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Laser flare and cell photometry to measure inflammation after cataract surgery: a tool to predict the risk of cystoid macular edema

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Abstract

Purpose

To review the current adoption of laser flare and cell photometry (LFCP) in the setting of modern cataract surgery to analyze inflammation aiming to identify evidence of a correlation between LFCP values and the risk of cystoid macular edema (CME) development.

Methods

An extensive PubMed literature search was performed to review all the published studies investigating inflammation by LFCP after uncomplicated phacoemulsification. The following keywords were used: cataract surgery, cystoid macular edema, anterior chamber inflammation, laser flare, and cell photometry.

Results

Seventy-eight original articles investigating inflammation by LFCP were selected. Macula alterations were searched in 12 (15%) trials, by optical coherence tomography or fluorescein angiography in 11 (14%) and 1 (1%) studies, respectively. Among them, 9 (12%) papers investigated the correlation between LFCP values and cystic changes to the macula: 7 (9%) and 2 (3%) studies identified a positive and negative correlation, respectively. Three (4%) papers did not perform any correlation analysis.

Conclusion

CME, as a consequence of uncontrolled postoperative inflammation, is a common cause for unfavorable visual outcomes following uncomplicated phacoemulsification with IOL implantation. After surgery, intraocular inflammation is generally assessed by qualitative methods. Although well-established and practical in uveitis, they are inadequate to detect the modest inflammatory response that usually occurs after uneventful phacoemulsification. LFCP correlate with the chance of macula alteration after surgery and higher the values higher the risk of CME. The quantitative analysis of intraocular inflammation by LFCP after cataract surgery might be a tool to predict the risk of pseudophakic CME.

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Data availability

All authors declare that all data and materials as well as software application or custom code support their published claims and comply with field standards.

References

  1. Davis G (2016) The evolution of cataract surgery. Mo Med 113(1):58–62

    PubMed  PubMed Central  Google Scholar 

  2. Kim SJ, Schoenberger SD, Thorne JE et al (2015) Topical nonsteroidal anti-inflammatory drugs and cataract surgery: a report by the american academy of ophthalmology. Ophthalmology. https://doi.org/10.1016/j.ophtha.2015.05.014

    Article  PubMed  PubMed Central  Google Scholar 

  3. McCafferty S, Harris A, Kew C et al (2017) Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo. BMC Ophthalmol. https://doi.org/10.1186/s12886-017-0405-7

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chu CJ, Johnston RL, Buscombe C et al (2016) Risk factors and incidence of macular edema after cataract surgery a database study of 81984 eyes. Ophthalmology. https://doi.org/10.1016/j.ophtha.2015.10.001

    Article  PubMed  Google Scholar 

  5. Flach AJ (1998) The incidence pathogenesis and treatment of cystoid macular edema following cataract surgery. Trans Am OphthalmolSoc. https://doi.org/10.1136/bjo.2004.047662

    Article  Google Scholar 

  6. Bélair M-L, Kim SJ, Thorne JE et al (2009) Incidence of cystoid macular edema after cataract surgery in patients with and without uveitis using optical coherence tomography. Am J Ophthalmol 148:128–35.e2. https://doi.org/10.1016/j.ajo.2009.02.029

    Article  PubMed  PubMed Central  Google Scholar 

  7. Pollack A, Leiba H, Bukelman A, Oliver M (1992) Cystoid macular oedema following cataract extraction in patients with diabetes. Br J Ophthalmol. https://doi.org/10.1136/bjo.76.4.221

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rossetti L, Autelitano A (2000) Cystoid macular edema following cataract surgery. Curr Opin Ophthalmol. https://doi.org/10.1097/00055735-200002000-00010

    Article  PubMed  Google Scholar 

  9. Gulkilik G, Kocabora S, Taskapili M, Engin G (2007) Cystoid macular edema after phacoemulsification: risk factors and effect on visual acuity. Can J Ophthalmol. https://doi.org/10.1139/i06-062

    Article  PubMed  Google Scholar 

  10. Henderson BA, Kim JY, Ament CS et al (2007) Clinical pseudophakic cystoid macular edema. risk factors for development and duration after treatment. J Cataract Refract Surg. https://doi.org/10.1016/j.jcrs.2007.05.013

    Article  PubMed  Google Scholar 

  11. Coassin M, Iovieno A, Soldani A, Cavuto S, Cimino L, Sartori A, Fontana L (2016) Bromfenac ophthalmic solution 0.09% as an adjunctive therapy to topical steroids after cataract surgery in pseudoexfoliation syndrome. J Cataract Refract Surg 42(8):1119–1125

    Article  Google Scholar 

  12. Miyake K, Ibaraki N (2002) Prostaglandins and cystoid macular edema. Surv Ophthalmol. https://doi.org/10.1016/S0039-6257(02)00294-1

    Article  PubMed  Google Scholar 

  13. Jabs DA, Nussenblatt RB, Rosenbaum JT et al (2005) Standardization of uveitis nomenclature for reporting clinical data. results of the first international workshop. Am J Ophthalmol. https://doi.org/10.1016/j.ajo.2005.03.057

    Article  PubMed  Google Scholar 

  14. Sharma S, Lowder CY, Vasanji A et al (2015) Automated analysis of anterior chamber inflammation by spectral-domain optical coherence tomography. Ophthalmology. https://doi.org/10.1016/j.ophtha.2015.02.032

    Article  PubMed  Google Scholar 

  15. Sawa M, Tsurimaki Y, Tsuru T, Shimizu H (1988) New quantitative method to determine protein concentration and cell number in aqueous in vivo. Jpn J Ophthalmol 32:132–142

    CAS  PubMed  Google Scholar 

  16. Tugal-Tutkun I, Herbort CP (2010) Laser flare photometry: a noninvasive, objective, and quantitative method to measure intraocular inflammation. Int Ophthalmol 30(5):453–464. https://doi.org/10.1007/s10792-009-9310-2

    Article  PubMed  Google Scholar 

  17. Ursell PG, Spalton DJ, Whitcup SM, Nussenblatt RB (1999) Cystoid macular edema after phacoemulsification: relationship to blood-aqueous barrier damage and visual acuity. J Cataract Refract Surg. https://doi.org/10.1016/S0886-3350(99)00196-0

    Article  PubMed  Google Scholar 

  18. Miyanaga M, Miyai T, Nejima R et al (2009) Effect of bromfenac ophthalmic solution on ocular inflammation following cataract surgery. Acta Ophthalmol. https://doi.org/10.1111/j.1755-3768.2008.01433.x

    Article  PubMed  Google Scholar 

  19. Maca SM, Amon M, Findl O et al (2010) Efficacy and tolerability of preservative-free and preserved diclofenac and preserved ketorolac eyedrops after cataract surgery. Am J Ophthalmol. https://doi.org/10.1016/j.ajo.2009.12.010

    Article  PubMed  Google Scholar 

  20. Dieleman M, Wubbels RJ, Van Kooten-Noordzij M, De Waard PWT (2011) Single perioperative subconjunctival steroid depot versus postoperative steroid eyedrops to prevent intraocular inflammation and macular edema after cataract surgery. J Cataract Refract Surg. https://doi.org/10.1016/j.jcrs.2011.03.049

    Article  PubMed  Google Scholar 

  21. Wang QW, Yao K, Xu W et al (2013) Bromfenac sodium 0.1%, fluorometholone 0.1% and dexamethasone 0.1% for control of ocular inflammation and prevention of cystoid macular edema after phacoemulsification. Ophthalmologica. https://doi.org/10.1159/000346847

    Article  PubMed  Google Scholar 

  22. Ersoy L, Caramoy A, Ristau T et al (2013) Aqueous flare is increased in patients with clinically significant cystoid macular oedema after cataract surgery. Br J Ophthalmol. https://doi.org/10.1136/bjophthalmol-2012-302995

    Article  PubMed  Google Scholar 

  23. Conrad-Hengerer I, Hengerer FH, Al JM et al (2014) Femtosecond laser-induced macular changes and anterior segment inflammation in cataract surgery. J Refract Surg. https://doi.org/10.3928/1081597x-20140321-01

    Article  PubMed  Google Scholar 

  24. Zaczek A, Artzen D, Laurell CG et al (2014) Nepafenac 0.1% plus dexamethasone 0.1% versus dexamethasone alone: effect on macular swelling after cataract surgery. J Cataract Refract Surg. https://doi.org/10.1016/j.jcrs.2013.12.023

    Article  PubMed  Google Scholar 

  25. Giannaccare G, Finzi A, Sebastiani S et al (2018) The comparative efficacy and tolerability of diclofenac 0.1% and bromfenac 0.09% ophthalmic solutions after cataract surgery. Curr Eye Res. https://doi.org/10.1080/02713683.2018.1501489

    Article  PubMed  Google Scholar 

  26. Coassin M, De Maria M, Mastrofilippo V et al (2019) Anterior chamber inflammation after cataract surgery: a randomized clinical trial comparing bromfenac 0.09% to dexamethasone 0.1%. AdvTher 36:2712–2722. https://doi.org/10.1007/s12325-019-01076-4

    Article  CAS  Google Scholar 

  27. De Maria M, Coassin M, Mastrofilippo V et al (2020) Persistence of inflammation after uncomplicated cataract surgery: a 6-month laser flare photometry analysis. AdvTher. https://doi.org/10.1007/s12325-020-01383-1

    Article  Google Scholar 

  28. Shah SM, Spalton DJ, Taylor JC (1992) Correlations between laser flare measurements and anterior chamber protein concentrations. Invest Ophthalmol Vis Sci 33(10):2878–2884

    CAS  PubMed  Google Scholar 

  29. Shah SM, Spalton DJ, Smith SE (1991) Measurement of aqueous cells and flare in normal Eyes. Br J Ophthalmol. https://doi.org/10.1136/bjo.75.6.348

    Article  PubMed  PubMed Central  Google Scholar 

  30. Onodera T, Gimbel HV, DeBroff BM (1993) Aqueous flare and cell number in healthy eyes of Caucasians. Jpn J Ophthalmol 37:445–451

    CAS  PubMed  Google Scholar 

  31. Guillén-Monterrubío OM, Hartikainen J, Taskinen K, Saari KM (1997) Quantitative determination of aqueous flare and cells in healthy eyes. Acta Ophthalmol Scand 75:58–62

    Article  Google Scholar 

  32. Laurell CG, Zetterström C (2002) Effects of dexamethasone, diclofenac, or placebo on the inflammatory response after cataract surgery. Br J Ophthalmol. https://doi.org/10.1136/bjo.86.12.1380

    Article  PubMed  PubMed Central  Google Scholar 

  33. Dick HB, Schwenn O, Krummenauer F et al (2000) Inflammation after sclerocorneal versus clear corneal tunnel phacoemulsification. Ophthalmology. https://doi.org/10.1016/S0161-6420(99)00082-2

    Article  PubMed  Google Scholar 

  34. Schwenn O, Dick HB, Krummenauer F et al (2000) Healon5 versus Viscoat during cataract surgery: intraocular pressure, laser flare and corneal changes. Graefe’s Arch Clin Exp Ophthalmol. https://doi.org/10.1007/s004170000192

    Article  Google Scholar 

  35. Herbort CP, Jauch A, Othenin-Girard P et al (2000) Diclofenac drops to treat inflammation after cataract surgery. Acta Ophthalmol Scand. https://doi.org/10.1034/j.1600-0420.2000.078004421.x

    Article  PubMed  Google Scholar 

  36. Othenin-Girard P, Tritten JJ, Pittet N, Herbort CP (1994) Dexamethasone versus diclofenac sodium eyedrops to treat inflammation after cataract surgery. J Cataract Refract Surg. https://doi.org/10.1016/S0886-3350(13)80036-3

    Article  PubMed  Google Scholar 

  37. Miyake K, Masuda K, Shirato S et al (2000) Comparison of diclofenac and fluorometholone in preventing cystoid macular edema after small incision cataract surgery: a multicentered prospective trial. Jpn J Ophthalmol. https://doi.org/10.1016/S0021-5155(99)00176-8

    Article  PubMed  Google Scholar 

  38. Ohara K, Okubo A, Miyazawa A, et al (1989) Aqueous flare and cell measurement using laser in endogenous uveitis patients. Jpn J Ophthalmol 33(3):265–270

    CAS  PubMed  Google Scholar 

  39. El-Harazi SM, Feldman RM, Chuang AZ et al (1998) Reproducibility of the laser flare meter and laser cell counter in assessing anterior chamber inflammation following cataract surgery. Ophthalmic Surg Lasers. https://doi.org/10.3928/1542-8877-19980501-05

    Article  PubMed  Google Scholar 

  40. El-Harazi SM, Ruiz RS, Feldman RM, et al (2002) Quantitative assessment of aqueous flare: the effect of age and pupillary dilation. Ophthalmic Surg Lasers 33(5):379–382

    Article  PubMed  Google Scholar 

  41. Ladas JG, Wheeler NC, Morhun PJ et al (2005) Laser flare-cell photometry: methodology and clinical applications. Surv Ophthalmol 50:27–47. https://doi.org/10.1016/j.survophthal.2004.10.004

    Article  PubMed  Google Scholar 

  42. Agrawal R, Keane PA, Singh J et al (2016) Comparative analysis of anterior chamber flare grading between clinicians with different levels of experience and semi-automated laser flare photometry. OculImmunolInflamm. https://doi.org/10.3109/09273948.2014.990042

    Article  Google Scholar 

  43. Wielders LHP, Schouten JSAG, Winkens B et al (2018) European multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1. J Cataract Refract Surg 44:429–439. https://doi.org/10.1016/j.jcrs.2018.01.029

    Article  PubMed  Google Scholar 

  44. De Maria M, Coassin M, Mastrofilippo V, Fontana L (2018) Quantitative evaluation of anterior chamber inflammation after phacoemulsification in clinical trials. J Cataract Refract Surg. https://doi.org/10.1016/j.jcrs.2018.06.043

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Viale Risorgimento 80, 42122, Reggio Emilia, Italy

    Michele De Maria, Danilo Iannetta & Luigi Fontana

  2. Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy

    Michele De Maria

  3. Ophthalmology, University Campus Bio-Medico of Rome, Rome, Italy

    Marco Coassin

Authors
  1. Michele De Maria
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  2. Marco Coassin
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  3. Danilo Iannetta
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  4. Luigi Fontana
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MDM, DI, MC and LF. The first draft of the manuscript was written by MDM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Luigi Fontana.

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De Maria, M., Coassin, M., Iannetta, D. et al. Laser flare and cell photometry to measure inflammation after cataract surgery: a tool to predict the risk of cystoid macular edema. Int Ophthalmol 41, 2293–2300 (2021). https://doi.org/10.1007/s10792-021-01779-0

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