Update on Rubella-Associated Uveitis
American Journal of Ophthalmology, June 2019
Although vaccination programs have nearly eliminated congenital rubella virus from the Western world, associations of rubella with Fuchs uveitis syndrome (FUS) were noted in 2006. Since then, many have assumed that these conditions are linked. To explore this possibility, Groen-Hakan et al. evaluated clinical and lab findings of patients with rubella virus–positive uveitis, as well as aqueous humor samples from patients with FUS. The authors found that even though most cases of FUS included intraocular rubella infection, only some patients with rubella-associated uveitis displayed FUS.
This retrospective study, conducted between January 2010 and October 2016 at two sites in the Netherlands, involved consecutive patients with rubella virus–positive aqueous humor samples based on polymerase chain reaction (PCR) and/or Goldmann-Witmer coefficient (GWC) analysis. Anatomic classification and clinical characteristics were recorded, along with vaccination status. All patients with FUS received their diagnosis during the same period.
Among the 127 study participants (144 eyes), the virus was found in the aqueous fluid of 120 patients by GWC, 23 by PCR, and in 16 by both. Bilateral involvement was present in 17 patients (13%). Of the 39 patients with FUS phenotype, evaluated separately, 37 had positive rubella findings.
Blurred vision and floaters were common reasons for referral; ophthalmologic evidence included the combination of chronic anterior uveitis, keratic precipitates, vitritis, and absent posterior synechiae. Early development of cataracts and glaucoma was common, and cataract was the main cause of visual loss at presentation. Cystoid macular edema was unusual. None of the patients had been vaccinated against rubella virus at an early age.
This research not only negates the belief that rubella-associated uveitis always presents with the FUS phenotype but also exposes the diverse clinical nature of the condition, which often includes chronic unilateral anterior uveitis and vitritis. The authors stressed the importance of long-term IOP monitoring in patients with rubella-associated uveitis and emphasized diagnostic accuracy to ensure that immunosuppressant therapy is reserved for those who need it.
The original article can be found here.