In vivo confocal microscopy of keratic precipitates in anterior uveitis related to Herpesviridae

Abstract

Abstract Purpose To study the pattern of keratic precipitates (KPs) in anterior uveitis due to Herpesviridae using in vivo confocal microscopy Methods KPs of 17 consecutive patients (average age: 54+/‐8 years), addressed for anterior uveitis related to either Herpes simplex virus (HSV), Varicella‐zoster virus (VZV) or cytomegalovirus (CMV), were examined using the HRT II Rostock Cornea module, between May 2006 and June 2007. The diagnosis of HSV, VZV or CMV infection was based on PCR or specific antibodies production within the aqueous humor, or on clinical history for uveitis that rapidly followed herpes zoster ophthalmicus. At the time of in vivo confocal microscopy, the uveitis was in an acute period (recent increase of inflammation). Results The HRT II Rostock Cornea provided reproducible images of KPs, with both a heap‐shaped pattern and stars which were characterized by branches in weak number and of modest size. HRT imaging of the fellow eye was normal in all cases (control eyes). Conclusion Herpesviridae are a classic cause of unilateral and hypertonic uveitis. If the clinical pattern is often very suggestive, certain cases may be difficult to differentiate from other causes of uveitis, notably Fuch’s heterochromic cyclitis. The reproducible pattern of KPs in viral uveitis using in vivo confocal microscopy should be helpful to differentiate from non‐herpetic etiologies.