Factors Influencing Aqueous Flare After Cataract Surgery And Its Evaluation With Laser Flare Photometry

Despite the refinement of modern cataract surgery, postoperative inflammation still constitutes a substantial amount of visual morbidity worldwide. A surrogate for intraocular inflammation and blood–aqueous barrier breakdown can be objectively quantified by Laser flare photometry (LFP). 

This review outlines the utility of LFP in assessing the assessment of post-cataract surgery inflammation. 

This was a retrospective narrative review. Articles selected for eligibility were screened and deemed eligible if the aqueous flare was measured with LFP both before and after cataract surgery. All the articles were screened by two authors and flare data in relation to the preoperative patient’s factors/comorbidities, intraoperative steps (incision, method of cataract removal, ophthalmic viscosurgical device, irrigating solutions and intraocular lenses) and postoperative regime for control of inflammation were collected.

131 papers were eligible for discussion. We highlight the influence of preoperative pathological states such as uveitis and diabetes where the blood–aqueous barrier is compromised prior to surgery. Various intraoperative strategies can minimize postoperative flare, including clear corneal incisions, efficient phacoemulsification and in-the-bag IOL placement. The optimum postoperative anti-inflammatory regimen is subject to ongoing study.

Despite its success, the worldwide frequency of cataract surgery creates substantial morbidity associated with blood–aqueous breakdown and inflammatory sequelae. The optimization of an already refined operation with modest postoperative changes cannot rely on clinical grading, which is qualitative and fraught with interobserver variability, particularly at the lower levels seen after an uncomplicated cataract surgery. Aqueous flare is far from the only consideration in the assessment of cataract surgery strategies but it is only with objective and sensitive outcome measures of intraocular inflammation that the refinement of modern cataract surgery can continue.