Non-invasive Instrument-Based Tests for Quantifying Anterior Chamber Flare in Uveitis: A Systematic Review

ABSTRACT

Purpose: Anterior chamber (AC) flare is a key sign for anterior uveitis. New instrument-based techniques for measuring AC flare can offer automation and objectivity. This review aims to identify objective instrument-based measures for AC flare.

Methods: In this systematic review, we identified studies reporting correlation between instrument-based tests versus clinician AC flare grading, and/or aqueous protein concentration, as well as test reliability.

Results: Four index tests were identified in 11 studies: laser-flare photometry (LFP), optical coherence tomography, ocular flare analysis meter (OFAM) and the double-pass technique. The correlation between LFP and clinician grading was 0.40–0.93 and 0.87–0.94 for LFP and protein concentration. The double-pass technique showed no correlation with clinician grading and insufficient information was available for OFAM.

Conclusion: LFP shows moderate to strong correlation with clinician grading and aqueous protein concentration. LFP could be a superior reference test compared to clinician AC flare grading for validating new index tests.

KEYWORDS:

• Systematic review
• uveitis
• anterior chamber flare
• aqueous humor, aqueous humour
• Tyndall effect
• diagnostic test
• aqueous protein concentration
• optical coherence tomography
• laser flare photometry

Declaration of interest

AKD and PAK receive a proportion of their funding from the Department of Health’s NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology. XL and AKD receive a proportion of their funding from the Wellcome Trust, through a Health Improvement Challenge grant (200141/Z/15/Z). ALS is supported by an NIHR Clinician Scientist award (CS-2018-18-ST2-005). LED has no disclosures relating directly to this work. She has received research funding from Allergan Pty Ltd, Alcon Pty Ltd, and Azura Ophthalmics, and consulting income from Seqirus and Medmont International, outside of this work.

Author contributions

XL: lead reviewer, manuscript drafting, manuscript reviewing. TWM: second reviewer, data extraction manuscript drafting, manuscript reviewing. SB: data extraction, manuscript drafting, manuscript reviewing. LF, LED, ALS, SH: manuscript drafting, manuscript reviewing. PAK, DJM, AKD project conception, supervision, manuscript reviewing.

Supplementary material

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