Improved methods recommended for grading anterior chamber flare and vitreous cells

This article reports on the results of grading by uveitis specialists of intraocular inflammation activity and sites in 202 eyes of 101 uveitis patients using new criteria proposed by the Standardization of Uveitis Nomenclature Working Group. The study, which was conducted at three centers by four uveitis subspecialists, was designed to measure the reproducibility of these observations.

The authors concluded, based on the study's results, that the grading schema used appeared to be adequately reproducible. However, they recommended the use of improved methods for grading anterior chamber flare and vitreous cells.

To conduct the study, the investigators determined the primary site of inflammation and presence or absence of vitreous cells, and graded the degree of anterior chamber cells, flare and vitreous haze for each eye. The results of each of three of the investigators were compared with the findings of the fourth investigator, who visited the practices of the other three.

The authors determined that their grading of the site of intraocular inflammation had moderate reproducibility. They also found low to moderate levels of agreement for anterior chamber cell grading when agreement was defined as an exact match. However, agreement within one grade for anterior chamber cells was outstanding, with kappa ranging from 0.81 to 1.00. Agreement within one grade also was considered outstanding for vitreous haze grading. Agreement was in the moderate range for anterior chamber flare, but the distribution of grades was skewed toward lower grades, making the current grading system less ideal. Because there is no consensus on how to grade vitreous cells, the authors graded only their presence or absence, for which there was moderate interobserver agreement.

This article is most helpful for ophthalmologists who routinely see uveitis patients, such as uveitis specialists and retina and cornea specialists with an interest in uveitis. The information also will be helpful for ophthalmologists participating in clinical studies for which inflammation grading is part of the data collection. Because intraocular inflammation grading can be used as an outcome measure, the reproducibility of such measurements is of critical importance in clinical research.

Financial Disclosures
Dr. Thorne has no financial relationships to disclose.