Dr. Saisree Majji, M14638, Dr. Padmamalini Mahendradas, Dr.Ankush Kawali, Dr. Rohit Shetty, Dr. Shetty Bhujang
Presenting Author: Dr. Saisree Majji
Co-authors:, Dr. Padmamalini Mahendradas, Dr. Ankush Kawali, Dr. Rohit Shetty
Narayana Nethralaya, Bangalore
Introduction:
Laser flare meter is used to measure the aqueous flare intensity and it is a noninvasive, objective, quantitative and reproducible method to measure the intraocular inflammation. 1 It is estimated to be 2.9–6.5 ph/ms in healthy individuals. The most common method for grading flare is by observation of (SUN) iris details by slit-lamp examination and applying the Standardization of Uveitis Nomenclature2,3. The laser flare meter is an instrument that allows a non-invasive quantification of aqueous flare by measurement of scattered light. The instrument consists of a diode laser that scans the anterior chamber and a photomultiplier that records the light scattered from the aqueous protein. Levels of protein concentration in the anterior chamber correlate linearly with the amount of scattered light which can be quantified and measured in a numeric scale. This produces an objective measurement of flare, which could offer an advantage over the current clinical method.
Aim:
The aim of the study is to compare the standard qualitative assessment of anterior chamber flare, according to the SUN classification, with the quantitative readings obtained by the laser flare meter
Materials and Methods:
It is a cross sectional observational case series of uveitis patients presenting to the ocular Immunology and Uveitis department at Narayana Nethralaya, Bangalore. The diagnosis of uveitis was made based on the presentation, clinical findings and laboratory diagnosis. The study followed the tenets of Declaration of Helsinki. The Ethics Committee and Institutional Review Board of Narayana Nethralaya approved the study. All patients gave a written consent for the study. All patients underwent a complete ophthalmic examination including measurement of the best-corrected visual acuity (BCVA), anterior segment examination, measurement of the flare ,intraocular pressure , and fundus examination .In the clinical evaluation , estimation of flare and cells using SUN classification findings were documented.
Laser flaremeter grading using Laser Flare metery(Kowa FM-600) was used to estimate the flare in the anterior chamber and the results obtained were compared with the SUN classification grading. Patients with active and inactive uveitis were included in the study.
Patients with opaque cornea not able to assess anterior chamber flare by slit lamp examination were excluded from the study.
Results:
Total of 109eyes in 80 patients were studied, among which 32 had grade 0 flare with laser flare mean 20.36,55 with grade 1with laser flare mean 39.79, 18 with grade 2 with laser flare 134.41,3 with grade 3 with laser flare mean 423.15,1 with grade 4 with laser flare mean 600 which showed significant correlation (p <0.001;spearmens correlation)
Discussion:
Konstantopoulou K et al described the laser flare meter provides an accurate, reproducible, non-invasive assessment of aqueous flare that can prove valuable in research and clinical decisions. They found discrepancies observed between clinical grading and kowa laser flaremeter reading indicating that clinical grading is an approximate science. Contrary to this, we found good agreement between both the methods. Limitation of our study is smaller sample size with cross sectional study.
Conclusion: Laser flaremeter can be used as an objective method of grading in estimating the
flare in various uveitis entities.
References:
- Shah SM, Spalton DJ, Smith SE. Measurement of aqueous cells and flare in normal eyes. J. Ophthalmol. 1991;75(6), 348–352.
- Jabs DA, Nussenblatt RB, Rosenbaum JT; Standardization of Uveitis Nomenclature (SUN) Working Group.. Standardization of uveitis nomenclature forreporting clinical data. Results of the First International Workshop. Am JOphthalmol. 2005 Sep;140(3):509-16. Review. PubMed PMID: 16196117.
3. Trusko B, Thorne J, Jabs D, Belfort R, Dick A, Gangaputra S, Nussenblatt R,Okada A, Rosenbaum J; Standardization of Uveitis Nomenclature (SUN) Project.. TheStandardization of Uveitis Nomenclature (SUN) Project. Development of a clinical evidence base utilizing informatics tools and techniques. Methods Inf Med.2013;52(3):259-65, S1-6. doi: 10.3414/ME12-01-0063. PubMed PMID: 23392263.
4. Agrawal R, Keane PA, Singh J, Saihan Z, Kontos A, Pavesio CE. Classificationof semi-automated flare readings using the Kowa FM 700 laser cell flare meter in patients with uveitis. Acta Ophthalmol. 2016 Mar;94(2):e135-41. doi:10.1111/aos.12833. PubMed PMID: 26408205.
5.Konstantopoulou K, Del’Omo R, Morley AM, Karagiannis D, Bunce C, Pavesio C. A comparative study between clinical grading of anterior chamber flare and flarereading using the Kowa laser flare meter. Int Ophthalmol. 2015 Oct;35(5):629-33. doi: 10.1007/s10792-012-9616-3. PubMed PMID: 22855363.