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FA Lattanzio, JD Sheppard, PG Loose-Thurman, PB Williams; Uveitis Detection by Confocal Microscopy Permits Earlier Institution of Therapy Following Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4270.
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Purpose: Cataract surgery for uveitis patients involves increased risk and aggressive peri-operative anti-inflammatory therapy. Early intervention for relapse or exacerbation of uveitis is highly desirable. Subtle signs heralding new inflammation or treatment resistance may be difficult to detect via slit lamp examination (SLE). Early detection of inflammation allows timely initiation of therapy. Confocal microscopy (CF) was compared with standard SLE to determine whether the clinical treatment profile would be significantly altered by using CF as a diagnostic tool. Methods: 5 patients with known uveitis were examined by CF and SLE at their first post-op visit (POD1) following insertion of an IOL and 1 month (POD30) later. All patients were quiet pre-op and treated with Voltaren (V) qid post-op. Those with signs of intense uveitis were also treated with Pred Forte (PF) while those with quiet SLE were advised to taper their V. Archived CF images were compared to masked chart notes and slit lamp examinations. Results: At POD1, CF detected subtle inflammatory changes on the endothelium and in the anterior chamber of 3 patients deemed quiet by SLE. These patients continued on V qid without the customary taper. Another patient received more intense initial PF therapy than otherwise would have been prescribed, then continued PF at POD30 despite a quiet SLE, due to a positive CF. CF altered treatment in 4 of 5 patients at POD1 and 1 of 5 at POD30. Another POD30 patient with positive CF and quiet SLE rebounded when V was stopped. Conclusions: For patients with quiet SLE and CF exams, V can be tapered. Those with quiet SLE but positive CF require continued qid therapy. Thus, treatment profile modification based on CF is effective. Logic decision trees were generated and compared to patient clinical profiles, then followed using this paradigm. Our ability to control the development of uveitis or to stifle existing inflammation without prescribing unnecessary therapy improved. Thus, CF appears to be a more sensitive tool to detect early or subtle ocular inflammation when compared to SLE. Results View OriginalDownload SlideView OriginalDownload Slide
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