Abstract
BackgroundUveitis describes a group of inflammatory conditions affecting the eye. The ability to monitor inflammatory changes in anterior uveitis is crucial in clinical practice for making treatment decisions and in clinical trials for testing therapeutic agents. The current standard for quantifying anterior segment inflammation is clinical slit-lamp examination findings classified using the Standardisation of Uveitis Nomenclature (SUN) grading system. Such clinical grading systems rely on a subjective estimation using the slit lamp and are often non-linear and non-continuous scales, with large increases in cell count between each grade. Novel instrument-based technologies have emerged over the last few decades, which can provide objective and quantifiable measurements. This review will evaluate the reliability of such technologies and their level of agreement with anterior chamber (AC) cell count using clinical slit-lamp examination.MethodsStandard systematic review methodology will be used to identify, select and extract data from studies that report the use of any instrument-based technology in the assessment of AC cells. Searches will be conducted through bibliographic databases (MEDLINE, EMBASE and Cochrane Library), clinical trial registries and the grey literature. No restrictions will be placed on language or year of publication. The outcomes of interest are the correlation of index test measurements of AC cells with clinical grading systems using slit-lamp examination and the reliability of each index test identified. Quality assessment will be undertaken using QUADAS2. Degree of correlation between the index and reference test measures will be pooled and meta-analysed if appropriate.DiscussionA number of instrument-based tools are available for measuring AC cells. This review will evaluate the technologies available and measure the level of correlation of these alternative methods with clinical grading systems as well as their performance in reliability and repeatability. The findings of this review will identify those objective, instrument-based technologies which show good utility for measuring AC cells in a quantifiable way and which warrant further exploration for their sensitivity and reliability over the current standard.Systematic review registrationPROSPERO CRD42017084156 (Liu X, Moore DJ, Denniston AK). Instrument-based tests for measuring anterior chamber (AC) cells in uveitis: a systematic review. 2017). Study screening stage is complete. Data extraction stage has not yet commenced.
Highlights
Uveitis describes a group of inflammatory conditions affecting the eye
This systematic review focuses on inflammation in the anterior chamber, where inflammation causes a disruption to the normal blood-aqueous barrier, resulting in leakage of cells into the aqueous humour
The assessment of uveitis is complex: firstly, because uveitis describes a heterogeneous group of diseases with significant variations between different anatomical and disease-specific subtypes, and secondly, because many clinical measures in ophthalmology are based on visual function, which are subjective to the patient and do not always reflect active inflammation
Summary
Protocol This protocol is designed as per guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) [15]. Studies which do not report a correlation coefficient but report matched measurements for the index and reference tests can be included, and the correlation coefficient extrapolated during analysis. Type of study There will be no restrictions on study design; evaluation of correlation between index test and clinical grading using slit-lamp examination requires both tests to be done in a cross-sectional manner. Those studies where measurements are taken within a reasonable time point (within 24 h of each other) will be included. Information to be extracted from all studies include the following: Study characteristics Title, authors, publication year, journal and language Sample size Study design Index test used 1. If the two measurements are not matched, we will contact the authors for matched measurements
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