were studied by UBM and
FFA. Ophthalmology 2006;113:473– 480 © 2006 by the American Academy of Ophthalmology.

Fuchs’ syndrome, usually termed Fuchs’ heterochromic
iridocyclitis or Fuchs’ heterochromic uveitis in the English
literature, is one of the relatively uncommon uveitides. It
was first described by Ernst Fuchs in a series of 38 patients
in 1906.1 This syndrome has attracted many researchers and
ophthalmologists in the subsequent century, and a number
of reports about Fuchs’ syndrome have been published.
According to the guidelines of the International Uveitis
Study Group,2 the classic features of Fuchs’ syndrome
include a chronic unilateral nongranulomatous inflamma-
tion mainly involving the anterior uvea, insidious onset, low
grade in activity, affecting of both genders equally, a pre-
ponderance in those between 20 and 45 years old, unrespon-
siveness to corticosteroid therapy, absence of systemic dis-
orders, and generally a good prognosis except for the
development of cataract and glaucoma. However, there are
substantial differences in clinical manifestations among the

Originally received: June 5, 2005.

Accepted: October 14, 2005. Manuscript no. 2005-492. with the Division of Immunology, Children’s Hospital–Boston, Harvard
1
Medical School, Boston, Massachusetts.
Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou,
China. This study was supported by the Fund for Innovative Research Groups,
2
Beijing, China (grant no.: 30321004); Guangdong Province Natural Sci-
Uveitis Study Center, Sun Yat-sen University, Guangzhou, China. ence Foundation, Guangzhou, China (grant no.: 036648); and Guangdong
3
Animal Sciences Group, Wageningen University and Research Center, Famous Doctor Project, Guangzhou, China (grant no.: 2004,199).
Lelystad, The Netherlands. No author has a proprietary or financial interest in any product mentioned.
4
Eye Research Institute Maastricht, Maastricht, The Netherlands. Reprint requests to Prof Dr Peizeng Yang, MD, PhD, Zhongshan Ophthal-
5
Department of Ophthalmology, Academic Medical Center, University of mic Center, Xianlie Road 54, Guangzhou 510060, China. E-mail:
Amsterdam, Amsterdam, The Netherlands. Dr Jin presently is affiliated peizengy@126.com.

© 2006 by the American Academy of Ophthalmology ISSN 0161-6420/06/$–see front matter 473
Published by Elsevier Inc. doi:10.1016/j.ophtha.2005.10.028
 Ophthalmology Volume 113, Number 3, March 2006
Figure 1. Age at onset and the age at which the diagnosis of Fuchs’ syndrome was made in 104 Fuchs’ syndrome patients.
patients from different races, based on reports from The
Netherlands,3 Spain,4 England,5,6 Mexico,7 the United
States,8,9 Brazil,3 and the International Uveitis Study
Group.10 The clinical features of Fuchs’ syndrome in Chi-
nese patients have not been addressed well. Therefore, a
retrospective study was performed to characterize the clin-
ical features in Chinese patients with Fuchs’ syndrome.
Subjects and Methods
A retrospective study was performed based on the charts of 104
patients with Fuchs’ syndrome referred to the uveitis study center
of the Zhongshan Ophthalmic Center from January 1999 to March
2005. Most of the patients were referred to us by ophthalmologists
from other hospitals. The diagnosis of Fuchs’ syndrome was
principally a clinical one and generally based on the classic de-
scription by Kimura et al in 195511 and La Hey et al in 1991.3
Patients were included in the study when most (although not all) of
the following clinical features were present: lack of acute symp-
toms of severe pain, redness, and photophobia during follow-up
visits; characteristic diffusely spread stellate keratic precipitates
(KPs); low-grade anterior chamber (AC) reaction; iris depigmen-
tation with or without heterochromia; and absence of posterior
synechiae. Posterior subcapsular cataract, vitreous opacity, and
secondary glaucoma could be present but were not essential cri-
teria for the diagnosis. Other causes of anterior or intermediate
uveitis were excluded. The follow-up period varied from 1 month
to 6 years (average, 34 months).
A detailed history, including age, laterality, complaints, visual
change, and associated systemic diseases, was taken from each
patient. The same uveitis specialist examined all patients. The
examinations included determination of best-corrected visual acu-
ity (BCVA), slit-lamp biomicroscopy for the bilateral anterior
segment of the eye, gonioscopy, and ophthalmoscopy through the
dilated pupil. The severity of AC activity was evaluated clinically
using Hogan et al’s grading system.12,13 Laser flare-cell photom-
etry was randomly performed on 25 patients with unilateral in-
volvement who were in compliance with the doctor’s instructions
using the FC-2000 laser flare-cell meter (version 1.0, Kowa Co.,
Ltd., Tokyo, Japan) quantitatively to evaluate AC flare and cells.
This examination also was performed concurrently in 25 normal
individuals as gender- and age-matched controls. Results were
analyzed using SPSS 11.0 (SPSS Inc., Chicago, IL). In these 25
patients examined by laser flare-cell photometry, fundus fluores-
cein angiography also was performed to evaluate the changes in
the retina, retinal blood vessels, and optic nerve. Ultrasound biomi-
croscopy (UBM) was also performed in 24 of these 25 patients.
Laboratory examinations, including red and white blood cell
counts, anti–streptolysin O (ASO) titer, erythrocyte sedimentation
474
rate, C-reactive protein, antinuclear antibody, and rheumatoid fac-
tor, were performed in all patients to examine whether there were
changes in these parameters. Serum angiotensin-converting en-
zyme assay, tuberculin skin testing, and tests for syphilis (includ-
ing rapid plasma reagin and microhemagglutination assay for
Treponema pallidum) were performed, if needed, to rule out cer-
tain diseases. HLA-B27 typing was performed randomly in 26
patients to evaluate if Fuchs’ syndrome was associated with this
antigen. A serological test for Toxoplasma gondii was performed
randomly by enzyme-linked immunosorbent assay in 25 patients.
For comparison of our findings with those presented by others
in the English literature, we performed a literature search using the
PubMed database from 1980 to March 2005. References were also
identified from the relevant articles and books.
Results
Of our 104 patients, the median age at the onset of the disease was
35 years (range, 15–75). The median age at which the diagnosis of
Fuchs’ syndrome was made was 38.5 years (range, 15–74) (Fig 1).
The diagnosis of Fuchs’ syndrome was not always made immedi-
ately at presentation. The delay in diagnosis ranged from 1 month
to 10 years, with a mean of 4.6 years. The 104 patients included 49
men (47.1%) and 55 women (52.9%). All the patients were of
Chinese Han nationality. Neither systemic disorders attributed to
an association with uveitis (e.g., systemic autoimmune diseases)
nor a family history of Fuchs’ syndrome was observed in these
patients, although hypertension (4 cases), cervical spondylopathy
(4 cases), diabetes mellitus (3 cases), gastric ulcer (3 cases),
cervicitis (3 cases), and an old myocardial infarction (1 case) were
present in some of the patients. Unilateral uveitis was noted in 90
(86.5%) patients, and bilateral involvement in 14 (13.5%) patients.
Of the patients with unilateral involvement, the right eye was
affected in 49 cases (54.4%), and the left eye in 41 cases (45.6%).
Table 1. Major Presenting Symptoms in 104 Patients with
Fuchs’ Syndrome
Complaints n*
Decrease/blurred vision 86
Eye pain 16
Floaters 15
Red eye 14
Photophobia 10
Eye discomfort 2
Headache 1
*A number of patients had more than one symptom.
 Yang et al 䡠 Fuchs’ Syndrome in Chinese Patients

Figure 4. Morphology of keratic precipitates in the affected 118 eyes of

Figure 2. Best-corrected visual acuity of the affected 118 eyes in 104
Fuchs’ syndrome patients at the first examination.
The most common complaints at presentation were blurred
vision or slowly decreased vision (86 eyes), followed by eye pain
(16 eyes) and floaters (15 eyes). Red eye, photophobia, discomfort
around the eye, and headache were present at presentation in a few
patients but absent at follow-up (Table 1). All patients had been
treated by ophthalmologists in other hospitals before presenting to
our uveitis study center. Fuchs’ syndrome was diagnosed previ-
ously in only 8 patients by the referring ophthalmologists. The
initial diagnosis made in other hospitals included uveitis, iridocy-
clitis, anterior uveitis, complicated cataract, vitreous opacity, Pos-
ner–Schlossman syndrome, panuveitis, intermediate uveitis, and
others (Table 2).
The BCVA at the first examination is shown in Figure 2.
Seventy-eight eyes had a visual acuity (VA) of ⱖ0.3. Four eyes
had VA⬍0.01, 1 due to optic atrophy resulting from secondary
glaucoma and 3 due to dense cataract.
Keratic precipitates were present in all the affected eyes, al-
though they sometimes were absent during follow-up examina-
tions. Keratic precipitates usually were stellate and medium-sized
in morphology, and diffusely distributed on the entire posterior
surface of the cornea in most cases (Figs 3, 4). Mild to moderate
AC activity was observed in most cases at presentation (Fig 5) and
Table 2. Initial Referral Diagnosis Made in the 104 Patients
Initial Diagnosis No. of Cases*
Fuchs’ syndrome
Uveitis
Iridocyclitis
Anterior uveitis
Complicated cataract
Vitreous opacity
Posner–Schlossman syndrome
Secondary glaucoma
Panuveitis
Intermediate uveitis
Others†
104 Fuchs’ syndrome patients at the first examination. *Including old
pigmented KPs and mutton fat–like but somewhat smaller KPs.
in all cases during follow-up visits. Although varying degrees of
iris depigmentation (Fig 6) were seen in all affected eyes, hetero-
chromia observed under slit-lamp biomicroscopy (Fig 7) was
noted in only 15 affected eyes during follow-up visits. A moth-
eaten appearance of the iris was noted in 17 eyes, and a swollen iris
in 3 eyes. Iris nodules were observed in 33 eyes (28.0%) (Koeppe
nodules in 31 and Busacca nodules in 2). Posterior synechiae were
absent in all the affected eyes, although a transient localized
posterior synechia was noted in one patient at presentation.
Mean laser flare photometry values in patients and controls
were 6.4⫾2.3 and 5.3⫾2.3 photon counts per millisecond, respec-
tively (t ⫽ 2.500, P ⫽ 0.016). Numbers of AC cells in patients and
controls were 1.5⫾1.2 and 0.8⫾0.6 cells per 0.5 mm3, respectively
(t ⫽ 2.500, P ⫽ 0.022). There was a significant difference between
patients and controls with regard to the laser flare photometry
value and cell counts in the AC.
Complicated cataract (cataract associated with uveitis) was
observed in 84 eyes (70.7%) during the follow-up visits, of which
69 showed a posterior subcapsular opacity. The patients with
cataract had varying degrees of visual impairment. Routine phaco-
emulsification and intraocular lens implantation in the capsular bag
was performed in 9 eyes in our hospital. Best-corrected VA ⱖ 1.0
was achieved in all operated eyes. A number of patients underwent
cataract surgery at local hospitals. These patients’ VAs were not
obtained by us and therefore are not presented here.
Vitreous opacity was present in 31 of 42 eyes in which the lens
was transparent enough for one to visualize the ocular fundus
during the follow-up visits. An increased cup-to-disc ratio was
observed in 3 patients. No patient showed retinochoroidal lesions
8 throughout the fundus.
32 During the follow-up visits, intraocular pressure (IOP) eleva-
25 tion was observed in 24 (23.1%) eyes, mostly showing a mild to
22 moderate elevation (range, 22–35 mmHg). A well-controlled IOP
16 was achieved in 23 patients. One patient with an IOP of 60 mmHg
13
7
6
4
3
9

*Some patients had more than one diagnosis initially.

†
Including refractive error, conjunctivitis, keratitis, and strabismus.

Figure 3. Distribution of keratic precipitates in the affected 118 eyes of Figure 5. Grades of inflammatory activity in the anterior chamber in the
104 Fuchs’ syndrome patients at the first examination. affected 118 eyes of 104 Fuchs’ syndrome patients at the first examination.

475
 Ophthalmology Volume 113, Number 3, March 2006

Figure 6. Slit-lamp photography of a 38-year-old male patient with unilateral Fuchs’ syndrome. The left eye (A) showed apparent depigmentation of the
iris as compared with the unaffected right eye (B). No heterochromia was observed in this patient.

did not respond to antiglaucoma drugs, and therefore, a filtrating Discussion

surgery was performed on him. Unfortunately, this patient lost his
vision due to the optic nerve damage from the uncontrolled IOP.
Fundus fluorescein angiography revealed mild to apparent ret-
inal capillary leakage in the midperipheral fundus in 15 of 25 eyes
(60%) and disc staining at the late stage in 17 of 25 eyes (68%)
(Fig 8).
To evaluate the changes in the ciliary body and surrounding
tissues, UBM was performed in 24 patients with unilateral involve-
ment. Interestingly, 18 of 24 affected eyes showed different types
of exudates, mainly including masslike (Fig 9A), linear (Fig 9B),
or dotted (Fig 9C) at the pars plana and basal vitreous body. A
slightly swollen ciliary body (Fig 9D) was noted in 2 patients.
Neither angle synechiae nor ciliary detachment was observed in
any patient investigated by UBM.
Laboratory examinations, including red and white blood cell
counts, anti–streptolysin O titer, erythrocyte sedimentation rate,
C-reactive protein, antinuclear antibody, and rheumatoid factor,
did not show any abnormalities in the patients. Results of exam-
inations of serum angiotensin-converting enzyme and tests for
syphilis were negative in all the tested patients. An intermediate
tuberculin skin test was positive in 1 of 15 patients. However, a
chest x-ray examination and systemic examinations were per-
formed on this patient in our internal medicine department and
failed to confirm the tuberculosis diagnosis. HLA-B27 was found
in 2 of the tested 43 patients (4.65%) and 7 of 150 normal
individuals (4.67%). There was no difference between patients and
controls concerning this positive rate (␹2 ⫽ 0, P ⫽ 0.997). The
serological test result for T. gondii antibody was negative for all
the 25 tested patients.
In this retrospective study, we characterized the clinical
features of Fuchs’ syndrome in Chinese patients based on
the clinical data of 104 cases referred to the uveitis study
center of the Zhongshan Ophthalmic Center. Our patients
typically showed a mild unilateral anterior uveitis with
stellate and medium-size KPs, diffusely or centrally distrib-
uted on the corneal endothelium, and varying degrees of iris
depigmentation in all patients, but with heterochromia in
only a few patients. Patients presented mostly in the third or
fourth decades, and both genders were affected equally.
Complicated cataract, vitreous opacity, and secondary glau-
coma were common. As these patients are from all over
China, the clinical features we reported here might be con-
sidered as a general spectrum of Fuchs’ syndrome in Chi-
nese patients. Our results are well in accordance with those
reported for other patients, especially heavily pigmented
ones (nonwhite race) (Table 3).3,7,9 However, there seems to
be a substantial difference between Chinese patients and
less pigmented patients concerning heterochromia. Few pa-
tients in our series demonstrated heterochromia, whereas
apparent heterochromia is very common in white patients
(Table 4).3– 6,8,10
Keratic precipitates in Fuchs’ syndrome have been de-
scribed typically as small white, translucent, medium-size,
stellate dots in most reports.3– 8,10,11,14 –16 They are distrib-

Figure 7. Slit-lamp photography of a 32-year-old female patient with unilateral Fuchs’ syndrome. The right eye (A) showed marked depigmentation and
subtle iris heterochromia as compared with the unaffected left eye (B).

476
 Yang et al 䡠 Fuchs’ Syndrome in Chinese Patients

Figure 8. Fundus fluorescein angiography showed retinal capillary leakage in the midperipheral fundus in a 35-year-old female patient with unilateral
Fuchs’ syndome (A) and disc staining at the late stage in another 42-year-old male patient with unilateral Fuchs’ syndrome (B).

uted diffusely or centrally on the corneal endothelium. Our
study showed similar findings in Chinese patients. These
patients almost uniformly showed stellate and medium-size
KPs, although they might change in appearance over time.
About 92% of the patients showed this typical configuration
of KPs at the first visit, and eventually, almost all patients
had this feature during follow-up examinations.
The changes in the iris have been considered classic
features in Fuchs’ syndrome. One of the important mani-
festations is heterochromia due to depigmentation of the iris
in the affected eye.1,3,6,9 Other changes related to the iris
include iris swelling, iris nodules, abnormal iris blood ves-
sels, and, rarely, peripheral anterior synechiae and filiform
hemorrhages in the AC angle on the opposite site of a
paracentesis (Amsler’s sign).17 All of our patients showed
varying degrees of depigmentation in their affected iris.
However, only a few exhibited subtle heterochromia upon
slit-lamp biomicroscopy. Our findings are similar to those
reported in patients with a dark or brown iris, such as
blacks,9 Mexicans,7 and Brazilians.3 Perhaps the iris depig-
mentation caused by this disease is not sufficient to induce
a gross change in most heavily pigmented patients. We
believe that Fuchs’ syndrome has not been diagnosed cor-
rectly for a long time in most patients observed elsewhere in
our referral area due to the absence of heterochromia.
Therefore, Fuchs’ syndrome or Fuchs’ uveitis syndrome
might be more suitable than Fuchs’ heterochromic iridocy-
clitis for this disease in patients with a dark or brown iris.
Other changes, including iris swelling (spongy appearance)
and iris nodules, were also noted in our cases. Koeppe

Figure 9. Ultrasound biomicroscopy of the ciliary body and adjacent tissues. A, Masslike exudates at the basal vitreous body were observed in a 29-year-old
female patient. B, C, Linear and dotted exudates at the pars plana and basal vitreous body were seen in a 32-year-old male patient. D, A slightly swollen
ciliary body accompanied by exudates adjacent to it was present in a 25-year-old male patient.

477
 Ophthalmology Volume 113, Number 3, March 2006

Table 3. Clinical Findings in Our Patients and Other Nonwhite Patient Studies

Present Study, China Arellanes-Garcia et al,* Mexico Tabbut et al,† United States Silva et al,‡ Brazil
Clinical Features (2005) (2002) (1988) (1989)
No. of cases 104 68 13 (blacks) 132
Age (yrs) [mean (range)] 39.5 (16–78) 31 (5–80) — 38 (11–75)
Gender (male:female) 1:1.12 1:0.84 — 1:1.14
Bilateral involvement 13.5% 10.3% 0% 21%
Keratic precipitates 99.2% 90% 100% 99%
Cell/flare aqueous 68.7%/71.2% 86% — 60%
Heterochromia 12.7% 25.3% 76% 34%
Iris nodules 28.0% 30.7%/17.1%§ 30% —
Absence of synechiae 100% — 100% 94%
Cataract储 70.7% 69.33% 23% 70%
Vitreous opacity 73.8% 46.6% — —
Glaucoma 23.1% 30.7%/4%¶ 38 19%
Chorioretinal lesions 0 1.3% 23%# 28%**
Cystoid macular edema 0 — — —

*Arellanes-Garcia L, del Carmen Preciado-Delgadillo M, Recillas-Gispert C. Fuchs’ heterochromic iridocyclitis: clinical manifestations in dark-eyed
Mexican patients. Ocul Immunol Inflamm 2002;10:125–31. All patients were dark-eyed Mexicans.
†
Tabbut BR, Tessler HH, Williams D. Fuchs’ heterochromic iridocyclitis in blacks. Arch Ophthalmol 1988;106:1688 –90. All patients were black.
‡
Cited from La Hey E, Baarsma GS, De Vries J, Kijlstra A. Clinical analysis of Fuchs heterochromic cyclitis. Doc Ophthalmol 1991;78:225–35. The
patients’ races were not mentioned.
§
Koeppe nodules were present in 23 eyes (30.7%), and Busacca nodules in 13 (17.1%).
储
Including aphakic or pseudophakic eyes after cataract surgery.
¶
Transitory high intraocular pressure in 23 eyes (30.66%); 3 (4%) had a definite diagnosis of glaucoma.
#
Nonactive scars and no toxoplasmalike scars.
**Six active chorioretinal lesions and 31 scars (type of lesions not mentioned).

nodules typically appeared fluffy. Busacca nodules have been
considered a sign of granulomatous uveitis. It is unknown why
Busacca nodules may occur in few patients with Fuchs’ syn-
drome, which is usually classified as a nongranulomatous
uveitis. It is worth mentioning that Busacca nodules in patients
with Fuchs’ syndrome also appear fluffy, quite in contrast to
those observed in granulomatous uveitis such as Vogt–Koya-
nagi–Harada syndrome and sarcoidosis. No abnormal iris
blood vessels or peripheral anterior synechiae were observed in
our patients. Amsler’s sign has been regarded as a pathogno-
monic feature of Fuchs’ syndrome by some European ophthal-
mologists.18 However, in 75 patients examined by 2 Interna-
tional Uveitis Study Group members, Amsler’s sign was not
found in any patient with Fuchs’ syndrome.10 In view of the
fact that there is great controversy as to the role of Amsler’s
sign in the diagnosis of this disease,10,17–19 we did not use it as
a criterion. In fact, paracentesis is not necessarily performed in
patients with Fuchs’ syndrome’s typical clinical appearance.
A mild or occasionally moderate AC reaction has been
considered another feature of Fuchs’ syndrome. Our expe-
rience confirmed this as well. Most patients showed mild
flare and few cells in the AC when examined by slit-lamp
biomicroscopy, although the amount of AC reaction did
change over time. To quantify the AC activity, laser flare-
cell photometry was performed on a number of patients. The
results were in accordance with those observed clinically,
showing a breakdown of the blood–aqueous barrier and a
mild inflammatory reaction.
It is well known that ciliary body involvement is a
feature in Fuchs’ syndrome. However, the changes in the
ciliary body have not been clinically characterized well due
to the difficulty in visualizing this tissue with conventional
techniques. High-frequency UBM provides a useful tool to
illustrate the changes in the ciliary body and its surrounding
tissues in vivo.20 Interestingly, using this technique we
found a number of changes in the unselected patients, such
as masslike, linear, or dotted exudates closely adjacent to
the pars plana or at the basal vitreous body and, occasion-
ally, a swollen ciliary body. Actually, Fuchs’ syndrome has
been considered a subset of intermediate uveitis.21 The
findings revealed by UBM provide substantial evidence to
show that inflammation in the ciliary body is one of the
important features in Fuchs’ syndrome.
It has been documented that the posterior segment also
may be involved in Fuchs’ syndrome.3–9,22–24 The signs in
the posterior segment include vitreous opacity, chorioretinal
lesions consistent with toxoplasmosis, and, occasionally,
cystoid macular edema.3,5 In this study, we found varying
degrees of vitreous opacity in most patients. However, no
chorioretinal lesions were observed, indicating the disasso-
ciation of Fuchs’ syndrome with ocular toxoplasmosis in
Chinese patients. Fundus fluorescein angiography revealed
retinal capillary leakage in the midperipheral fundus and
disc staining at a late stage in about two thirds of patients
studied. Although a chorioretinal lesion was not observed in
any of our subjects, our findings suggest that subclinical
retinal and optic nerve involvement may be a feature in
Chinese patients with Fuchs’ syndrome.
In conclusion, our study characterizes the clinical fea-
tures in Chinese patients with Fuchs’ syndrome. These
patients typically show a mild uveitis with typical stellate
KPs, diffusely distributed on the whole or central cornea; a
depigmented iris; and, occasionally, heterochromia. The
results of laser flare-cell photometry, fundus fluorescein
angiography, and UBM in one group of patients revealed a
disturbed blood–aqueous barrier; exudates adjacent to the

478
 Yang et al 䡠 Fuchs’ Syndrome in Chinese Patients

Table 4. Clinical Findings in Our Patients and White Patient Studies

Present La Hey et Fearnley and Velilla et

Study, al,* Rosenthal,‡ Jones,§ Liesegang,储 al,¶ Tabbut et al,#
China Netherlands Dernouchamps,† England England United States Spain United States
Clinical Features (2005) (1991) IUSG (1984) (1995) (1991) (1982) (2001) (1988)
No. of cases 104 51 550 77 103 54 26 54 (whites)
Age (yrs) [mean (range)] 39.5 (16–78) 40 (17–71) 34 (8–73) 43.7 (14–79) 36.1 (8–71) 44.5** 30.2 (9–50) —
Gender (male:female) 1:1.12 1:0.73 — 1:0.93 1:1.06 1:1.35 1:1.17 —
Bilateral involvement 13.5% 4% 8% 15.6% 7.8% 0 3.7% 7%
Keratic precipitates 99.2% 88% 96% 80.9% 83.8% 96.3% 100% 90%
Cell/flare aqueous 68.7%/71.2% 60% — 61.8% 46.9% 74.1%/18.5% 66.6% —
Heterochromia 12.7% 82% 87% 70.1% 90.3% 46.3% 70.4% 92%
Iris nodules 28.0% 10% — 31.5% 14.6% 1.9% 7.4% 20%
Absence of synechiae 100% 100% — 98.1%†† 96.1%‡‡ 100% 100% 100%
Cataract§§ 70.7% 82% 84% 73.0% 80.2% 90.7% 77.8% 75%
Vitreous opacity 73.8% 84% 69% 83.9% 66.6% — 14.8% —
Glaucoma 23.1% 22% 19% 15.7% 26.2% 59% 14.8% 11%
Chorioretinal leisions 0 20%储储 — 18.4% 7.2%¶¶ 14.8%## 7.4% 7%
Cystoid macular edema 0 2% — 2.3% — — — —

*La Hey E, Baarsma GS, De Vries J, Kijlstra A. Clinical analysis of Fuchs heterochromic cyclitis. Doc Ophthalmol 1991;78:225–35. Forty-eight patients
were white; 1, Turkish; and 2, Surinamese (nonwhite).
†
Dernouchamps JP. Fuchs heterochromic cyclitis: an IUSG study about 550 cases. In: Saari KM, ed. Uveitis Update: Proceedings of the First International
Symposium on Uveitis Held in Hanasaari, Espoo, Finland, on May 16 –19, 1984. Amsterdam: Exerpta Medica; 1984:129 –35. Patients’ races were not
mentioned.
‡
Fearnley IR, Rosenthal AR. Fuchs’ heterochromic iridocyclitis revisited. Acta Ophthalmol Scand 1995;73:166 –70. Seventy-one patients were white, and
6 Asian.
§
Jones NP. Fuchs’ heterochromic uveitis: a reappraisal of the clinical spectrum. Eye 1991;5:649 – 61. Ninety-five patients were white; 3, Asian; and 5,
Afro-Caribbean or mixed race (nonwhite).
储
Liesegang TJ. Clinical features and prognosis in Fuchs’ uveitis syndrome. Arch Ophthalmol 1982;100:1622– 6. Both blue-eyed and brown-eyed patients
were included, but their races were not mentioned.
¶
Velilla S, Dios E, Herreras JM, Calonge M. Fuchs’ heterochromic iridocyclitis: a review of 26 cases. Ocul Immunol Inflamm 2001;9:169 –75. Patients’
races were not mentioned.
#
Tabbut BR, Tessler HH, Williams D. Fuchs’ heterochromic iridocyclitis in blacks. Arch Ophthalmol 1988;106:1688 –90. All patients were white.
**Age range not mentioned.
††
One of 53 phakic eyes (1.9%) had a single synechia, whereas 6 of 36 aphakic or pseudophakic eyes (16.7%) had transient synechiae.
‡‡
All patients with synechiae had previously had cataract surgery.
§§
Including aphakic or pseudophakic eyes after cataract surgery.
储储
Nonactive scars, and 8% toxoplasmalike scars.
¶¶
Resembling old scars of toxoplasmosis.
##
Mild pigmented, punched-out peripheral lesions were found in 2 patients, and venous sheathing in 6 patients.

ciliary body, pars plana, and basal vitreous body; retinal
capillary leakage in the midperiphery fundus; and optic
staining in most of the patients who were studied. Compli-
cated cataract is the most common complication, followed
by secondary glaucoma.
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