Silent Anterior-Segment Remodeling in Fuchs Uveitis Syndrome: Structural and Pupillometric Findings

Purpose To quantify anterior-segment remodelling and pupillary behaviour in unilateral Fuchs uveitis syndrome (FUS) and to evaluate the diagnostic utility of anterior-segment metrics.Methods Single-centre, retrospective, paired-eye study of 42 patients with unilateral FUS was conducted. Each patient’s FUS eye was compared with the contralateral clinically healthy eye. Anterior-segment parameters (K1, K2, Kmax, central corneal thickness, anterior chamber depth (ACD), anterior chamber volume, iridocorneal angle (ICA)) were obtained with a Scheimpflug system. Static pupillometry recorded pupil diameter under scotopic (0.04 lx), mesopic (4 lx), and photopic (40 lx) conditions. The discriminative performance of parameters was assessed by receiver-operating characteristic (ROC) analysis.Results FUS eyes showed a wider ICA and deeper ACD (p < 0.001, for each). K2 and Kmax were steeper in FUS (both p < 0.001). On pupillometry, the photopic pupil was larger in FUS (p = 0.001), whereas scotopic and mesopic diameters were comparable (p = 0.78 and 0.64, respectively). The mesopic to photopic constriction amplitude was reduced in FUS (p = 0.002); the scotopic to photopic amplitude was borderline (p = 0.061), and scotopic to mesopic was not different (p = 0.739) between eyes. In ROC analysis, ACD discriminated FUS from fellow eyes with an AUC of 0.747 (95% CI, 0.638–0.846); the cutoff was 3.05 mm, with a sensitivity of 0.67 and a specificity of 0.79.Conclusions Unilateral FUS exhibits a coherent structural–functional signature: wider angles and deeper ACD, axis-selective anterior steepening, and attenuated photopic constriction with a larger photopic pupil. Combining Scheimpflug anterior-segment metrics with standardized pupillometry provides practical, adjunctive markers that may strengthen diagnostic confidence and sharpen hypotheses on FUS pathophysiology.