Visual Blurring Following Posterior Vitreous Detachment in Fuchs Uveitis Syndrome

To describe the clinical presentation, diagnostic challenges, management, and visual outcome of acute posterior vitreous detachment (PVD) in patients with Fuchs uveitis syndrome (FUS).

This retrospective case series included consecutive patients with FUS who presented with acute PVD at a referral center from 2020 to 2024. The diagnosis of PVD was established based on fundus examination and dynamic B-scan ultrasonography findings.

Sixteen eyes of 16 patients (11 females, 5 males) with a mean age of 43 $\pm$ 9.8 years were studied. All patients reported sudden blurred vision in a white, painless eye, with 43.8% noting a new onset or an increased floater. The mean best-corrected visual acuity (BCVA) ranged from 20/25 to 20/200 at presentation, with an average of 0.43 logMAR. B-scan imaging revealed that following PVD, the majority of echogenic vitreous opacities were confined to the detached, shrunken vitreous body, and in some instances, accumulated within the peripheral vitreous cortex. The liquefied vitreous humor between the retina and the posterior hyaloid remained relatively echo-free. Within 3 months, spontaneous visual improvement occurred in 62.5% of patients, with mean BCVA improving from 0.310 to 0.127 logMAR. In three patients with persistent symptoms, pars plana vitrectomy (PPV) resulted in significant visual improvement, with the mean logMAR changing from 0.740 to 0.133.

Acute PVD in patients with FUS can lead to sudden blurred vision, likely due to the increased density of inflammatory cells, opacities, and condensed vitreous strands within a detached, shrunken vitreous gel. In some cases, inflammatory deposits were layering over the peripheral vitreous body, contributing further to visual disturbance. Although most eyes showed spontaneous improvement, PPV was an effective intervention for patients with persistent, intolerable symptoms.