Abstract
Purpose :
Keratic precipitates (KPs) are a feature of ocular inflammation. KP morphology has been described as a vital diagnostic clue for different forms of inflammatory disease, yet there is no agreed morphology classification system. We aimed to undertake a rapid review to identify the most commonly used descriptors for KP morphology, and to describe the degree of consensus around slit-lamp based descriptions of KP morphology amongst a group of paediatric uveitis specialists.
Methods :
Rapid literature review (search term: “keratic precipitates”) to identify the descriptive terms used for KPs, and frequency of use, in the published literature. REDCap image based electronic survey of KP morphology undertaken by members of the United Kingdom’s Paediatric Ocular Inflammation Group (POIG), who were asked to indicate KPs type present in each image. Degree of consensus for each of the 29 images in the survey was analysed for each KP morphological parameter with a threshold set at 80% agreement.
Results :
The rapid review identified 469 papers, of which 259 used descriptive terms for keratic precipitates. The most commonly used descriptors (total 76 terms identified) were ‘mutton-fat’ (n=93 papers), ‘fine’ (n=76), ‘stellate’ (n=40), ‘large’ (n=33) and ‘medium’ (n=32).
The response rate for the survey was 26/32 (81.%). Consensus was met for the descriptive terms ‘large’ (consensus reached for 25/29 images, median consensus 91%, range 58 – 100%), mutton-fat (23/29, median 91%, range 54 – 100%), stellate (25/29, 90%, 57 – 100%), but not for the terms fine/dust (12/27, 74%, 50 – 96%) or medium (11/27, 73%).
Conclusions :
This survey reveals an absence of clinical consensus around the classification of KPs using size (fine V medium), although there is evidence of good consensus on the appearance of large, stellate and mutton-fat KP. Harmonisation of clinical nomenclature is a key foundation for multi-centre research such as the currently underway POIG supported UNICORN (UK Uveitis in Childhood Prospective National Cohort study). These findings work will support future attempts to create consensus based nomenclature for this important diagnostic sign.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.