眼前节共焦显微镜在感染性与非感染性葡萄膜炎中的应用。

In vivo confocal microscopy of keratic precipitates in infectious versus noninfectious uveitis.

机构信息

Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Super Speciality Eye Hospital and Post Graduate Institute of Ophthalmology, Banglore, India.

出版信息

Ophthalmology. 2010 Feb;117(2):373-80. doi: 10.1016/j.ophtha.2009.07.016.

DOI:10.1016/j.ophtha.2009.07.016

PMID:20022116

Abstract

PURPOSE

To test the hypothesis that morphologic patterns of keratic precipitates (KPs) evaluated by in vivo confocal microscopy (IVCM) can differentiate infectious from noninfectious uveitis.

DESIGN

Cross-sectional, observational case series.

PARTICIPANTS

Sixty-eight eyes of 53 subjects with uveitis.

METHODS

A cross-sectional study was performed in patients with infectious and noninfectious uveitis presenting to a tertiary care eye hospital. Detailed ophthalmologic evaluation was performed in all the subjects. Keratic precipitates were studied by IVCM using the HRT II Rostock corneal module (Heidelberg Engineering GmbH, Heidelberg, Germany) and categorized on the basis of morphologic patterns.

MAIN OUTCOME MEASURES

Morphology of KPs by slit-lamp biomicroscopy and confocal microscopy.

RESULTS

The age of patients ranged from 15 to 87 years (median 40 years). Thirty-two patients were male (60.37%). Thirty-eight subjects had a unilateral presentation (71.69%) of uveitis. Infectious uveitis was seen in 38 cases (71.69%). The characteristics in KPs as seen in infectious uveitis were dendritic, central globular with dendritic, and infiltrative. In noninfectious uveitis (28.3%), stippled, globular, and multiple globular types of KPs were found. The sensitivity, specificity, and positive predictive value for specific combinations of KPs with an infectious cause were 84.21%, 93.33%, and 96.96%, respectively.

CONCLUSIONS

In vivo confocal microscopy can act as an adjunct tool for differentiating infectious from noninfectious uveitis. A central globular with dendritic form of KPs is strongly suggestive of infectious uveitis.

摘要

目的

通过活体共聚焦显微镜（IVCM）评估的角膜后沉着物（KP）形态模式来验证以下假说，即该模式可区分感染性和非感染性葡萄膜炎。

设计

横断面、观察性病例系列。

参与者

53 例葡萄膜炎患者的 68 只眼。

方法

在一家三级保健眼科医院对患有感染性和非感染性葡萄膜炎的患者进行了一项横断面研究。对所有受试者进行了详细的眼科评估。使用 HRT II Rostock 角膜模块（德国海德堡工程公司）通过 IVCM 研究 KP，并根据形态模式进行分类。

主要观察指标

裂隙灯生物显微镜和共聚焦显微镜下 KP 的形态。

结果

患者年龄为 15 至 87 岁（中位数 40 岁）。32 例（60.37%）为男性。38 例（71.69%）表现为单侧葡萄膜炎。38 例（71.69%）为感染性葡萄膜炎。感染性葡萄膜炎中 KP 的特征为树枝状、中央团块状伴树枝状和浸润性。在非感染性葡萄膜炎（28.3%）中，发现了点彩状、团块状和多团块状 KP。特定组合的 KP 与感染性病因相关的敏感性、特异性和阳性预测值分别为 84.21%、93.33%和 96.96%。