This prospective study investigates the relationship between keratic precipitates (KP) and endothelial changes in patients with anterior uveitis, utilising specular microscopy. Thirteen patients, with a mean age of 42.9 years (ranging from 20 to 76), were recruited, and the study focused on examining various types of uveitis and their associated KP at different stages of the disease.

Using a Tomey-1100 contact wide-field specular microscope, the researchers captured endothelial images and recorded data regarding the type, number, size, and nature of the KP until the resolution of uveitis. Automated morphometric analysis was performed to evaluate cell size, cell density, and coefficient of variation, allowing for statistical comparisons (using Student’s t-test) between the endothelium in the vicinity of fresh and resolving KP, fresh KP and normal endothelium, and resolving KP and normal endothelium.

The results showed that fresh KP appeared as dense, white glistening deposits, typically occupying 5-10 endothelial cells in diameter, while fine KP were smaller and more widely distributed. Notably, KP in Posner-Schlossman syndrome exhibited a distinct morphology. As uveitis resolved, KP underwent characteristic morphological changes, with old KP presenting a large dark halo surrounding a central white deposit. Additionally, endothelial blebs were observed as dark shadows or defects in the endothelial mosaic in patients with recurrent uveitis.

Statistical analysis revealed significant differences in mean cell size and cell density of endothelial cells near fresh KP compared to the normal endothelium of the unaffected eye.

In conclusion, this study provides insights into the various specular microscopic features of KP associated with anterior uveitis, highlighting the distinct morphological characteristics of large and fine KP. These features changed dramatically upon the resolution of uveitis, and abnormalities in the endothelium near KP normalised following treatment. This research underscores the importance of understanding the interplay between keratic precipitates and endothelial health in managing anterior uveitis effectively.

For further details, the full study is available for review.