Limited Utility of Keratic Precipitate Morphology as an Indicator of Underlying Diagnosis in Ocular Inflammation

Katherine Terence; Olivia Cundy; Salomey Kellett; Andrew D Dick; Jugnoo Rahi; Ameenat Lola Solebo

doi:10.1080/09273948.2023.2242946

Limited Utility of Keratic Precipitate Morphology as an Indicator of Underlying Diagnosis in Ocular Inflammation

Katherine Terence
, Olivia Cundy
, Salomey Kellett
, Andrew D Dick
, Jugnoo Rahi
, Ameenat Lola Solebo^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

3 Citations (Scopus)

Abstract

OBJECTIVES: We aimed to establish the degree of consensus among clinicians on descriptors of KP morphology.

METHODS: A web-based exercise in which respondents associated KP descriptors, as identified through a scoping review of the published literature, to images from different disorders. Inter-observer agreement was assessed using the Krippendorff kappa alpha metric.

RESULTS: Of the 76 descriptive terms identified by the scoping review, the most used included "mutton-fat" ( n = 93 articles, 36%), "fine/dust" ( n = 76, 29%), "stellate" ( n = 40, 15%), "large" ( n = 33, 12%), and "medium" ( n = 33, 12%). The survey of specialists ( n = 26) identified inter-observer agreement for these descriptors to be poor ("stellate," kappa: 0.15, 95% confidence interval 0.13-0.17), limited ("medium": 0.27, 95% CI 0.25-0.29; "dust/fine": 0.36, 95% CI 0.34-0.37), or moderate ("mutton fat": 0.40, 95% CI 0.36-0.43; "large": 0.43, 95% CI 0.39-0.46).

CONCLUSION: The clinical utility of KP morphology as an indicator of disease classification is limited by low inter-observer agreement.

Original language	English
Pages (from-to)	1-6
Number of pages	6
Journal	Ocular Immunology and Inflammation
Early online date	14 Aug 2023
DOIs	https://doi.org/10.1080/09273948.2023.2242946
Publication status	E-pub ahead of print - 14 Aug 2023

Bibliographical note

Funding Information:
AL Solebo and S Kellett are supported by an NIHR Clinician Scientist award (CS-2018-18-ST2-005). JS Rahi and AD Dick are supported in part by the NIHR BRC based at Moorfields Eye Hospital NHS Foundation Trust and by the UCL Institute of Ophthalmology, and an NIHR Senior Investigator award. This work was undertaken at UCL Institute of Child Health/Great Ormond Street Hospital for children which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centers funding scheme. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.

Access to Document

10.1080/09273948.2023.2242946Licence: CC BY-NC

Handle.net

Persistent link

Cite this

@article{a8396583f4964ffd8cfea89d887a733b,

title = "Limited Utility of Keratic Precipitate Morphology as an Indicator of Underlying Diagnosis in Ocular Inflammation",

abstract = "OBJECTIVES: We aimed to establish the degree of consensus among clinicians on descriptors of KP morphology.METHODS: A web-based exercise in which respondents associated KP descriptors, as identified through a scoping review of the published literature, to images from different disorders. Inter-observer agreement was assessed using the Krippendorff kappa alpha metric.RESULTS: Of the 76 descriptive terms identified by the scoping review, the most used included {"}mutton-fat{"} ( n = 93 articles, 36\%), {"}fine/dust{"} ( n = 76, 29\%), {"}stellate{"} ( n = 40, 15\%), {"}large{"} ( n = 33, 12\%), and {"}medium{"} ( n = 33, 12\%). The survey of specialists ( n = 26) identified inter-observer agreement for these descriptors to be poor ({"}stellate,{"} kappa: 0.15, 95\% confidence interval 0.13-0.17), limited ({"}medium{"}: 0.27, 95\% CI 0.25-0.29; {"}dust/fine{"}: 0.36, 95\% CI 0.34-0.37), or moderate ({"}mutton fat{"}: 0.40, 95\% CI 0.36-0.43; {"}large{"}: 0.43, 95\% CI 0.39-0.46). CONCLUSION: The clinical utility of KP morphology as an indicator of disease classification is limited by low inter-observer agreement.",

author = "Katherine Terence and Olivia Cundy and Salomey Kellett and Dick, \{Andrew D\} and Jugnoo Rahi and Solebo, \{Ameenat Lola\}",

note = "Funding Information: AL Solebo and S Kellett are supported by an NIHR Clinician Scientist award (CS-2018-18-ST2-005). JS Rahi and AD Dick are supported in part by the NIHR BRC based at Moorfields Eye Hospital NHS Foundation Trust and by the UCL Institute of Ophthalmology, and an NIHR Senior Investigator award. This work was undertaken at UCL Institute of Child Health/Great Ormond Street Hospital for children which received a proportion of funding from the Department of Health{\textquoteright}s NIHR Biomedical Research Centers funding scheme. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: {\textcopyright} 2023 The Author(s). Published with license by Taylor \& Francis Group, LLC.",

year = "2023",

month = aug,

day = "14",

doi = "10.1080/09273948.2023.2242946",

language = "English",

pages = "1--6",

journal = "Ocular Immunology and Inflammation",

issn = "0927-3948",

publisher = "Taylor \& Francis Group",

}

TY - JOUR

T1 - Limited Utility of Keratic Precipitate Morphology as an Indicator of Underlying Diagnosis in Ocular Inflammation

AU - Terence, Katherine

AU - Cundy, Olivia

AU - Kellett, Salomey

AU - Dick, Andrew D

AU - Rahi, Jugnoo

AU - Solebo, Ameenat Lola

N1 - Funding Information: AL Solebo and S Kellett are supported by an NIHR Clinician Scientist award (CS-2018-18-ST2-005). JS Rahi and AD Dick are supported in part by the NIHR BRC based at Moorfields Eye Hospital NHS Foundation Trust and by the UCL Institute of Ophthalmology, and an NIHR Senior Investigator award. This work was undertaken at UCL Institute of Child Health/Great Ormond Street Hospital for children which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centers funding scheme. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.

PY - 2023/8/14

Y1 - 2023/8/14

N2 - OBJECTIVES: We aimed to establish the degree of consensus among clinicians on descriptors of KP morphology.METHODS: A web-based exercise in which respondents associated KP descriptors, as identified through a scoping review of the published literature, to images from different disorders. Inter-observer agreement was assessed using the Krippendorff kappa alpha metric.RESULTS: Of the 76 descriptive terms identified by the scoping review, the most used included "mutton-fat" ( n = 93 articles, 36%), "fine/dust" ( n = 76, 29%), "stellate" ( n = 40, 15%), "large" ( n = 33, 12%), and "medium" ( n = 33, 12%). The survey of specialists ( n = 26) identified inter-observer agreement for these descriptors to be poor ("stellate," kappa: 0.15, 95% confidence interval 0.13-0.17), limited ("medium": 0.27, 95% CI 0.25-0.29; "dust/fine": 0.36, 95% CI 0.34-0.37), or moderate ("mutton fat": 0.40, 95% CI 0.36-0.43; "large": 0.43, 95% CI 0.39-0.46). CONCLUSION: The clinical utility of KP morphology as an indicator of disease classification is limited by low inter-observer agreement.

AB - OBJECTIVES: We aimed to establish the degree of consensus among clinicians on descriptors of KP morphology.METHODS: A web-based exercise in which respondents associated KP descriptors, as identified through a scoping review of the published literature, to images from different disorders. Inter-observer agreement was assessed using the Krippendorff kappa alpha metric.RESULTS: Of the 76 descriptive terms identified by the scoping review, the most used included "mutton-fat" ( n = 93 articles, 36%), "fine/dust" ( n = 76, 29%), "stellate" ( n = 40, 15%), "large" ( n = 33, 12%), and "medium" ( n = 33, 12%). The survey of specialists ( n = 26) identified inter-observer agreement for these descriptors to be poor ("stellate," kappa: 0.15, 95% confidence interval 0.13-0.17), limited ("medium": 0.27, 95% CI 0.25-0.29; "dust/fine": 0.36, 95% CI 0.34-0.37), or moderate ("mutton fat": 0.40, 95% CI 0.36-0.43; "large": 0.43, 95% CI 0.39-0.46). CONCLUSION: The clinical utility of KP morphology as an indicator of disease classification is limited by low inter-observer agreement.

U2 - 10.1080/09273948.2023.2242946

DO - 10.1080/09273948.2023.2242946

M3 - Article (Academic Journal)

C2 - 37579245

SN - 0927-3948

SP - 1

EP - 6

JO - Ocular Immunology and Inflammation

JF - Ocular Immunology and Inflammation

ER -

Limited Utility of Keratic Precipitate Morphology as an Indicator of Underlying Diagnosis in Ocular Inflammation

Abstract

Bibliographical note

Access to Document

Handle.net

Fingerprint

Cite this