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Doran Spencer, Stephen D Anesi, C. Stephen Foster; Characterization of corneal endothelial pseudoguttata in the setting of anterior uveitis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):557.
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© ARVO (1962-2015); The Authors (2016-present)
Corneal endothelial pseudoguttata are a poorly recognized physical finding that have been described previously primarily as a sign of corneal pathology; their association with intraocular inflammation is nearly undocumented and unknown in ophthalmology. We describe the novel characteristics of pseudoguttata in patients with anterior uveitis (AU) of various etiologies seen at a Uveitis referral center. Per our experience, pseudoguttata represent a reliable and highly clinically relevant marker of anterior segment intraocular inflammation.
The clinical characteristics of 14 AU patients are detailed, including their age, gender, diagnosis, Standardization of Uveitis Nomenclature (SUN) anterior chamber cell severity, presence of pseudoguttata, flaremeter reading, specular and slit lamp microscopic findings; unaffected, contralateral eye characteristics are reported when appropriate. The evolution of these characteristics in response to treatment are also described.
14 patients with active AU were seen. All patients with non-operative AU were noted to have pseudoguttata. Etiologies of AU included HLA-B27-associated (4), idiopathic (3), Juvenile Idiopathic Arthritis (JIA)-associated (1), Behcet’s (1) and post-operative (5). AU SUN cell severity of study patients ranged from trace to 3+, with absence of keratic precipitates; pseudoguttata prominence was noted to correlate directly with SUN severity in non-operative patients, ranging from trace to near confluent. Flaremeter readings correlated with SUN cell and pseudoguttata severity in non-operative patients. Pseudoguttata were readily visible via specular microscopy when noted at the slit lamp. Pseudoguttata were noted to disappear in response to treatment in direct correlation with SUN AU cell severity and flaremeter readings. Post-operative cataract patients (POD#1) were observed not to have prominent pseudoguttata on slit lamp or specular microscopic examination nor elevated flaremeter readings, despite typical SUN anterior chamber cell scores of 1+.
We have described the novel finding of corneal endothelial pseudoguttata in 14 AU patients. In our experience, pseudoguttata represent a reliable, clinically relevant and readily discernible finding that associates with active, non-surgical AU. We believe that this represents a significant advancement in terms of uveitis assessment and evaluation of treatment efficacy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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