A comparative study between clinical grading of anterior chamber flare and flare reading using the Kowa laser flare meter

Abstract

To assess the accuracy of standard clinical grading of aqueous flare in uveitis according to the Standardization of Uveitis Nomenclature consensus, and compare the results with the readings of the laser flare meter, Kowa 500. Two examiners clinically graded the flare in 110 eyes. The flare was then measured using the Kowa laser flare meter. Twenty-nine eyes were graded as anterior chamber flare +2; for 18 of these, the clinicians were in agreement, the rest differed by the order of one grade. The range of the laser flare meter for these eyes was 5.2-899.1 photons/ms. The median value was 41.4. Seventy-four eyes were graded with flare +1. Agreement was established in 51 of these eyes. Disagreement for the rest was again by the order of 1, and the flare meter range was 1.1-169.9 photons/ms, median value 18.4. For the clinical measure of flare 0, the clinicians disagreed on three out of five eyes. The flare meter readings ranged from 2.5 to 14.1 photons/ms, median value 9.9. Only two eyes were graded with flare +3 and there was one step disagreement on both of them. We found little evidence of association between the flare readings and intraocular pressure or age. Our findings suggest that clinical evaluation of aqueous flare is subjective. Compared with the Kowa laser flare meter's numeric readings, the discrepancies observed indicate that clinical grading is an approximate science. The laser flare meter provides an accurate, reproducible, non-invasive assessment of aqueous flare that can prove valuable in research and clinical decisions.

Correlation between anterior chamber characteristics and laser flare photometry immediately after femtosecond laser treatment before phacoemulsification

“…The slit width was 0-11 mm and was continuously available. 9,10 OCULUS Pentacam (Oculus, Inc.) images were obtained under pupil dilatation with 1% tropicamide. To reduce operator-dependent variables, Pentacam's automatic release mode was used.…”

“…10,14 Damage to the blood-aqueous barrier immediately after cataract surgery was related to the type of surgery, systemic diseases, incision size, bubble formation, and the mechanical trauma to the uveal tissues. 2,[15][16][17][18] Abell et al 19 demonstrated that lower anterior segment inflammation was observed in FLACS versus manual surgery.…”

“…9 The laser flare photometry provided an accurate, reproducible and non-invasive assessment of aqueous flare that could prove valuable in research and clinical decisions. 10 The aim of this study was to assess the AC characteristics and its correlation to the laser flare photometry immediately after femtosecond laser-assisted capsulotomy and photodisruption; the idea was to identify structural changes that were likely to lead to corneal reactions and increases in intraocular inflammation in some patients, while most patients did not suffer from side effects.…”

‘Approved for use in uveitis’: drug approval for an orphan disease

“…Historically, aqueous flare is not used as a direct indication of inflammation; this is attributable not only to the fact that a breakdown of the blood-brain barrier may constitute permanent damage, but also that the gradings from clinicians are not universal, consistent, or an accurate depiction of the inflammatory status of a given patient [18]. Most commonly, aqueous flare is graded by direct visualization of the iris on slit lamp biomicroscopy and is highly subjective, based on the clinician's experience [18].…”

Laser flare photometry in clinical practice

“…K. Konstantopoulou et al сравнили результаты биомикроскопии у двух офтальмо-логов [36]. Всего в исследование было включено 110 глаз, и в 35,5 % случаев (39 глаз) выявлены несоответствия показателей степени опалесцен-ции между двумя исполнителями.…”