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E. Bidlot, M. D. de Smet, F. D. Verbraak, RESCU Study Group; Scoring Fluorescein Angiograms in Uveitis Patients Taking Part in Clinical Studies. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5152.
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To develop a simple but comprehensive scoring system for Fluorescein Angiography (FA) in clinical uveitis studies.
We developed a scoring system which included the following categories: choroidal lesions, retinal vascular leakage, retinal microvascular leakage, macular edema (cystoid or not) and disc leakage (Table 1). Each category was scored separately and a sum-score was calculated by adding the category scores.To test the reliability of this scoring system for FA in uveitis patients we used the data of 11 patients (22 eyes) participating in the Remicade European Study of Chronic Uveitis (RESCU) (1,2). A study designed to determine the efficacy of Infliximab (Remicade) in patients with sight threatening autoimmune uveitis.The diagnostic group included: intermediate uveitis (n=6), Behçet’s syndrome (n=1), idiopathic uveitis (n=2), birdshot chorioretinopathy (n=1) and sympathetic ophthalmia (n=1).FAs were obtained at baseline, 10 weeks and 46 weeks. From every FA a selection of 4 central retinal images was made: 1) color image, 2) early phase image (30-60 sec), 3) mid phase image (2 minutes), 4) late phase image (10 minutes). All images were scored by 2 investigators independently. We compared the sum-score of both investigators and the changes in sum-score over time (in percentages and absolute scores).
Relatively high inter-observer variability was noted, though the intra-observer variability between the left and the right eye was low. This indicates a consistent scoring of both observers separately. The absolute changes over time showed the same trend for both observers.
Overall severity on fluorescein angiography of uveitis patients are scored consistently by observers. Although the changes over time showed the same trend for different observers, the values of the sum score differ. To systematically assess change in longitudinal studies will require the definition of a set of relevant parameters easily recognized by independent researchers.
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