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      Laser Flare Photometry

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      Springer Berlin Heidelberg

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          Laser flare photometry: a noninvasive, objective, and quantitative method to measure intraocular inflammation.

          Aqueous flare and cells are the two inflammatory parameters of anterior chamber inflammation resulting from disruption of the blood-ocular barriers. When examined with the slit lamp, measurement of intraocular inflammation remains subjective with considerable intra- and interobserver variations. Laser flare cell photometry is an objective quantitative method that enables accurate measurement of these parameters with very high reproducibility. Laser flare photometry allows detection of subclinical alterations in the blood-ocular barriers, identifying subtle pathological changes that could not have been recorded otherwise. With the use of this method, it has been possible to compare the effect of different surgical techniques, surgical adjuncts, and anti-inflammatory medications on intraocular inflammation. Clinical studies of uveitis patients have shown that flare measurements by laser flare photometry allowed precise monitoring of well-defined uveitic entities and prediction of disease relapse. Relationships of laser flare photometry values with complications of uveitis and visual loss further indicate that flare measurement by laser flare photometry should be included in the routine follow-up of patients with uveitis.
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            Interobserver agreement in grading activity and site of inflammation in eyes of patients with uveitis.

            To evaluate the reproducibility of new criteria for grading the site and activity of intraocular inflammation. Cross-sectional agreement study. Grading of 202 eyes of 101 patients with uveitis was conducted by pairs of uveitis subspecialists at three uveitis subspecialty clinics. Agreement in grading location of inflammation, anterior chamber (AC) cells, AC flare, vitreous cells (present or absent), and vitreous haze was calculated. Proposed criteria for grading the location of intraocular inflammation had moderate reproducibility (kappa range, 0.49 to 0.61). Reproducibility improved (kappa range, 0.61 to 0.73) when the newly proposed category of anterior and intermediate uveitis was excluded. The ranges of kappa statistics for exact agreement on gradings of AC cells (range, 0.34 to 0.43) demonstrated low to moderate levels of agreement, and gradings of AC flare (range, 0.50 to 0.64), vitreous cells (range, 0.48 to 0.51), and vitreous haze (0.53) were in the moderate agreement range. However, agreement within 1 grade was outstanding for AC cells (kappa range, 0.81 to 1.00) and vitreous haze (kappa, 0.75). For AC flare, a distribution skewed toward low grades within 1 grade made kappa statistics unstable. Proposed methods for grading inflammatory activity have moderate reproducibility for exact agreement in most instances. However, agreement within 1 grade is excellent for grading of AC cells and vitreous haze. The method for grading the site of intraocular inflammation also produces moderate levels of agreement, and in our hands was improved by excluding both anterior and intermediate uveitis. Improved methods for grading AC flare and vitreous cells are needed.
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              Laser flare-cell photometry: methodology and clinical applications.

              Diagnosis and management of intraocular inflammation involves the assessment of cells and protein levels ("flare") in the aqueous humor. These factors are difficult to quantify precisely on clinical examination alone. Laser flare-cell photometry provides an automated technique to quantify these factors objectively, and it has been used in a variety of research and clinical situations to assess anterior segment inflammation. Any new technique requires evaluation to determine accuracy and reproducibility of measured values, and initial applications require critical appraisal to assess the value of the technique. Both in vitro and in vivo studies of laser flare-cell photometry have been performed to determine its validity and utility as a research and clinical tool. This article reviews published studies that describe the technique of laser flare-cell photometry; it provides new in vitro data that supplements information on the capabilities of this technique and factors that influence photometry results, and it reviews representative publications that have used laser flare-cell photometry for study of specific disease entities. This information can help clinicians and researchers to become familiar with the strengths and limitations of laser flare-cell photometry, to identify appropriate future uses for this technique, and to use it and interpret its results appropriately. Laser flare-cell photometry offers an opportunity to improve upon current techniques of inflammation assessment and should not be considered simply an objective surrogate for clinical grading of cells and flare at the slit-lamp biomicroscope. Its research applications and utility for monitoring patients with uveitis have not yet been fully explored.
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                Author and book information

                Book Chapter
                2016
                : 227-235
                10.1007/978-3-540-75387-2_15
                34db1c33-6357-4aab-a722-22a60a23f79a

                http://www.springer.com/tdm

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