Guex-Crosier Y, Pittet N, Herbort C P
Department of Ophthalmology, Hôpital Jules Gonin, University of Lausanne, Switzerland.
Ophthalmology. 1995 Apr;102(4):613-21. doi: 10.1016/s0161-6420(95)30976-1.
Laser flare photometry is a new quantitative method for evaluating aqueous flare, making flare the only inflammatory parameter that can be evaluated precisely and objectively. The validity of the method already has been demonstrated in anterior segment inflammation. The aim of this study is to assess the validity and limitations of the method to quantify and monitor inflammation in uveitis with predominant involvement of the posterior segment.
Five well-defined conditions with uveitis predominant in the posterior segment were analyzed in this study: Behçet uveitis, pars planitis, posterior sarcoidosis, posterior pole toxoplasmosis, and birdshot chorioretinopathy. (1) Mean initial (pretreatment) flare was determined; (2) in the patients needing systemic steroid therapy, introduction of therapy was correlated with evoluting laser flare photometry; and (3) in patients with quiescent disease, the predictive value of a defined subclinical photometry-detected flare rise for disease recrudescence was analyzed.
Initial pretreatment flare was 331.8 +/- 47.7 photon counts per millisecond (ph/msecond) (mean +/- standard error of the mean) for Behçet uveitis, 15.6 +/- 1.3 ph/msecond for pars planitis, 26.9 +/- 4.6 ph/msecond for posterior sarcoidosis, 7.5 +/- 1.0 ph/msecond for posterior pole toxoplasmosis, 5.8 +/- 0.7 ph/msecond for birdshot chorioretinopathy, and 4.7 +/- 0.1 ph/msecond for a group of 88 control eyes. A significant flare reduction after start of steroid therapy was seen in Behçet uveitis (78% reduction), sarcoidosis (44.8%), and pars planitis (51%), but not in toxoplasmosis or in birdshot. A small flare rise had a predictive value for disease recrudescence in 27/35 patients (predictive value, 0.77; sensitivity rate, 100%). The level of associated blood-aqueous barrier disruption for reliable follow-up of posterior uveitis was empirically determined to be 13 to 15 ph/msecond.
Laser flare photometry was found to be very sensitive to monitor inflammation in uveitis of the posterior segment as long as a sufficient level of associated blood-aqueous barrier disruption (flare) was present.
激光散射光度测定法是一种评估房水闪光的新定量方法，使闪光成为唯一可精确、客观评估的炎症参数。该方法的有效性已在前节炎症中得到证实。本研究的目的是评估该方法在量化和监测以眼后段受累为主的葡萄膜炎炎症中的有效性和局限性。
本研究分析了五种明确的以眼后段为主的葡萄膜炎情况：白塞氏葡萄膜炎、中间葡萄膜炎、后结节病、后极部弓形虫病和匐行性脉络膜视网膜病变。（1）确定平均初始（治疗前）闪光值；（2）在需要全身类固醇治疗的患者中，治疗的开始与激光散射光度测定法的变化相关；（3）在病情静止的患者中，分析定义的亚临床光度检测到的闪光增加对疾病复发的预测价值。
白塞氏葡萄膜炎治疗前初始闪光值为331.8±47.7光子计数/毫秒（ph/msecond）（平均值±平均标准误差），中间葡萄膜炎为15.6±1.3 ph/msecond，后结节病为26.9±4.6 ph/msecond，后极部弓形虫病为7.5±1.0 ph/msecond，匐行性脉络膜视网膜病变为5.8±0.7 ph/msecond，88只对照眼的一组为4.7±0.1 ph/msecond。在白塞氏葡萄膜炎（降低78%）、结节病（降低44.8%）和中间葡萄膜炎（降低51%）中，类固醇治疗开始后可见闪光显著降低，但在弓形虫病或匐行性脉络膜视网膜病变中未见到。在35例患者中的27例中，小的闪光增加对疾病复发具有预测价值（预测值为0.77；敏感度为100%）。经经验确定，可靠随访后葡萄膜炎的相关血-房水屏障破坏水平为13至15 ph/msecond。
只要存在足够水平的相关血-房水屏障破坏（闪光），激光散射光度测定法对监测后段葡萄膜炎的炎症非常敏感。
