Journal of Ophthalmic and Vision Research

LETTER
Year
: 2015  |  Volume : 10  |  Issue : 3  |  Page : 353--354

Fuch's heterochromic iridocyclitis in Iran: Is the disease going to fade away?


Niloofar Piri, Hossein Asghari, Henry J Kaplan 
 Department of Ophthalmology and Visual Sciences, University of Louisville, Kentucky, USA

Correspondence Address:
Niloofar Piri
301 E Muhammad Ali Blvd, Louisville, KY 40202
USA




How to cite this article:
Piri N, Asghari H, Kaplan HJ. Fuch's heterochromic iridocyclitis in Iran: Is the disease going to fade away?.J Ophthalmic Vis Res 2015;10:353-354


How to cite this URL:
Piri N, Asghari H, Kaplan HJ. Fuch's heterochromic iridocyclitis in Iran: Is the disease going to fade away?. J Ophthalmic Vis Res [serial online] 2015 [cited 2019 Sep 16 ];10:353-354
Available from: http://www.jovr.org/text.asp?2015/10/3/353/170363


Full Text



Dear Editor,

There is a diverse group of well-known uveitic entities which are of unknown etiology. Many experts believe that the majority of them are the consequences of unknown infectious pathogens, most probably viral.[1]

Fuch's heterochromic iridocyclitis (FHI) is a well-known entity, which usually presents as a unilateral low-grade inflammation in a white eye with diffuse, stellate keratic precipitates and, mild anterior chamber inflammation, iris atrophy and no posterior synechiae.[2],[3] In addition there is an associated 70% risk of cataracts and 15% risk of glaucoma.[2],[3]

FHI is unique in that polymerase chain reaction (PCR) studies on aqueous samples in several clinical studies has identified the rubella virus as the cause of the entity.[4],[5],[6] Nowadays, FHI is rarely seen in uveitis cases in the United States which is in contrast to developing countries. We assume the reason is the difference in national immunization programs between Western countries and developing countries.

The mumps, measles, and rubella (MMR) vaccine was licensed in the United States in 1971, although it was first used in 1969. In an epidemiologic study at the University of Chicago, it was shown that after vaccination with MMR vaccine, the incidence of the diseases were decreased by almost 30% each decade afterwards.[7] Today, after over 40 years since starting immunization, a patient with FHI younger than 40 years of age is hardly ever seen which supports the efficacy of vaccination in preventing the disease.

MMR vaccination was started routinely as a national health care protocol in Iran since 2005, before which rubella and mumps were not included in the national immunization program.

If we accept the aforesaid scenario, a 30% decrease of the disease in each subsequent decade can be expected, and theoretically after half a century, the disease will disappear with 100% vaccination.

There are many other uveitis entities in which the etiology is unknown. Acute posterior multifocal placoid pigment epitheliopathy is a rare condition in the United States today, although according to the anecdotal data the prevalence of the disease was much higher 20 years before; however at present, it is commonly seen in Iran. A possible underlying infectious etiology which has faded in the West but is still very common in developing countries, such as tuberculosis should be considered.

We believe and hope that a better understanding of the pathogenesis of uveitis disorders will be beneficial in preventing them in near future.

References

1Kongyai N, Sirirungsi W, Pathanapitoon K, Tananuvat N, Kunavisarut P, Leechanachai P, et al. Viral causes of unexplained anterior uveitis in Thailand. Eye (Lond) 2012;26:529-534.
2AAO, the Eye MD Association. Pathology: Cataract associated with uveitis. In: Basic and Clinical Science Course, Section 11, Lens and Cataract. Ch. 4. Canada: American Academy of Ophthalmology; 2015-2016.
3AAO, the Eye MD Association. Open angle glaucoma. In: Basic and Clinical Science Course, Section 10, Glaucoma. Ch. 4. Canada: American Academy of Ophthalmology; 2015-2016.
4Suzuki J, Goto H, Komase K, Abo H, Fujii K, Otsuki N, et al. Rubella virus as a possible etiological agent of Fuchs heterochromic iridocyclitis. Graefes Arch Clin Exp Ophthalmol 2010;248:1487-1491.de Groot-Mijnes JD, de Visser L, Rothova A, Schuller M,
5van Loon AM, Weersink AJ. Rubella virus is associated with fuchs heterochromic iridocyclitis. Am J Ophthalmol 2006;141:212-214.
6Quentin CD, Reiber H. Fuchs heterochromic cyclitis: Rubella virus antibodies and genome in aqueous humor. Am J Ophthalmol 2004;138:46-54.
7Birnbaum AD, Tessler HH, Schultz KL, Farber MD, Gao W, Lin P, et al. Epidemiologic relationship between fuchs heterochromic iridocyclitis and the United States rubella vaccination program. Am J Ophthalmol 2007;144:424-428.