This video demonstrates what cell and flare look like under the slit-lamp microscope. “Cell” is the individual inflammatory cells while “flare” is the foggy appearance given by protein that has leaked from inflamed blood vessels. This finding is commonly seen with uveitis, iritis, and after surgery … and actually seeing it can be challenging for the beginning ophthalmology residents.
The technique for seeing inflammation is to shorten your light beam, widen it slightly, and angle your light-path such that the beam hits the cornea on the left, the iris on the right, with you focusing on the anterior chamber in the middle of the eye. This allows you to use the pupil as a black background.
The first eye in this movie shows copious pigment floating in AC after a laser iridotomy. You can’t miss the pigment cells floating there. The second segment shows mild inflammatory cells, but a lot of flare (it looks like the beam a film-projector would make in a smokey movie theater). The last segment shows a moderate amount of cell that is moving by convection currents: the cells in the back float upward because the chamber is warmer there, and sink in the front where the aqueous is cooler.
Download this video for powerpoint
To download this video, right click on a link below and choose “Save Target As…”
cellandflare.wmv (8.4 meg, Windows video file) cellandflare.mov (Quicktime format coming soon)
Hi,
this is a very good video showing cell and flare after an iridotomy. Severe inflammation is common after iridotomy, and this video gives doctors a clue as to what a patient’s vision is like after an iridotomy. You see thousands of tiny little white spots, and you also see those hundreds of pigment cells, and these spots and cells obstruct your vision. Together with glare and double vision (these are further adverse effects of iridotomy), it makes your vision very miserable. An iridotomy is a permanent hole (wound) in the iris, and consequently the inflammation is permanent, too. This causes your vision to be permanently damaged.
Iridotomies have devastating side-effects!!!
Dorri
Please see the comments about iridotomy on this page of the site. Laser iridotomy is a vision-saving procedure that has saved many, many more eyes from acute glaucoma than it has caused side-effects.
Those with side effects (like yourself?) are quite vocal against the procedure, while those who’s eyes have been “saved” do not write about it (because these “saves” are not having any problems). This gives the false illusion that the iridotomy procedure is terrible. I’ve never had a single patient complain of any of side effects you describe, though they can occur. MANY more people complain about surgical iridotomies, which is the only alternative procedure.
The inflammation goes away, usually in about a week. It is not permanent like you describe. The vast majority of people notice NO change in their vision.
Finally, cell and flare (like in this video) do not cause visible floaters. You are describing floaters in the back of the eye in the vitreous cavity.
I do *not* describe floaters in the back of the eye in the vitreous cavity.
I describe thousands of tiny white spots which I am seeing ever since I had my iridotomies 2 years ago and which look exactly like the cell and flare in the video.
I had severe inflammation after the iridotomies in both eyes, which developed into uveitis (probably because I was not put on steroids). And this uveitis led to an increase in IOP. It was normal before the iridotomies, but is now between 29 and 35 with 3 glaucoma medications (Timolol, Trusopt, Xalatan).
My iridotomies are still patent and I do not have any other form of glaucoma besides having narrow angles before the iridotomies.
Besides I have double vision, glare and a considerable drop in visual acuity (from 20/20 to 20/100), mainly due to uveitis.
Two ophthalmologists agreed that all these visual aberrations are side effects of my iridotomies. One possible explanation might be that perhaps there was some sort of inflammation in the eyes before the iridotomies and the doctor didn’t realize it?
I know that problems after iridotomies are rare (ca. 15%), but with about 80.000 iridotomies being done every year, there are thousands like myself who suffer.
Even if the majority don’t suffer, those who do should be given attention.
Every ophthalmologist should keep records of all the side effects his patients have (also long-term effects!)and a list of all these side-effects should be publishd and made available on the net for every doctor. Thus every doctor will know what the real side-effects are and this will enable him to be well-prepared in case his patients encounter these problems.
Why is the comment form on the site you asked me to go to closed?
Well Dorri,
My first inclination is to delete your posts, as this website is not intended to be a public forum for grievances. However, I hate to delete posts by people who have been kind enough to leave comments, and your comments are well written and you make several good points.
I won’t counter your points one-by-one, other than to point out that LONG-TERM side effects of a laser iridotomy occurs in MUCH less than 15% of patients (less than 1% in my personal experience performing the procedure and discussion with others in the field) and that if “thousands” suffer from side effects, “tens of thousands” are saved from BLINDNESS from acute glaucoma.
Thank you for posting, Dorri. I did not mean to imply that the visual floaters you were “describing” weren’t like the floaters you see in this video. Instead, I mean that cell and flare do not CAUSE visual floaters. These particles are too small and too far anterior to the optical nodal point of the eye to be visible. Instead, your floaters are likely caused by debris in the BACK of your eye, pieces of debris casting shadows on your retina. You can see what these “other” floaters look like in this video.
The important point here, is that it’s important to properly warn patients about these potential side effects BEFORE doing a laser procedure. These side effects are rare (LONG-term side effects REALLY are rare despite what you might read on the internet) … but there is no question that they CAN occur. You know this more than anyone Dorri, as you’re suffering from glare, double vision, and iritis.
Your doctor performed this procedure in an attempt to lessen your chance of going blind. It’s unfortunate that your eye is prone to inflammation, and now it seems that things are worse than ever … but I’m sure your doctor had good intentions. Who knows, maybe you would have gone into angle-block last week and lost ALL vision if that hole hadn’t been created. Or maybe you wouldn’t have had any problems your entire life and that iridotomy wasn’t really necessary. Life is funny that way.
Thank you for writing Dorri. I can say that comments like yours have changed my practice over the past few years. The internet is a wonderful communication tool. I still perform iridotomies (they save MANY more eyes than they harm) but I spend a lot of time going over the risks and benefits very carefully so that my patients can make an educated decision and choose for themselves.
thanks for your kind answer. I am so glad that comments like mine make doctors go over the risks and benefits more carefully.
Excuse me for writing here, I didn’t know it wasn’t a public forum, and this is my last post.
My life was ruined by the iridotomies. I lost my job, can’t drive, can’t leave the house unaided and reading and writing on the internet takes ages. It is only possible with magnifying glasses. But it helps me to have at least some communication, for which I am so grateful. It is the net which makes me refrain from committing suicide.
By the way, the second and third ophthalmologists I went to told me with Shaffer grade 3 my iridotomies weren’t really necessary.
Life isn’t funny, it is sometimes very cruel.
Take care, of yourself and your patients.
Well, all comments about iridotomies aside, this is a great video. I am going to use it in a presentation to our residents.
Out of curiosity, Dorri, were your iridotomies done by an ophthalmologist or an optometrist? Some states allow optoms to do them and it seems like everyone and their mother are getting one. Regardless, it’s a shame you weren’t put on steroids. Undoubtedly, you developed an immune response to the uveal tissue floating around in your eye, and your other problems stem from the resultant uveitis.
my iridotomies were done by an ophthalmologist.
Yes, everyone and their mother are getting iridotomies, no matter whether they need them or not, and everyone and their mother are doing them. It’s a knee-jerk reaction whenever a doctor thinks a patient might have a very slightly narrow angle. As it is extremely difficult to see whether the angle is open or narrow (e.g. if you have blue eyes the angle may seem closed when in reality it is wide open)most of the iridotomies are done unnecessarily. And hardly any doctor knows about the devastating effects of this procedure.
Go to the ‘Prevent Blindness America’ website and look for ‘iridotomy’. There are almost 2000 posts about iridotomies(Iridotomy1, Iridotomy2 and now Iridotomy 3), and you will see there are so many people suffering from this procedure which in 90% of all the cases is completely unnecessary.
Kind regards, Dorri
Cell and Flare (Photo)
This photo shows what cell and flare look like under the slit-lamp. The "cell" are indidual cells, such as WBCs, that are floating in the aqueous. The "flare"... Anterior Chamber Inflammation (Photo)
This photo shows anterior chamber cell and flare. The cells are individual white blood cells floating in the aqueous. You can actually watch them moving in the convection... Perfluron Eye Complication (Photo)
This photograph shows a perfluron "bubble" sitting in the bottom of the anterior chamber of the eye. This molecule is denser than water and thus sinks. This is... Welcome to the premiere source for ophthalmology videos!
This website is chock-full of eye videos taken at the slit-lamp. Here you’ll find movies covering a wide variety of ocular pathology, ranging from the cornea all the way back... Our Videos! Check out our huge selection of streamable/downloadable ophthalmology videos. These eye videos are great for beginning residents and medical students and the acting clinician. Plus, each is in a downloadable...
To download this video, right click on a link below and choose “Save Target As…” 
cellandflare.wmv (8.4 meg, Windows video file)
