Laser flare-cell photometry: methodology and clinical applications
Abstract
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.
Key words: aqueous humor, flare, inflammation, photometry, protein, tyndallometry, uveitis
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Dr. Ladas is now affiliated with the Wilmer Ophthalmological Institute, Johns Hopkins School of Medicine, Baltimore, MD. Dr. Wheeler has recently been affiliated with, and is now retired from, the Department of Statistics, California Polytechnic State University, San Luis Obispo, CA. Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, NY, (Dr. Holland), the Skirball Foundation, Los Angeles, CA (Dr. Holland), and the David May II Endowed Professorship (Dr. Holland). Dr. Holland is a recipient of a Research to Prevent Blindness Physician-Scientist Award. Fei Yu, PhD, of the Jules Stein Eye Institute Clinical Research Center provided assistance with the critical review of statistical methods described in selected publications cited in this article. The FC-1000 was provided by Kowa Company, Ltd., Electronics and Optics Division, Tokyo, Japan, for generation of the original research data presented herein. Dr. Holland was an unpaid member of the Kowa Laser Flare-Cell Photometry Medical Advisory Board from 1991 to 1995. The authors have no other interest in the products or techniques described in this report or in competing techniques.Members of the Kowa Laser Flare-Cell Photometry Medical Advisory Board were: Rubens Belfort, Jr., MD, PhD (Sao Paulo, Brazil), Robert C. Drews, MD (Clayton, MO), Gary N. Holland, MD (Los Angeles, CA), Carl Herbort, MD, PhD (Lausanne, Switzerland), Robert B. Nussenblatt, MD (Chairman; Bethesda, MD), David J. Spalton, MD (London, UK), and Scott M. Whitcup, MD (Bethesda, MD). Dr. Whitcup is currently located in Irvine, CA. The opinions expressed herein are those of the authors, and may or may not be shared by other members of the Kowa Laser Flare-Cell Photometry Medical Advisory Board.
PII: S0039-6257(04)00159-6
doi:10.1016/j.survophthal.2004.10.004
© 2005 Elsevier Inc. All rights reserved.
