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Alvise La Gloria Valerio, Daniela Lazzarini, Aurora Bertoncello, Angela Castegnaro, Iva Fregona, Andrea Leonardi; A new grading scale score for corneal staining in patient with vernal keratoconjunctivitis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5631.
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© ARVO (1962-2015); The Authors (2016-present)
The assessment of ocular surface function and epithelial damage is considered an essential tool to define disease severity and to evaluate treatments effects. Objective clinical measures including corneal and conjunctival staining are evaluated by the Oxford (Ox), Van Bijsterveld (VB) and CLEK scoring systems. Although these systems have been developed for dry eye disease (DED), they are also used in vernal keratoconjunctivitis (VKC) clinical trials. The aim of the present study is to verify which scoring system and objective clinical evaluation is more appropriate in VKC.
8 DED and 7 VKC patients and 8 normal subjects were included and evaluated by symptomatology questionnaires (OSDI for DED; QUICK for VKC) and objective clinical measures: fluorescein (Ox) and lissamine green staining (VB), corneal esthesiometry and confocal microscopy (CFM) (HRT 3). We also performed an inter-observer evaluation using both Ox and VB scores assigned by an experienced ophthalmologist and an assistant.
Mean Ox score was 2.6±1.6 in DED and 1.8±1.2 in VKC and mean total VB score was 5.4±2.7 in DED and 0.9±1.2 in VKC with significantly higher corneal and conjunctival staining in DED compared to VKC (p<0.001). The results of the 2 scoring systems were correlated each other only in DED (p<0.001). The pattern staining distribution in VKC was completely different from the standard scales of both Ox and VB since the limbus and the upper cornea were more positive compared to the standard schemes and the bulbar conjunctiva was less involved. The inter-observer study showed a significant correlation in DED (r=0.933) (p<0.001) for the Ox score and in both DED and VKC for the VB (p<0.001). The OSDI was correlated with both Ox and VB in DED (p<0.05) but not the QUICK and the staining scores in VKC. Mean corneal esthesiometry was 45±17 in DED and 50 ±15 in VKC. Epithelial density by CFM was significant inversely correlated to Ox (p=0.003) both in DED and VKC but to VB only in VKC(p=0.004).
The Oxford Van Bijsterveld tests do not seem to be adequate for evaluation of the surface damage in VKC because the staining patterns proposed by these tests does not correspond to the staining patterns in VKC . For this reason we propose a new modified CLEK scoring system to better evaluate limbal and central corneal involvement in VKC.
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