Laser Flare Photometrie zur Identifizierung von Hochrisikopatienten für proliferative Vitreoretinopathie

Abstract

Proliferative vitreoretinopathy (PVR) is a complication of rhegmatogenous retinal detachment and trauma, which occurs in approximately 10% following vitreoretinal surgery. The visual prognosis for established PVR is poor and so far there is no established conservative treatment for PVR. In the currently recruiting PRIVENT trial the aim is to find a prophylactic treatment possibility for PVR. The PRIVENT study examines the influence of intraoperative adjuvant pharmacotherapy on reducing the incidence of PVR; however, this requires the identification of eyes with increased risk for PVR. Laser flare photometry is a simple method to predict the individual risk for PVR. It is a non-invasive technique that objectifies the Tyndall effect. Various laser flare meter devices are available on the market. In previous studies it could be shown that laser flare photometry can predict the development of PVR in eyes with primary rhegmatogenous retinal detachment with a sensitivity of 80%. The identification of these high-risk eyes for PVR could be the first step towards solving the problem of PVR.

Association between blood-aqueous barrier disruption and extent of retinal detachment

“…A visible tyndall effect on slit lamp examination occurs with values more than 30 pc/ms. 2 Clinical use of LFP is used to monitor inflammation levels in uveitis therapy or postsurgical inflammation. 3 There is limited data available on laser flare levels in the context of retinal detachment.…”

Relevanz der Laser-Flare-Photometrie bei retinalen Pathologien

“…Die proliferative Vitreoretinopathie (PVR) ist eine Komplikation nach postoperativer Versorgung einer Netzhautablösung und tritt in 5 – 10% der Fälle auf ( Abb. 3 ) 2 , 24 , 25 . Des Weiteren kann sie auch primär entstehen.…”

“…Dazu gehören bspw. Hornhaut- und Linsentrübungen, aber auch eine Kapselfibrose und ein Pseudoexfoliationssyndrom 2 , 37 .…”

“…A normal, healthy eye is between 1 and 9 pc/ms, whilst values between 10 and 500 pc/ ms can be reached if the eye is inflamed. During slit lamp examination the Tyndall effect only becomes apparent at values of greater that 30 pc/ms [2].…”

Lens status and degree of lens opacity influence laser flare photometry (objective tyndallometry)

“…A visible tyndall effect on the slit lamp occurs with values more than 30 pc/ms. 2 Clinical use of LFP is usually for monitoring uveitis therapy or degree of postsurgical inflammation. 3 A reliable reproducibility of the in vivo tyndallometric measurements has been demonstrated in various studies.…”