Abstract
Purpose::
To propose a novel classification system for the ocular surface findings in patients with Stevens-Johnson syndrome and to evaluate its reproducibility.
Methods::
A grading system that covers the entire spectrum of clinical features (eyelid and eyelash involvement, dry eye, conjunctival inflammation/cicatrisation, corneal involvement and limbal stem cell deficiency)of the ocular surface in the chronic stage of SJS was initially developed. The grading scheme recognizes four levels of severity in each of the five features and a final grade. To avoid bias we included only eyes that have not been submitted to ocular surface reconstruction or oculoplastic surgery. To evaluate the level of inter-observer agreement, four ophthalmologists were involved and the inter-observer reproducibility was calculated by means of general Kappa statistics.
Results::
We evaluated 17 eyes of 10 patients seen at the Department of Ophthalmology of the Federal University of São Paulo with the diagnosis of SJS. The data showed a moderate agreement between the observers (kappa =0.563, CI 0.353-0.730). When each feature was analyzed separately the data shows a strong agreement for conjunctival inflammation/cicatrisation (kappa=0.775, CI 0.602-0.902) and limbal stem cell deficiency (kappa=0.799, CI 0.574-0.901) but not for eyelid and eyelash involvement (kappa=0.373, CI 0.121-0.601) and corneal involvement (kappa=0.454, CI 0.231-0.630). The dry eye feature was based on schirmer’s test values and had no inter-observer agreement to be calculated.
Conclusions::
The new classification for the ocular surface findings in SJS seems to be easy to be used and the statistics showed that it has a moderate reproducibility.
Keywords: cornea: clinical science • autoimmune disease • clinical (human) or epidemiologic studies: outcomes/complications