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K.W. McDonald, J.D. Sheppard, F.A. Lattanzio, P.B. Williams; Predicting Perioperative Inflammation with Confocal Microscopy Versus Standard Slit Lamp Exam . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3629.
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Purpose: Cataract surgery for uveitis patients involves increased complication risk and requires aggressive peri-operative anti-inflammatory therapy. A recent study, involving 5 cataract patients with uveitis history, found that anti-inflammatory medication regimens can be more tightly controlled using confocal microscopy (CF) compared to standard slit lamp examination (SLE). This prompted a look at additional patients to determine whether CF examination is more sensitive than SLE in predicting peri-operative inflammatory risk in uveitic cataract patients. These patients were also evaluated for a relationship between underlying cause of uveitis and degree of inflammation pre and post operatively. Methods: CF and SLE were used to examine 5 uveitis patients preoperatively, on day 1 (POD1) following insertion of an IOL, then 7 days after surgery (POD7) and 1 month later (POD30). Results were compared to establish which examination method detected more subtle inflammatory changes with the potential to accurately predict peri-operative uveitis flares. Archived CF images were compared to masked chart notes and slit lamp examinations. Results: Preoperatively, four of five patients had no inflammatory activity by SLE. Patient 5, who suffers from rheumatoid arthritis (RA), had mild activity on SLE, versus moderate activity by CF. In all preoperative examinations, some degree of inflammation was detected by CF, while SLE predictably detected less or no inflammation. At POD1, only one patient was quiet by SLE. However, the CF examination detected subtle inflammatory changes on the endothelium and in the anterior chamber. At all four examination points (pre-op, post-op day 1, 7, and 30), CF detected greater inflammatory changes than SLE in all 5 participants. Although SLE did detect inflammation, CF was more sensitive to the degree of activity. This study did not identify a correlation between uveitis etiology and the degree of inflammation seen on CF or SLE. Conclusions: Based on results from this study, confocal microscopy offers clinicians a more sensitive tool to identify uveitis patients at higher risk of post-operative flare than does slit lamp examination. Further, evaluation of these 5 patients revealed that degree of peri-operative inflammation was independent of the underlying disease process. These results support the conclusion that confocal microscopy is a useful adjunct, or stand alone method, for evaluating and predicting post-operative inflammation in patients with a known history of uveitis.
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