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Downloaded from http://bjo.bmj.com/ on November 15, 2016 - Published by group.bmj.com Clinical science autofluorescence in Fuchs’ heterochromic Qian Liu,1 Yading Jia,1 Suhua Zhang,1 Juan Xie,1 Xin Chang,1 Jia Hou,1 Gaiyun Li,1 Douglas D Koch,2 Li Wang1,2

1Retinal Department, Shanxi ABSTRACT The autofluorescence imaging of melanin excited Hospital, Taiyuan, Shanxi Aims To explore the characteristic autofluorescence by near-infrared laser was described by Keilhauer Province, China 6 2Department of patterns of iris depigmentation in diagnosed with and Deloir. In a previous study, we used the indo- , Cullen Eye Fuchs’ heterochromic uveitis (FHU). cyanine green angiography (ICGA) mode of the Institute, Baylor College of Methods Near-infrared autofluorescence images and Heidelberg Angiograph 2 (HRA2, Medicine, Houston, Texas, USA colour images of iris were taken in 21 eyes of 21 Heidelberg, Germany) and 795 nm laser to excite patients with FHU, 30 eyes of 15 normal subjects, 30 melanin-related fundus autofluorescence.7 To the Correspondence to Dr Yading Jia, Shanxi Eye eyes of 15 normal age-related iris atrophy and 33 eyes best to our knowledge, there are no studies evaluat- Hospital, 100 Fudong Street, of 20 patients with uveitis other than FHU. The confocal ing the iris using the near-infrared autofluores- Taiyuan, Shanxi Province scanning laser ophthalmoscope (Heidelberg Retina cence. In this study, excitation laser light with the 030002, China; Angiograph 2, HRA2) was used for melanin-related wavelength of 795 nm was applied to detect the [email protected] autofluorescence imaging. The indocyanine green morphological characteristics of iris autofluores- Received 22 July 2015 angiography mode of HRA2 was applied for near- cence in patients with FHU. Revised 4 December 2015 infrared laser imaging, and the wavelength of the Accepted 12 December 2015 excitation laser was 795 nm. Iris colour images were SUBJECTS AND METHOD Published Online First also taken with the . Subjects 12 January 2016 Results In normal iris, moderately intense This study obtained Institutional Review Board autofluorescence was noted for the pigment ruff at the approval. Patients provided informed written pupillary border, the crests in the pupillary zone and the consent prior to their participation. The tenets of collarette; and there was mild autofluorescence in the the Declaration of Helsinki were followed. ciliary zone. In eyes with age-related iris atrophy and We enrolled 21 eyes of 21 patients who were uveitis, much less autofluorescence was seen than the diagnosed with FHU at the Division of the healthy normal irides. In eyes with FHU, there was Shanxi Eye Hospital from July 2012 to September moderate but discontinuous autofluorescence in the 2015, including 5 eyes from 5 male patients and 16 pigment ruff, a petaloid pattern of autofluorescence in eyes from 16 female patients. The average age of the pupillary zone, moderate autofluorescence in the these patients was 51.4 years (range 19–78 years). collarette and reticular pattern of autofluorescence in the All patients’ natural iris colour was brown. ciliary zone. The diagnostic criteria of FHU were as follows: Conclusions Characteristic autofluorescence patterns mild uveitis at the anterior segment with no appeared in eyes diagnosed with FHU. Near-infrared obvious acute exacerbation; dispersed distribution autofluorescence is a promising objective technique to of pigment on ; diffuse iris document the iris changes in FHU. atrophy with or without obvious heterochromia iridis and no posterior synechiae.8 Of the 21 eyes examined with FHU, FHU was INTRODUCTION diagnosed in one eye in 20 of the 20 (95.2%) Fuchs’ heterochromic uveitis (FHU) was first patients and in two eyes in 1 patient (4.8%), who described by Ernst Fuchs in 1906.1 Diagnosis of had cataract surgery done in one eye, which we this condition does not rely on laboratory examina- excluded from the study (table 1). Six of the 21 tions but is based purely on clinical observations.2 eyes (28.6%) with FHU had a history of diagnosed Generally, heterochromia iridis is considered the uveitis, steroid and mydriatic treatments. Eighteen characteristic clinical manifestation of this disease. eyes (85.7%) showed symptoms of uveitis during In many cases, diagnosis of FHU is delayed for the study, with new keratic precipitates observed on years. Norrsell and Sjodell suggested that excessive the corneal endothelium. Of these 18 eyes, 6 attention to heterochromia iridis and failure to (28.6%) showed mild anterior chamber flare and notice iris atrophy are the main causes of misdiag- Koeppe nodules around the were observed in nosis of FHU.2 To date, there has been a lack of an 2 eyes. In these FHU cases, vitritis/vitreous haze efficient and objective diagnostic approach for iris was present in three eyes (14.3%), and fundus find- depigmentation. ings were unremarkable in all eyes. The anatomical structures of the iris from the Two normal control groups were also included. anterior to posterior are as follows: anterior limit- To study the characteristic autofluorescence pat- ing layer, stroma, iris sphincter muscle centrally, iris terns of the iris in normal eyes, 15 subjects were dilator muscle, anterior pigment epithelium and enrolled, with a mean age of 39.5 years (range 20– posterior pigment epithelium. The colour of the 50 years). To evaluate the autofluorescence of iris To cite: Liu Q, Jia Y, iris largely depends on the content of melanin in depigmentation in normal age-related atrophy, 15 Zhang S, et al. Br J the stroma.34Iris near-infrared autofluorescence subjects with apparent iris atrophy by slit lamp Ophthalmol originates from the melanin pigment in the iris examination were enrolled, with a mean age of – 2016;100:1397 1402. stromal layer.5 72.0 years (range 60–83 years). The inclusion

Liu Q, et al. Br J Ophthalmol 2016;100:1397–1402. doi:10.1136/bjophthalmol-2015-307246 1397 Downloaded from http://bjo.bmj.com/ on November 15, 2016 - Published by group.bmj.com Clinical science

Table 1 Demographics and characteristics of patients diagnosed with Fuchs’ heterochromic uveitis Anterior Keratic chamber Iris Iris Posterior Mild uveitis Vitritis/vitreous Patient no Gender Age Eye precipitates flare atrophy Heterochromia nodules Cataract history haze

1 F 44 OS + − ++ − + −− − 2 F 35 OD + − + −−+ − + − 3 F 78 OD −−++ − + − + − 4 F 72 OD + + + + − + − ++ 5 F 19 OD + − + −−+ −− − 6 F 32 OS + + + −−+ − ++ 7 F 25 OD + + + + + + − + − 8 F 32 OD + −−+ − + −− − 9 F 51 OD + − + −−+ −− − 10 M 56 OD + + + + − + −− − 11 F 73 OD + − + −−+ −− − 12 F 65 OS + − + − ++−− − 13 F 69 OD −−+v − + −− − 14 F 48 OD + −−− −+ −− − 15 M 44 OD + − + −−+ −− − 16 M 54 OD + −−− −+ −− − 17 F 46 OD + −−− −+ −− − 18 F 60 OS −−++ − + − + − 19 M 69 OD + + + −−+ −− + 20 F 73 OD + − + −−+ −− − 21 M 35 OS + + −− −+ −− − +, present; −, not present; OD, right eye; OS, left eye.

criteria for these two control groups were normal subjects Slit lamp photos and autofluorescence imaging without: (1) any corneal or ocular disease except cataract, (2) All patients underwent iris colour imaging with the slit lamp , (3) a history of or current uveitis except FHU and (4) (TOPCON DC-3, Topcon Medical Systems, Oakland, New prior ophthalmic surgery. Jersey, USA). The angular field of the imaging scope was 60° One disease control group was included as well. To investigate and the resolution was 3264×2448 pixels. the characteristic autofluorescence patterns of the iris in patients A confocal scanning laser ophthalmoscope, the HRA 2, was with uveitis other than FHU, 33 eyes of 20 subjects were used for melanin-related autofluorescence imaging. The ICGA enrolled, with a mean age of 44.2 years (range 15–70 years). mode of HRA2 was applied for near-infrared laser imaging, and The inclusion criteria for this group were patients with a the wavelength of the excitation laser was 795 nm. All tests current or a history of uveitis except FHU and without: (1) any were performed by the same experienced user. Eyes were not corneal or ocular disease except cataract, (2) glaucoma and (3) dilated before undergoing autofluorescence tests. prior ophthalmic surgery. Of the 33 eyes, 14 eyes (42.4%) of 8 Autofluorescence imaging was achieved through HRA2 auto- patients had acute uveitis (table 2) and 19 eyes of 12 subjects matic synthesis of nine images per second. The imaging field of had a history of uveitis (table 3). In eyes with acute uveitis, view was 55°, focal length was 90 D, energy level was 94% and keratic precipitates were seen on the corneal endothelium and image resolution was 496×596 pixels. moderate-to-severe anterior chamber flare was observed. In eyes Slit lamp photo and autofluorescence imaging were obtained with a history of uveitis, keratic precipitates were seen on the in both eyes of all patients. corneal endothelium, and no anterior chamber flare was To study the characteristic autofluorescence patterns of iris, observed. we evaluated the following zones (figure 1A)9:

Table 2 Demographics and characteristics of patients with primary acute uveitis other than Fuchs’ heterochromic uveitis Keratic Posterior Vitritis/vitreous Patient no Gender Age Eye precipitates Anterior chamber flare synechia haze Comments

1 F 15 OU − +++ −− Upper respiratory tract infection history 2 M 26 OU + ++ −− Upper respiratory tract infection history 3 M 28 OU − ++ −− Upper respiratory tract infection history 4 M 33 OU − ++ −− Upper respiratory tract infection history 5 F 37 OU − + −− Upper respiratory tract infection history 6 M 46 OU + ++ −− Upper respiratory tract infection history 7 M 34 OD + ++ −− history 8 M 38 OD + +++ (with gelatinous exudation) −− Ankylosing spondylitis history +, present; −, not present; OD, right eye; OU, both eyes.

1398 Liu Q, et al. Br J Ophthalmol 2016;100:1397–1402. doi:10.1136/bjophthalmol-2015-307246 Downloaded from http://bjo.bmj.com/ on November 15, 2016 - Published by group.bmj.com Clinical science

Table 3 Demographics and characteristics of patients with a history of uveitis other than Fuchs’ heterochromic uveitis Patient no Gender Age Eye Keratic precipitates Anterior chamber flare Posterior synechia Vitritis/vitreous haze Comments

1 M 70 OU −− + −− 2 F 43 OS + −−−− 3 F 47 OD + − + −− OS −− + −− 4 F 60 OU + − + − history 5 F 50 OU + − + − Tuberculosis history 6 F 54 OD + − + − history OS + −−− 7 F 55 OU + −−−Rheumatoid arthritis history 8 F 58 OS + − + − Rheumatoid arthritis history 9 F 63 OS −− + − Rheumatoid arthritis history 10 M 45 OD + − + − Ankylosing spondylitis history 11 M 40 OD −− + − Ankylosing spondylitis history OS + − + − 12 M 42 OD + − + − Ankylosing spondylitis history +, present; −, not present; OD, right eye; OS, left eye; OU, both eyes.

1. Pigment ruff on the pupillary border, which is a lace-like collarette and (4) in the ciliary zone generally mild with some central termination of the iris pigment epithelium. dark radial regions (figure 1). 2. Pupillary zone, which is the 1–2 mm zone central to collar- ette; features include radial crests and intervening deep Autofluorescence in normal age-related iris atrophy radial slits. The autofluorescence presented as follows: (1) marked for the 3. Collarette of the iris, which is a wavy circular line approxi- pigment ruff at the pupillary border; (2) minimal in the pupil- mately 1–1.5 mm from the pupillary border; the collarette is lary zone; (3) mild for the collarette and (4) minimal in the the thickest portion of the iris measuring 0.6–1.0 mm; on ciliary zone (figure 2). In general, irides with age-related depig- either side of the collarette are pits called crypts. mentation showed much less autofluorescence than the healthy 4. Ciliary zone, which is the 3–4 mm zone peripheral to the irides of the younger subjects. collarette; features include ridges created by radially oriented blood vessels and surrounding stromal connective tissue. Autofluorescence in iris with uveitis other than FHU The autofluorescence was noted as follows: (1) moderate for the We graded the intensity of autofluorescence as marked if very pigment ruff at the pupillary border; (2) minimal in the pupil- bright, moderate, mild and minimal if barely discernable. lary zone; (3) mild for the collarette and (4) minimal in the ciliary zone. In general, irides with acute or a history of uveitis RESULTS other than FHU showed much less autofluorescence than the Table 4 summarises the characteristic autofluorescence patterns healthy irides of the younger subjects, and similar autofluores- of normal iris, iris in normal age-related atrophy, iris with cence to irides with age-related iris atrophy (figure 3). uveitis other than FHU and iris in FHU at different zones. Autofluorescence in FHU The autofluorescence was observed as follows: (1) moderate but Autofluorescence in normal iris discontinuous for the pigment ruff on the pupillary border in The autofluorescence was noted as follows: (1) fairly uniform with moderate intensity for the pigment ruff at the pupillary border; (2) for the pupillary zone, moderate for the crests and Table 4 Characteristic autofluorescence patterns of normal iris, mild for the deep radial slits; (3) largely moderate for the iris in normal age-related atrophy, iris with uveitis except Fuchs’ heterochromic uveitis and iris in Fuchs’ heterochromic uveitis at different zones Ciliary Pigment ruff Pupillary zone Collarette zone

Normal Moderate Moderate Moderate Mild Normal Marked Minimal Mild Minimal age-related atrophy Uveitis except Moderate Minimal Mild Minimal Fuchs’ heterochromic uveitis Fuchs’ Moderate Petaloid pattern: Moderate Reticular heterochromic discontinuous moderate along pattern Figure 1 Iris colour image (A) and near-infrared autofluorescence (B) uveitis crests and minimal in normal iris in a 30-year-old man (left eye) (a: pigment ruff, b: in deep troughs pupillary zone, c: collarette and d: ciliary zone).

Liu Q, et al. Br J Ophthalmol 2016;100:1397–1402. doi:10.1136/bjophthalmol-2015-307246 1399 Downloaded from http://bjo.bmj.com/ on November 15, 2016 - Published by group.bmj.com Clinical science

The patient diagnosed with bilateral FHU showed heterochro- mia iridis with more evident iris atrophy in the right eye. Typical autofluorescence FHU features were noted in both eyes (figure 6). The left eye had undergone cataract surgery.

DISCUSSION There is often a significant delay between the onset and final diagnosis of FHU. We found an average delay of 2.8 years (0– 9 years) in our patients according to their medical histories. The average delay was 3 years (0–26 years) in the study by Norrsell and Sjodell,2 and 6.7 years (0–30 years) in the study by Fearnley and Rosenthal.10 Before the diagnosis of FHU was confirmed, Figure 2 Iris colour image (A) and near-infrared autofluorescence (B) some patients, especially those with vitreous opacities, were in iris with normal age-related atrophy in a 68-year-old man (right eye). treated with a uveitis therapeutic protocol that included long- term topical and systemic administration, which 17 of the 21 eyes with FHU (81.0%) and completely absent in can cause many side effects. six eyes; (2) in the pupillary zone, petaloid pattern with moder- Heterochromia iridis has been recognised as a characteristic ate autofluorescence along the crests and minimal autofluores- feature in the clinical diagnosis of this disease. However, in this cence in deep radial troughs; (3) moderate for the collarette and study, only 8 of the 21 eyes (38.1%) showed obvious hetero- (4) in the ciliary zone, moderately intense reticular pattern with chromia iridis. In the study by Norrsell and Sjodell,2 only 15% minimal autofluorescence in intervening regions (figures 4–6). of patients showed obvious heterochromia iridis. They also Figure 4 shows an example of a patient with clinically diag- found that heterochromia iridis was usually not seen in eyes nosed FHU in the right eye. Colour images show some iris with brown irides, and early iris atrophy may elude detection. atrophy and barely detectable heterochromia in the affected eye; In addition, heterochromia iridis and iris atrophy are also some- whereas near-infrared autofluorescence pictures show typical times difficult to observe in patients with blue eyes. autofluorescence features of FHU in the right eye and a normal Furthermore, heterochromia iridis and iris atrophy are indis- pattern in the left unaffected eye. Figure 5 is another sample of cernible in patients with bilateral FHU because of the absence patients with clinically diagnosed FHU in one eye. Typical auto- of a control condition. There was one (10%) patient with bilat- fluorescence features of eyes with FHU were noted in the right eral FHU in our study who was referred to our clinic due to eye. Although the left eye was diagnosed normal clinically, the decreased binocular visual acuity. By comparing both eyes, the autofluorescence pattern shows a petaloid pattern in the pupil- right eye was diagnosed with FHU. Due to advanced cataract in lary zone and reticular pattern in the ciliary zone, indicating an the left eye, cataract surgery was performed in this eye and near- early stage of FHU. infrared autofluorescence images were taken after the surgery.

Figure 3 Iris colour image (A) and near-infrared autofluorescence (B) in iris with acute uveitis in a 28-year-old woman, and iris colour image (C) and near-infrared autofluorescence (D) in iris with a history of uveitis in a 65-year-old man.

1400 Liu Q, et al. Br J Ophthalmol 2016;100:1397–1402. doi:10.1136/bjophthalmol-2015-307246 Downloaded from http://bjo.bmj.com/ on November 15, 2016 - Published by group.bmj.com Clinical science

Figure 4 Colour images (A and B) and near-infrared autofluorescence (C and D) in both eyes of a patient (35 years old). The right eye was diagnosed with Fuchs’ heterochromic uveitis (FHU) and the left eye was normal. Colour images showed some iris atrophy and barely detectable heterochromia in the affected eye, whereas near-infrared autofluorescence pictures showed typical autofluorescence features of FHU in the right eye and a normal pattern in the left unaffected eye.

Although obvious heterochromia iridis was observed, both eyes that objectively detects the distribution of melanin particles in showed similar abnormal near-infrared autofluorescence appear- the iris. ance (figure 6). Another interesting finding in our study was that the near- Based on the above observations, we believe that clinical signs infrared autofluorescence may be a tool to detect early stage of of iris atrophy, including heterochromia iridis, are not uniformly FHU in patients before the appearance of their clinical FHU fea- evident in eyes with FHU. There is evidence that iris colours tures. For patient case #4, based on clinical features, the right differ because of the number of melanin granules within superfi- eye was diagnosed as FHU and the left eye was normal. cial stromal melanocytes.4 The aetiology of heterochromia in However, near-infrared autofluorescence demonstrated that a FHU is felt to be due to loss of stromal melanocytes and mild but typical pattern of FHU autofluorescence, indicating reduced size of melanosomes.11 An objective diagnostic method early FHU. that analyses iris pigment status is desirable. In cultured cells, Pupil colour is fully developed in infancy. Although melano- Geng et al12 demonstrated that the iris hyperfluorescence cytes from adults have the ability to synthesise melanin in excited by near-infrared laser originates from the melanin in the vitro,13 obvious pigment synthesis has not been observed in the iris. Autofluorescence is a simple non-invasive testing method human iris after birth. Hence, the change of iris colour over time originates from complications of aging and certain dis- – eases.14 16 Compared with healthy normal irides, much less autofluorescence was noted in eyes with age-related iris atrophy and acute or a history of uveitis. This study has certain limitations. This was a single site study with small sample size, and the specificity of near-infrared auto- fluorescence in FHU still needs to be further verified. The of the eyes in our study were all in their natural status, and therefore showed different sizes under different light stimu- lations (eg, both eyes of a patient shown in figure 6). Therefore, the degree of eversion of the pigment ruff on the pupillary border was different. All subjects enrolled in this study were vis- iting our hospital for cataract evaluation. Our study was thus an Figure 5 Near-infrared autofluorescence in both eyes of a patient observational study on patients with FHU after the condition (72 years old). The right eye (A) was diagnosed with Fuchs’ had developed to a certain stage. Currently, in our hospital, all heterochromic uveitis (FHU) and typical autofluorescence features of patients with FHU routinely receive near-infrared autofluores- eyes with FHU were noted. The left eye (B) was diagnosed as normal cence testing. Further investigation of near-infrared autofluores- fl iris clinically; however, the auto uorescence pattern showed a petaloid cence appearance in early-stage FHU eyes is desirable. We did pattern in the pupillary zone and reticular pattern in the ciliary zone, not do molecular diagnostic tests to rule out associated viral indicating an early stage of FHU. aetiologies and did not find out the cause of FHU in these

Liu Q, et al. Br J Ophthalmol 2016;100:1397–1402. doi:10.1136/bjophthalmol-2015-307246 1401 Downloaded from http://bjo.bmj.com/ on November 15, 2016 - Published by group.bmj.com Clinical science

Figure 6 Near-infrared autofluorescence and colour images of iris in the patient with bilateral Fuchs’ heterochromic uveitis (FHU). Typical autofluorescence FHU features were noted in both eyes (A and B), and colour images showed heterochromia iridis with more evident iris atrophy in the right eye (C and D). The left eye had undergone cataract surgery.

cases. Finally, in the future it will be important to compare the 2 Norrsell K, Sjodell L. Fuchs’ heterochromic uveitis: a longitudinal clinical study. Acta FHU iris findings in our study to (1) patients with iris atrophy Ophthalmol 2008;86:58–64. 3 Wielgus AR, Sarna T. Melanin in human irides of different color and age of donors. from other causes other than natural ageing, (2) patients with Pigment Cell Res 2005;18:454–64. certain other types of uveitis, such as and 4 Imesch PD, Wallow IH, Albert DM. The color of the : a review of Varicella zoster and (3) patients with pigment dispersion morphologic correlates and of some conditions that affect iridial pigmentation. Surv syndrome. Ophthalmol 1997;41(Suppl 2):S117–23. In conclusion, our study demonstrated that near-infrared 5 Weiter JJ, Delori FC, Wing GL, et al. Retinal pigment epithelial lipofuscin and fl melanin and choroidal melanin in human eyes. Invest Ophthalmol Vis Sci auto uorescence may be used as an objective method for docu- 1986;27:145–52. menting the iris changes in FHU. Additional studies are desir- 6 Keilhauer CN, Delori FC. Near-infrared autofluorescence imaging of the fundus: able to provide quantitative measurements of autofluorescence visualization of ocular melanin. Invest Ophthalmol Vis Sci 2006;47:3556–64. in iris of normal eyes, eyes diagnosed with FHU and eyes with 7 Qian Liu, Ya-Ding Jia. Autofluoresence manifestation in related lesions of peripheral . Chin J Ocul Fundus Dis 2011;27:119–22. iris atrophy of other aetiologies. Further studies with large 8 Norrsell K, Holmer AK, Jacobson H. Aqueous flare in patients with monocular iris sample size and in eyes with iris colours other than brown are atrophy and uveitis. A laser flare and iris angiography study. Acta Ophthalmol warranted. Scand 1998;76:405–12. 9 Bron AJ, Tripathi RC, Tripathi BJ. Wolff’s anatomy of the eye and . 8th edn. Contributors We confirm that all authors included on this manuscript fulfil the London: Chapman & Hall Medical, 1997. criteria of authorship. 10 Fearnley IR, Rosenthal AR. Fuchs’ heterochromic iridocyclitis revisited. Acta – Funding Supported in part by a grant for Basic research project of Shanxi Province Ophthalmol Scand 1995;73:166 70. 11 McCartney AC, Bull TB, Spalton DJ. Fuchs’ heterochromic cyclitis: an electron (project number: 2014021039-5) (QL and YJ), and an unrestricted grant from – Research to Prevent Blindness, New York, NY (DDK and LW). microscopy study. Trans Ophthalmol Soc UK 1986;105:324 9. 12 Geng L, Wihlmark U, Algvere PV. Lipofuscin accumulation in iris pigment epithelial Competing interests None declared. cells exposed to photoreceptor outer segments. Exp Eye Res 1999;69:539–46. Patient consent Obtained. 13 Hu DN, McCormick SA, Orlow SJ, et al. Melanogenesis by human uveal melanocytes in vitro. Invest Ophthalmol Vis Sci 1995;36:931–8. Ethics approval Institutional review board at Institute of Shanxi Eye Research. 14 Arranz-Marquez E, Teus MA, Saornil MA, et al. Analysis of irises with a Provenance and peer review Not commissioned; externally peer reviewed. -induced change in iris color. Am J Ophthalmol 2004;138:625–30. 15 Grierson I, Jonsson M, Cracknell K. Latanoprost and pigmentation. Jpn J Ophthalmol 2004;48:602–12. REFERENCES 16 Stjernschantz JW, Albert DM, Hu DN, et al. Mechanism and clinical significance of 1O’Connor GR. Doyne lecture. Heterochromic iridocyclitis. Trans Ophthalmol Soc UK prostaglandin-induced iris pigmentation. Surv Ophthalmol 2002;47(Suppl 1): 1985;104:219–31. S162–75.

1402 Liu Q, et al. Br J Ophthalmol 2016;100:1397–1402. doi:10.1136/bjophthalmol-2015-307246 Downloaded from http://bjo.bmj.com/ on November 15, 2016 - Published by group.bmj.com

Iris autofluorescence in Fuchs' heterochromic uveitis

Qian Liu, Yading Jia, Suhua Zhang, Juan Xie, Xin Chang, Jia Hou, Gaiyun Li, Douglas D Koch and Li Wang

Br J Ophthalmol 2016 100: 1397-1402 originally published online January 12, 2016 doi: 10.1136/bjophthalmol-2015-307246

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