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Deciphering infectious uveitis etiology: Immune cell profiling in keratic precipitates using in vivo confocal
Fang Fang1,2, Yanbing Wang1,2, Yangyan Xiao1,2
1Department of Ophthalmology, the Second Xiangya Hospital, Central South University, China.
Insights
Infectious uveitis diagnosis is improved by analyzing keratic precipitates (KPs) with in vivo confocal microscopy (IVCM). Neutrophil-rich KPs suggest bacterial/fungal infections, while dendritic cells and lymphocytes indicate viral causes.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microscopy
Background:
- Infectious uveitis requires accurate etiologic diagnosis for effective treatment.
- Keratic precipitates (KPs) are key indicators of intraocular inflammation.
- In vivo confocal microscopy (IVCM) offers detailed cellular analysis of ocular structures.
Purpose of the Study:
- To determine the etiology of infectious uveitis by analyzing keratic precipitates (KPs) using in vivo confocal microscopy (IVCM).
- To differentiate between bacterial, fungal, and viral causes of infectious uveitis based on KP morphology.
Main Methods:
- A cross-sectional, observational case series of 36 subjects (46 eyes) with infectious uveitis.
- Detailed ophthalmologic evaluation and in vivo confocal microscopy (IVCM) using the HRT II Rostock corneal module.
- Categorization of KPs based on cell size, morphology, and reflection.
Main Results:
- Neutrophil-dominated KPs were observed in 100% of bacterial and fungal endophthalmitis cases.
- Viral uveitis cases consistently showed dendritic cells and lymphocytes in KPs (100%).
- Increased sub-basal corneal epithelial Langhans cells were associated with viral uveitis.
Conclusions:
- Neutrophil-rich KPs are indicative of bacterial or fungal endophthalmitis.
- Dendritic cells and lymphocytes in KPs suggest viral uveitis.
- In vivo confocal microscopy (IVCM) is a valuable tool for differentiating infectious uveitis etiologies.
Purpose:
To elucidate the etiology of infectious uveitis through the comprehensive analysis of keratic precipitates (KPs) using in vivo confocal microscopy (IVCM).
Design:
Cross-sectional, observational case series.
Methods:
This single-center, cross-sectional study was conducted at a tertiary care eye hospital from January 2021 to October 2023. It involved a detailed ophthalmologic evaluation of all subjects and included a total of 46 eyes from 36 subjects who were diagnosed with infectious uveitis. IVCM, specifically utilizing the HRT II Rostock corneal module, was employed to study the biomicroscopic morphology of KPs. The categorization of KPs was based on cell size, morphology, and reflection.
Results:
Cells of KPs were assessed for size, morphology, and reflection through in vivo confocal microscopy. Patients, ranging in age from 13 to 80 years (median 51 years), exhibited diverse morphologic forms of KPs. Neutrophil-dominated KPs with uniform size were predominantly observed in bacterial and fungal endophthalmitis cases (19/19, 100 %), accompanied by small numbers of mononuclear-macrophages in three eyes (3/19, 15.8 %). Viral uveitis cases displayed a broader array of immune cell types, including characteristic striated or dendritic cells in all eyes (27/27, 100 %). Lymphocytes were commonly present (24/27, 88.9 %), forming clusters in sixteen eyes and dispersed in the corneal endothelium below the midline in eight eyes. Neutrophil infiltration was notable in three cytomegalovirus-infected eyes (3/27, 11.1 %). A marked increase in sub-basal corneal epithelial Langhans cells was associated with viral uveitis.
Conclusions:
Neutrophil-dominated KPs strongly indicate endogenous bacterial or fungal endophthalmitis, while the presence of dendritic cells and lymphocytes in KPs is suggestive of viral uveitis. In vivo confocal microscopy emerges as a crucial tool for differentiating the etiologic diagnosis of infectious uveitis.
