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T. Wong, L.L. Lim, S.R. Planck, E.B. Suhler, W.D. Mathers, J.T. Rosenbaum; Intravital Microscopy of Keratic Precipitates in Patients With Uveitis Obtained With the Heidelberg Confocal Laser Microscope . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4510.
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Our previous in vivo imaging of keratic precipitates (KP) in ocular inflammatory diseases was limited to tandem scanning microscopy that uses white light. Recent advances in laser confocal microscopy have provided images with far greater resolution. We now report the appearance of KP in various ocular inflammatory diseases using the Heidelberg Confocal Laser Microscope (HRT II).
Patients with active uveitis (N=27) were scanned with an HRT II equipped with a Rostock Cornea Module attachment at an optical depth of 450–650 ÿm from the corneal epithelial surface and a minimum coverage area of 4 mm2. Twenty two of these patients had non–infectious uveitis: 4 had HLA–B27+ acute anterior uveitis (AAU), 4 had sarcoidosis–associated granulomatous uveitis, 1 had tubulo–interstitial nephritis and uveitis, 1 had juvenile idiopathic arthritis, 1 had rheumatoid sclerouveitis and 11 had idiopathic disease (3 AAU, 2 intermediate uveitis, 1 pars planitis, 5 panuveitis). Of the infectious cases (N=5), 4 had herpetic uveitis and 1 had post–surgical infective endophthalmitis.
Improved visualization of KP details was noted in comparison to the tandem scanning microscope (see Figure 1). As a result, dendritiform–appearing KP were observed in 15 of 22 patients with non–infectious uveitis with acutely active inflammation. Patients with HLA B27 AAU within this subset were noted to have a unique morphology of dendritiform KP. In contrast, non–dendritiform KP were observed in all cases of infective uveitis (N=5) and 7 patients with non–infectious uveitis. However, all of these patients (N=12) had been treated with a topical corticosteroid and were therefore less acutely inflamed. KP of differing morphology were also observed in the same eye at the same time point in 4 patients.
The KP image quality with the laser confocal microscope is far superior to previous technology and has allowed us to refine our prior interpretations of KP morphology. Confocal microscopy appears to be useful in the diagnosis of specific subtypes of uveitis, such as HLA B27 associated disease.
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