房水闪辉和细胞的定量测量

激光蛋白细胞检测仪可快速、精确、定量测定房水蛋白浓度和细胞数量,评价各种眼内疾病、手术和治疗对血-房水屏障功能的影响,对疾病的诊断和疗效观察提供有利帮助,本文就其在临床上的应用作一综述。     

Quantitative assessment of aqueous flare and cells in uveitis

Validity of the laser flare-cell meter in uveitis was evaluated. A comparative study of slit-lamp examination and flare-cell meter measurements was carried out in the evaluation of iridocyclitis in a total of 251 measurements in patients with uveitis of various etiologies, including Beh?et's disease, Vogt-Koyanagi-Harada's disease and sarcoidosis. The data obtained by these two methods showed a significant overall correlation both in the measurement of flare intensity (Kendall tau = 0.580, P less than 0.001) and cell count (tau = 0.390, P less than 0.001). Problems inherent to the slit-lamp examination were marked in terms of wide variations in grading within groups and large overlaps in scores between groups. The flare-cell meter was highly reliable in the measurement of flare intensity; whereas it could not detect low numbers of cells in some cases. Ninety-one eyes of patients with Beh?et's disease were divided into three groups based on the interval from the last ocular attack episode. The flare-cell meter examination revealed that values for flare intensity remained abnormally high even in patients free from an attack episode for more than six months prior to the examination. It was considered that deterioration or breakdown of the blood-aqueous barrier function persists in patients with Beh?et's disease.     

正常人房水闪辉和细胞的定量测量

目的 测量正常人的房水闪辉和细胞数量,观察年龄和性别对血-房水屏障的影响.设计前瞻性病例系列研究.研究对象 221例正常人(442眼).方法 采用FC-2000型激光蛋白细胞检测仪(LFCM)非接触、定量地检测了221例正常人(442眼)的房水闪辉和细胞.主要指标房水闪辉和细胞.结果 正常人的房水闪辉平均值为(4.7±2.9)pc/ms,其中＜10岁为(3.1±1.0)pc/ms,40～49岁组为(3.8±1.9)pc/ms,≥80岁者达到(11.0±4.8)pc/ms.与40～49岁组相比,50岁以上各年龄组的房水闪辉值均显著增高(P均＜0.05),男性与女性之间无显著差异(P=0.686),左右眼之间无显著差异(P=512).正常人房水细胞平均值为(0.4±0.7)个,与40～49岁年龄组相比,80岁以上者房水细胞值显著增高(P=0.014),男性与女性之间无显著差异(P=0.413),左右眼之间无显著差异(P=0.886).结论 LFCM可定量检测房水闪辉值并了解蛋白浓度和细胞数量,此项检查对定量检测血-房水屏障的改变和前房炎症具有重要意义.     

Measurement of aqueous cells and flare in normal eyes.

(abstractThe Kowa laser cell flare meter has been recently introduced to quantify the assessment of aqueous cells and flare in vivo by measurement of light scattering from a low power HeNe beam. Computer analysis of this scattered light can distinguish cells (expressed as cell count) from protein (expressed as photon count/ms), and in-vitro work with albumin solutions has shown that the photon count/ms is linearly related to protein concentration. This study of 106 normal eyes (53 subjects) assesses the accuracy and sensitivity of the instrument and the factors affecting the interpretation of its results. Using in-vitro solutions of human albumin we found a highly significant linear correlation (r = 1, p = 0.0001) between photon count and protein concentration. The results show that the instrument has a photon count/ms reproducibility of 8.26% and that there is a within-subject variability in photon count/ms (aqueous flare) of 12.2% in normal eyes. No significant difference in photon count/ms (aqueous flare) was found to exist between right and left eyes (p greater than 0.4), between sexes (p greater than 0.5), or between irides of different colour (p greater than 0.8). There was also no statistically significant variation in photon counts/ms with time of day over the period of measurement (1000-1900 h) (p = 0.4). There was, however, an increase in photon count/ms with age (r = 0.57, p less than 0.001) and a decrease with pupillary dilatation at both 30 and 60 minutes after instillation of tropicamide 1% (p less than 0.05). An occasional cell was found in only 10.4% of normal eyes, and there was no significant increase in the cell counts on mydriasis (p>0.05). These findings indicate that the Kowa laser flare meter is an accurate and sensitive instrument with potential application in the investigation of blood-aqueous barrier.     

Effect of tropicamide on aqueous flare before and after cataract surgery

PURPOSE: To examine the effect of tropicamide on flare intensity under phakic and pseudophakic conditions and to differentiate between the possible mechanisms of action of tropicamide on aqueous flare. SETTING: Department of Ophthalmology, Vienna General Hospital, University of Vienna, Vienna, Austria. METHODS: In this prospective study, aqueous flare was measured with the laser flare-cell meter in 20 eyes of 20 patients with age-related cataract enrolled for cataract surgery. Measurements were performed before and 30, 90, and 180 minutes after pupil dilation with tropicamide 0.5%. This measurement was performed in the phakic eye on the day before surgery and in the pseudophakic eye on postoperative days 1, 3, 7, and 28. RESULTS: After tropicamide instillation, aqueous flare decreased preoperatively and on all postoperative days. There was a continuous flare decrease until 3 hours after instillation, reaching a maximum decrease of about 30%. Pupil diameter reached its maximum after 30 minutes. CONCLUSION: Tropicamide significantly decreased aqueous flare, seemingly by pharmacological means, not volumetric changes. The time between drug application and measurement should be kept constant.     

Changes in anterior chamber flare and cells following cataract surgery.

The laser flare cell meter allows rapid non-invasive quantification of aqueous flare and cells. In this prospective study laser photometry was used to document the recovery of the blood-aqueous barrier in 27 normal eyes following cataract surgery. Aqueous flare and cells were highest on the first postoperative day, declining rapidly in the first week and returning to preoperative levels by 3 months. In six eyes (22.2%) there was an increase in either flare and cells or flare alone during the first postoperative week which was associated with a delayed recovery of the blood-aqueous barrier for up to 1 month following surgery. A consensual flare response was found to occur in the fellow eye in five patients (18.5%).     

Quantitative assessment of aqueous flare and aqueous 'cells' in pseudoexfoliation syndrome.

We used the laser flare-cell meter to measure aqueous flare and aqueous 'cells' in 38 eyes of 38 patients with pseudoexfoliation, in 36 normal control eyes of 36 subjects, and in 19 eyes of 19 patients with chronic open-angle glaucoma unrelated to pseudoexfoliation. In pseudoexfoliation eyes, both aqueous flare (0.61 +/- 0.55 mg/ml human albumin equivalent) and aqueous 'cells' (mean 10.70, range 0-50.6 cells/0.075 mm3) were significantly higher than in the normal control group (flare 0.15 +/- 0.06 mg/ml, 'cells' 0.43, range 0-2, P less than 0.0001) and in the glaucoma group without pseudoexfoliation (flare 0.19 +/- 0.08 mg/ml, 'cells' 0.80, range 0-2.4, P less than 0.0001 and P less than 0.005). No significant difference could be found between the flare and cell counts of normal eyes and glaucoma eyes without pseudoexfoliation (P greater than 0.09, P greater than 0.05) and between PSX eyes with (18 eyes) and without (20 eyes) open-angle glaucoma (P greater than 0.99, P greater than 0.4). Our findings indicate that the blood-aqueous barrier is impaired in eyes with pseudoexfoliation, and that the laser flare-cell meter may be a useful tool to quantify these changes. These alterations of the blood-aqueous barrier need to be considered in medical therapy and intraocular surgery.     

Relative mydriasis after photorefractive keratectomy

PURPOSE: To report the incidence of anisocoria after unilateral excimer laser photorefractive keratectomy (PRK) for myopia and subsequent corticosteroid therapy in a retrospective and prospective study and to explore possible etiologies. METHODS: The horizontal pupil diameter was determined in 6 patients (6 eyes) at 21.8 +/- 12.6 months after unilateral wide-field excimer laser PRK (retrospective group) as well as in 8 consecutive patients (8 eyes) before and 3.4 +/- 2.9 months after unilateral PRK (prospective group). The Schwind-Keratom wide-field excimer laser was used. Measurements were done in an examination room using Rosenbaum card comparison pupillometry and with a Goldmann perimeter at 31.5 asb. In the prospective group, the effect of fitting a hard contact lens of zero diopter power and the application of 0.1% pilocarpine were evaluated. RESULTS: Relative mydriasis was present in all treated eyes and the difference in pupil diameter between the two eyes measured 0.25 to 1.75 mm (retrospective group: +0.56 +/- 0.82 mm; prospective group: +0.72 +/- 0.29 mm). At the time of pupil measurement, the retrospective group had a significantly longer mean postoperative follow-up (21 mo) than the prospective group (3.4 mo) and significantly more eyes still received topical corticosteroid treatment (retrospective group, 1 of 6 eyes; prospective group, 7 of 8 eyes). The amount of anisocoria did not correlate with the applied laser energy, ablation depth, or refractive change, but showed a negative correlation with increasing time after PRK. Neither hard contact lens fitting nor pilocarpine 0.1% reduced the amount of anisocoria significantly. CONCLUSION: Unilateral PRK with wide-field excimer laser ablation and subsequent application of topical corticosteroids regularly resulted in a relative pupillary mydriasis. Neither an altered corneal profile nor parasympathetic denervation is responsible for this. Weakening of the pupillary sphincter of the treated eye may cause this phenomenon.     

Quantitative assessment of aqueous flare intensity in diabetes

Aqueous flare intensity was measured with the laser flare-cell meter in 231 eyes of diabetic patients and 31 eyes of normal age-matched controls. Diabetic patients were divided into four groups based on the degree of retinopathy: (1) non-retinopathy, 42 eyes; (2) background retinopathy, 72; (3) preproliferative retinopathy, 23; and (4) proliferative retinopathy, 94. There was no significant difference between the normal controls and the non-retinopathy group, whereas the rest of the diabetic groups showed significantly higher flare values than did normal controls (P < 0.001). Flare intensity increased with the progression of retinopathy. Our results demonstrate that clinical use of the flare-cell meter enables the quantitative assessment of blood-aqueous barrier function in diabetics and suggest that diabetic iridopathy, as one of the manifestations of diabetes in the anterior part of the eye, exists even in the early stages of this disease and progresses in parallel with retinopathy.Supported in part by research grant 62870070 from the Ministry of Education and Culture of Japan     

Assessment of anterior chamber flare and cells after laser in situ keratomileusis

PURPOSE: To determine the presence of anterior chamber flare and cells after laser in situ keratomileusis (LASIK) for the correction of myopia. SETTING: Hermann Eye Center and the University of Texas Medical School, Department of Ophthalmology and Visual Science, Houston, Texas, USA. METHODS: Forty-three eyes of 23 consecutive patients ranging in age from 24 to 62 years had LASIK for myopia. All surgeries were performed by a single surgeon using a VISX Star laser and the same technique. Patients received no preoperative antiinflammatory medications. Postoperatively, all patients were instructed to use 1 drop of ofloxacin (Ocuflox) and 1 drop of fluorometholone 0.1% (FML) in the operated eye 4 times daily while awake for 7 days. At baseline and postoperative days 1, 7, and 28, anterior chamber flare was measured and cells were counted using a Kowa laser flare meter (FM-500) and laser cell counter (LC-500), respectively. RESULTS: Flare and cells increased significantly on day 1 (P <.0001 for both flare and cells) and returned to preoperative levels by day 7. No statistically significant correlation was detected between the amount of inflammation and the number of laser pulses (P =.2922) or the ablation time (P =.8383). CONCLUSIONS: A significant increase in anterior chamber inflammation occurred during the first 24 hours after LASIK. Inflammation levels then subsided to preoperative levels by day 7 with steroid use. Anterior chamber inflammation did not appear to correlate with the duration of the ablation or the number of laser pulses.     

Factors associated with increased aqueous flare in psoriasis

PURPOSE: To evaluate the changes in aqueous flare in psoriasis patients and to identify the factors that influence the level of aqueous flare. METHODS: We examined the 68 eyes of 34 psoriasis patients and the 68 eyes of 34 healthy subjects with a laser flare-cell meter. Complete dermatologic and ophthalmic examinations were performed on the psoriasis patients. RESULTS: Flare was significantly higher in psoriasis patients than in normal controls (P <.000l). The factors that increased flare significantly were age and Psoriasis Area and Severity Index. Flare was not significantly associated with sex, psoriasis type, duration of disease, and cyclosporin therapy. A flare increase was significantly correlated with serum total protein and immunoglobulin (Ig) A, but not with albumin, IgG, and IgM. CONCLUSIONS: Psoriasis patients, even without ocular symptoms, had slight damage to the blood-aqueous barrier. Multiple linear regression analysis showed that flare had the strongest correlation with the severity of psoriasis.     

Corneal endothelial changes and aqueous flare intensity in pseudoexfoliation syndrome

Purpose: To determine the changes of corneal endothelium in pseudoexfoliation (PEX) syndrome and the relations between their changes and aqueous flare intensity. Methods: 26 eyes with PEX syndrome, 17 clinically unaffected fellow eyes and 27 normal age-matched eyes were studied. The corneal endothelium of the eyes was examined using a specular microscope, and the aqueous flare intensity of the eyes was measured using a laser flare cell meter. Results: The corneal endothelial density significantly decreased both in the eyes with PEX and in the clinically unaffected fellow eyes compared to the normal control eyes (p < 0.001, p < 0.01). The acqueous flare intensity significantly increased in PEX syndrome (p < 0.01). There was a significantly inverse correlation between the corneal endothelial cell density and the aqueous flare intensity in PEX. Conclusion: A decrease in corneal endothelial cells was quantitatively identified in PEX syndrome. This change might have a relationship with a disorder of the blood-aqueous barrier in this syndrome. Copyright Copyright 1999 S.Karger AG, Basel     

Reversible mydriasis and cycloplegia after isocyanate exposure]

We saw three patients working in the production of polyurethanes, who showed mydriasis and cycloplegia of unknown origin. In one patient there was also a transient opacification of corneal stroma. After discontinuation of working both mydriasis and cycloplegia resolved completely within 3-5 days. Because of the history and the analysis of chemical reactions involved in the production of polyurethanes there is strong evidence that both mydriasis and cycloplegia have been caused by topical and (/or) systemic intoxication with the aryl diet of the isocyanate molecule.     

Increased aqueous flare intensity in eyes with liquefied after-cataract

PURPOSE: To describe aqueous flare intensity in eyes with white liquefied after-cataract. SETTING: Department of Ophthalmology, Toyama Medical and Pharmaceutical University, Toyama, Japan. METHODS: Seven patients with unilateral liquefied after-cataract and another 10 unaffected patients with an intraocular lens (IOL) were examined. The eyes were divided into 3 groups. The first group was composed of 7 eyes with liquefied after-cataract. The second group included the fellow eyes of the patients with unilateral liquefied after-cataract; 4 had an IOL, and 3 had cataract. The third group included 10 additional eyes without liquefied after-cataract. All patients underwent cataract operations consisting of phacoemulsification/aspiration with continuous curvilinear capsulorhexis and acrylic IOL implantation in the capsular bag. Aqueous flare was measured using a laser flare-cell meter. RESULTS: The mean +/- SD of aqueous flare intensity was significantly higher in the first group (11.8 +/- 1.8 photon counts/msec) than in the second group (6.4 +/- 0.8 photon counts/msec) and in the third group (6.3 +/- 0.7 photon counts/msec). CONCLUSION: It is possible that liquefaction of after-cataract and disruption of the blood-aqueous barrier may be related.     

前葡萄膜炎患者房水闪辉和炎性细胞的定量测量

目的 探讨激光蛋白细胞检测仪定量测定前葡萄膜炎患者房水闪辉和炎性细胞的临床应用价值。方法 采用FC-2000型激光蛋白细胞检测仪(laser flare cell meter,LFCM)非接触性定量检测2001年12月至2002年4月于中山眼科中心就诊、复查的110例前葡萄膜炎患者(194只眼)和52例正常人(52只跟)的房水闪辉和炎性细胞出现情况,检测前所有患者均在裂隙灯显微镜下详细检查,并进行房水闪辉分级和定量检测细胞。结果 LFCM检测前葡萄膜炎患者0～2级房水闪辉的平均值分别为7.9、29.5和189.0 pc/ms;3-4级房水闪辉由于背景干扰大,检测结果显示为警告或无法检测。前葡萄膜炎患者的0～2级房水闪辉的裂隙灯显微镜检查与激光蛋白测定结果呈正相关性(r=0.75,P<0.001);与正常人房水闪辉值(5.3 pc/ms)比较,均显著增高(t=5.872,P<0.05)。LFCM检测前葡萄膜炎患者(0-4级房水闪辉)房水中炎性细胞的平均值分别为1.5、12.1、33.9、84.9和193.1个/0.5 mm3;裂隙灯显微镜检查与激光蛋白细胞计数结果呈正相关性(r=0.72,P<0.001);与正常人房水中炎性细胞值(0.9个/0.5 mm3)比较,均显著增高(t=7.35l,P<0.05)。结论LFCM检测可确切判断轻、中度的血房水屏障破坏和炎性反应改变,此项检查对判断眼前段炎性反应和指导临床用药有重要价值。(中华眼科杂志     

Paraneoplastic aqueous flare intensity in patients with esophagogastric carcinoma

A study was conducted of anterior chamber aqueous flare intensity in patients with esophagogastric malignancies. The subjects included 79 patients with upper alimentary tract malignancies (69 scheduled for surgery for the underlining cancer and 10 with metastases), 47 patients with stable ocular sarcoidosis, and 46 age-matched healthy volunteers. A laser cell-flare meter was used to measure flare intensity in patients and healthy controls. The average flare intensity before surgery in patients with cancer was 10.7 ± 4.9 photon counts/millisecond (pc/ms), which was not statistically significantly different from that in patients with sarcoidosis (11.9 ± 8.3 pc/ms) but was significantly higher (p &lt; 0.0001) than that in healthy volunteers (4.3 ± 1.3 pc/ms). The average flare intensity after surgery in patients with carcinomas was 7.5 ± 2.5 pc/ms, which was significantly (p &lt; 0.0001) lower than the preoperative value. These results suggest that alterations in aqueous flare intensity might represent a paraneoplastic syndrome in patients with esophagogastric carcinoma. If so, measurements of flare intensity may be helpful in the differential diagnosis and evaluation of the disease course of digestive tract cancer.