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Precipitati

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 PostPoslano: 15-11-2010 09:43  Citiraj (i odgovori)  
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Znakovi eksudacije u prednjoj komorici razvijaju se na slijedeći način: iz upaljenih šareničnih žila leukociti izlaze u sobnu vodicu, gdje se osvijetljeni procjepnim svjetlom vide kao svjetlucave lebdeće čestice, poput čestica dima u snopu svjetla kino-projektora (Tyndallov fenomen - pojava da osvijetljena koloidna čestica reflektira svjetlo kao sekundarni izvor svjetlosti).

Leukociti se hvataju na endotel rožnice, pa ovaj izgleda kao je prašnjav (prašinasti precipitati). Ako ih je mnogo, u daljnjem toku upale talože se na endotelu u obliku okomite crte koja seže okomito od dna prednje komorice do središta rožnice, a potom u obliku zrnastih precipitata koji oblikuju trokut s bazom prema dnu prednje komorice, a vrhom prema središtu rožnice, i to tako da su grublja zrnca bliže bazi, a sitnija bliže vrhu trokuta.

U najtežem slučaju leukociti se talože u dnu prednje komorice i vide se kao bijeli talog (hipopion). Intraokularni tlak je normalan ili malo povišen. Ovakav oblik iridociklitisa naziva se negranulomatoznim, a prema vrsti zamućenja sobne vodice razlikuje se serozni, fibrinozni, hemoragički ili purulentni iridociklitis. Negranulomatozni iridociklitis može imati akutan ili kroničan tok.

http://dro.hs.columbia.edu/kp.htm

Vrste:
1) Acute, fresh KPs tend to be white and round, while old KPs are usually irregular, faded and pigmented.
2) Mutton-fat KP: large, greasy-white KPs (approximately 1 mm in diameter), which represent clusters of macrophages and epithelioid cells. Typically occur in granulomatous uveitis.
3 ) Pigmented - stari od kronične upale
4) Red iliti crveni KP's (kod herpes simplex, herpes zoster)
Mutton-fat KPs occur in granulomatous inflammatory diseases, and they generally fill the Arlt triangle inferiorly. Arlt distribution is caused by convection currents within the anterior chamber and the cooler temperature in the inferior cornea. These larger granulomatous KPs will pigment and then shrink as inflammation abates or is controlled by steroid therapy. They often fail to disappear completely, and they may alter the endothelium where they rest, leaving a halo on the endothelium. Granulomatous deposits also may be seen in the anterior chamber angle by gonioscopy.

Nongranulomatous KPs are small to medium in size and white in color with Arlt distribution pattern. Old KPs accumulate pigment, and, as they begin to involute, shrink and disappear.

Either type of KP may be seen within the distribution of a central or peripheral herpetic disciform keratitis, which is often also accompanied by herpetic uveitis. Although the intraocular pressure is, as a rule, lowered in acute anterior uveitis, some patients may have elevated intraocular pressure because of inflammatory debris in the trabecular meshwork or herpetic trabeculitis. Precipitates identical in histopathologic content to KPs also may be seen deposited within the chamber angle, intraocular lenses, or seton implants.

Stellate KPs are unique, fibrillar, dendriform, microscopic lesions found throughout the endothelium. No predilection exists for the center, periphery, or Arlt inferior triangle. Stellate KPs typically are seen in Fuchs heterochromic iridocyclitis, but they commonly are noted in herpes simplex, herpes zoster, and CMV retinitis infections. Stellate KPs can be seen in toxoplasmosis, but granulomatous or nongranulomatous KPs also are seen.

Peripheral KPs may be seen following intraocular surgery, with peripheral corneal edema following intracapsular cataract surgery (Brown syndrome), with herpes simplex or zoster uveitis, following acute angle-closure glaucoma, or after blunt ocular trauma.

KPs must be differentiated from corneal endothelial guttatae and pigment deposits. Pigment may have a random, diffuse, central, or disciform distribution following previous inflammation. Krukenberg spindles are found in a central vertical pattern, which is not characteristic of inflammation. Guttatae are central or diffuse and do not fulfill the usual distribution patterns of inflammatory disease. Guttatae can be identified by specular microscopy and more elegantly by confocal microscopy.





http://books.google.hr/books?id=wuc0Ox0 ... de&f=false

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Anita Moorjani "Ponovno rodjena"


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 PostPoslano: 15-11-2010 13:06  Citiraj (i odgovori)  
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KP u infekcijskom i neinfekcijskom uveitisu

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.
_____________________________________________________________________________________________-

The morphology of keratic precipitates (KPs) is very useful to help distinguish non-granulomatous from granulomatous uveitis. Small diffuse KPs causing dusting of the endothelium are characteristic for non-granulomatous uveitis such as HLA-B27 related acute anterior uveitis.

When KPs become larger than endothelial dust they can be individualised and correspond to granulomatous KPs. The morphology and distribution of granulomatous KPs is often useful in orienting towards a more specific diagnosis within granulomatous causes .

Medium and large size KPs are called "mutton fat" KPs. There is a lot of confusion regarding the characterisation of KPs. In many textbooks only mutton-fat KPs are termed granulomatous and small granulomatous KPs as those found in Fuchs' uveitis are erroneously termed as non granulomatous. Therefore, Fuchs' uveitis is mistakenly classified as non-granulomatous in many textbooks. It is useful to distinguish between fresh and chronic (old) muton-fat KPs.
Old mutton-fat KPs tend to be less white, pigmented and less dense in the center.

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