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Graham Reeves, Marianne Lloyd, Bijay P. Rajlawat, Gillian L. Barker, Anne Field, Stephen B. Kaye; Ocular and oral grading of Mucous Membrane Pemphigoid. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4270.
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To investigate the reproducibility and agreement between two ocular (one established and one proposed) and an oral mucosal grading system for Mucous Membrane Pemphigoid (MMP).
Patients with MMP involving eye and mouth were assessed by three ophthalmologists and two oral medicine specialists. Ocular disease was graded using the system described by Rowsey and a proposed system based on measurement of vertical depth and horizontal width measured from the bulbar conjunctival aspect. Oral assessment used a ‘mucosal disease severity score’ originally described for lichen planus in which 17 areas of the mouth are scored for involvement together with a pain score. Levels of agreement used Fleiss' Kappa Statistic (FKS).
44 patients with MMP encompassing mild to severe disease were included. Good levels of agreement were observed between observers for both vertical (SD 0.52mm) and horizontal (SD 1.54mm) involvement for the proposed system and the Rowsey system (FKS 0.32), (p<0.01). There was a high coefficient of determination between the ocular grading systems (R2>0.8, p<0.01). Oral grading showed excellent levels of agreement (FKS 0.71) between observers. There was no significant association between the severity of oral and ocular disease using described grading systems.
The proposed grading systems for both oral and ocular involvement in MMP are easy to use and reproducible between observers. The proposed ocular system correlates well with current systems and overcomes some of the difficulties encountered with existing systems. For the individual patient a change of 1.5mm (vertical) and 3mm (horizontal) can be used as indicative of significant progression.This may increase our ability to detect change and enhance treatment planning. Although we have previously shown the risk of ocular involvement in patients with only oral involvement, the severity of oral and ocular disease are not well correlated.
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