Comparative study of laser flare photometry versus slit-lamp cell measurement in pediatric chronic non-infectious anterior uveitis

Yalçındağ, F Nilüfer; Köse, Helin Ceren; Temel, Emine

doi:10.1177/11206721221107303

Cited by 5 publications

(6 citation statements)

References 22 publications

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“…In our cohort, we further showed a persistent correlation between LFP values and AC cells, even though there were complications. This seems in accordance with previous data reported not only in a large adult cohort such as Gonzales et al, but also in pediatric cohorts by Holland et al, Davis et al,and Yalcidang et al [8,9,13,15]. However, our data seem to be in contrast with Tappeiner et al, who described an additional association between ocular hypertension and the epiretinal membrane, but a possible explanation might be that none of our patients showed these complications [14,20].…”

Section: Discussionsupporting

confidence: 93%

“…It was also recently used in association with SLE to monitor ocular inflammation in a randomized controlled trial conducted by Quartier et colleagues that contributed to the approval of adalimumab for the treatment of childhood chronic anterior uveitis [22]. Additionally, as recently reported by Yalcidang et al, it might be a useful tool for the monitoring of patients with idiopathic uveitis, as confirmed in our report where we assessed eleven patients with idiopathic uveitis that showed LFP parameters similar to JIA-associated uveitis and good concordance with AC grades over the time [13].…”

Section: Discussionsupporting

confidence: 79%

“…The use of this novel technique in routine clinical practice has already been reported in limited pediatric studies [8,10,13,15,21,22]. It was also recently used in association with SLE to monitor ocular inflammation in a randomized controlled trial conducted by Quartier et colleagues that contributed to the approval of adalimumab for the treatment of childhood chronic anterior uveitis [22].…”

Section: Discussionmentioning

confidence: 99%

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Laser Flare Photometry to Monitor Childhood Chronic Uveitis: A Preliminary Report of a Monocentric Italian Experience

Maccora,

De Libero,

Peri

et al. 2023

Diagnostics

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Background: Childhood chronic non-infectious uveitis (cNIU) is a challenging disease that needs close monitoring. Slit lamp evaluation (SLE) is the cornerstone of ophthalmological evaluation for uveitis, but it is affected by interobserver variability and may be problematic in children. Laser flare photometry (LFP), a novel and objective technique, might be used in children with uveitis. Aim: The aim of this study was to attempt the use of LFP in cNIU clinical practice. Methods: Children, attending the Rheumatology Unit and who were scheduled to receive ophthalmological evaluation, were prospectively enrolled to concomitantly receive SLE and LFP. SLE was performed blind to LFP measure. Demographic, laboratory, clinical, and ophthalmology data were collected. Results: A total of 29 children (58 eyes) were enrolled, including 3 with juvenile idiopathic arthritis without uveitis (JIA-no-U), 15 with JIA-associated uveitis (JIA-U), and 11 with idiopathic chronic uveitis (ICU). We observed significantly higher LFP values in the eyes of children with uveitis compared to the others (10.1 IQR 7.1–13.6 versus 6.2 IQR 5.8–6.9, p = 0.007). Accordance between the SLE and LFP measures, at baseline (ρ.498, p < 0.001) and during the follow-up (LFP II ρ 0.460, p < 0.001, LFP III ρ 0.631, p < 0.001, LFP IV ρ 0.547, p = 0.006, LFP V ρ 0.767, p = 0.001), was detected. We evaluated significant correlation between LFP values and the presence of complications (ρ 0.538, p < 0.001), especially with cataract formation (ρ 0.542, p < 0.001). Conclusions: In this cohort, LFP measurements showed a good correlation with SLE. LFP values showed a positive correlation with the presence of complications. LFP might be considered as a reliable objective modality to monitor intraocular inflammation in cNIU.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Laser Flare Photometry to Monitor Childhood Chronic Uveitis: A Preliminary Report of a Monocentric Italian Experience

Maccora,

De Libero,

Peri

et al. 2023

Diagnostics

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“…High LFP flare values have been found to be associated with a higher risk of ocular complications, and a 50% or more reduction of flare after treatment was shown to be associated with a lower risk of complications at long-term follow-up. 26 - 28 …”

Section: Clinical Evaluation Monitoring and Imaging Of Uveitis In Chi...mentioning

confidence: 99%

An Overview of Pediatric Uveitis

Tuğal-Tutkun¹

2023

Turkish Archives of Pediatrics

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Uveitis in childhood poses a distinct challenge, mainly because of the insidious onset and chronic course of intraocular inflammation in most cases, which may result in permanent visual loss due to delayed diagnosis and treatment. Although anterior uveitis, frequently associated with juvenile idiopathic arthritis, is the most common form of ocular involvement, idiopathic intermediate uveitis (pars planitis) is also a common uveitic entity in childhood. Posterior or panuveitis of a variety of noninfectious or infectious etiologies may be seen as well. Pediatric uveitis needs to be closely monitored since serious ocular complications such as intraocular pressure elevation, cataract, and macular edema may rapidly develop due to inadequately controlled inflammation and/or the use of corticosteroids. Methotrexate is generally the first-line corticosteroid-sparing agent, and adalimumab is the first-line biologic in refractory cases of noninfectious uveitis. A multidisciplinary approach is essential to monitor systemic disease associations, treatment response, and adverse events in children with uveitis.

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“…10 Recently, LFP has been shown to have a predictive value in monitoring the course and complications of pediatric non-infectious uveitis, as well as to stratify risk of long-term complications in patients with JIA-U. 11,12 While LFP has been used in research and clinical practice by ophthalmologists, there is no current literature documenting the utility of LFP in the pediatric rheumatology outpatient setting. The purpose of this study was to determine if LFP is a useful tool in the pediatric rheumatology o ce to diagnose patients with JIA-U.…”

mentioning

confidence: 99%

Screening for Juvenile Idiopathic Arthritis Associated Uveitis with Laser Flare Photometry in the Pediatric Rheumatology Office: A Prospective Observational Study

Ede,

Shishov,

Wershba

et al. 2024

Preprint

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Background Juvenile Idiopathic Arthritis (JIA) Associated Uveitis (JIA-U) remains one of the most serious complications of JIA in children. Historically, pediatric JIA is diagnosed by an Optometrist or Ophthalmologist; however, barriers to scheduling increase wait times that may delay diagnosis and treatment. The purpose of this study was to evaluate laser flare photometry (LFP) use to diagnose JIA-U in the Pediatric Rheumatology clinic for patients with JIA. Methods This prospective, observational study assessed pediatric patients diagnosed with JIA without a previous history of uveitis between January 2020 and September 2022. All patients underwent at least one evaluation of both eyes using a Kowa FM-600 laser flare photometer during a routine Rheumatology appointment, as well as a standard slit lamp examination (SLE) by optometry or ophthalmology during routine clinical care. Data collected at patient visits included demographics, JIA characteristics, treatment, LFP readings, and anterior chamber (AC) cell grade score utilizing the SUN grading system. Data were summarized using descriptive analyses and the uveitis false positive rate was calculated. Results The study cohort included 58 pediatric patients diagnosed with JIA. The mean age was 8.4 years (1.2–16.3 years) at diagnosis and 11.9 (4.8–16.5 years) at enrollment. Participants were predominantly female (n = 43, 74.1%) and white/Caucasian race (n = 37, 63.8%). The most common JIA subtypes included persistent oligoarticular JIA (n = 19, 32.8%), and 12 RF negative polyarticular JIA (n = 12, 20.7%). At enrollment, 15 patients (25.9%) were not on medications, with 26 (44.8%) on methotrexate, 22 (37.9%) on adalimumab, 6 (10.3%) on tocilizumab, and 5 (8.6%) on etanercept During the study period, no eye exams detected active uveitis based on SLE with a SUN grade over 0. However, of the 135 LFP readings, 131 (97.0%) were normal, yielding a false positive rate of 3% (95% CI: 0.8%, 7.4%). Conclusions LFP is a non-invasive tool that can be utilized in the pediatric rheumatology clinic to evaluate for JIA-U. There is a low false positive rate of LFP when compared with standard slit lamp exam.

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Comparative study of laser flare photometry versus slit-lamp cell measurement in pediatric chronic non-infectious anterior uveitis

Cited by 5 publications

References 22 publications

Laser Flare Photometry to Monitor Childhood Chronic Uveitis: A Preliminary Report of a Monocentric Italian Experience

Laser Flare Photometry to Monitor Childhood Chronic Uveitis: A Preliminary Report of a Monocentric Italian Experience

An Overview of Pediatric Uveitis

Screening for Juvenile Idiopathic Arthritis Associated Uveitis with Laser Flare Photometry in the Pediatric Rheumatology Office: A Prospective Observational Study

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