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Hon Shing Ong, Darwin Minassian, Saaeha Rauz, Jodhbir S Mehta, John K Dart; Clinical Severity Grading Tool for Cicatrising Conjunctivitis: A Validation Study. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1165.
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Cicatrising conjunctivitis (CC) refers to a group of sight-threatening conditions associated with conjunctival scarring and inflammation. No validated clinical system exists for measuring the severity and activity of CC.We have designed a tool based on previously described activity, damage indices of ocular surface disease, and findings of a cross-sectional study in mucous membrane pemphigoid (MMP).1 The tool uses objective parameters to measure disease activity and severity, such as an inflammation grading scale using photographs and scarring assessment using fornix depth measurements (FDM). We aim to validate this system as a standardised assessment tool in CC.
Design: Cross-sectional cohort studyParticipants: 74 patients (147 eyes) with CCTo test for inter-observer variability, all patients underwent clinical assessment by 2 independent examiners using the grading tool at a single visit. To test for intra-observer variability, all patients returned within 2 weeks and clinical assessment using the same tool was repeated by the same 2 examiners. In a subset of Stevens Johnson Syndrome (SJS) patients, we also compared our grading tool to a published but non-validated grading system for ocular SJS (Sotozono, et al 2007).
55 patients (109 eyes) had ocular MMP and 19 patients (38 eyes) had ocular SJS [mean age: 64.0±15.5 years; 42/74(56.8%) female]. Grading parameters with good inter- and intra-observer agreement include: ocular inflammation, limitation in motility, symblepharon measurement, FDM, subconjunctival fibrosis, corneal vascularization, corneal opacity, conjunctival and corneal keratinization [Intra-class correlation coefficient (ICC) 1.00, p<0.001]. Overall, this assessment tool delivered good inter-observer [ICC 0.91, p<0.001] and intra-observer agreement [ICC observer 1: 0.91, p<0.001; ICC observer 2: 0.98, p<0.001]. In SJS cases, there was good agreement between our tool and the Sotozono system [ICC 0.83, p<0.001]; this was also observed when the Bland-Altman plot was applied.
This study validates our severity grading tool, demonstrating that it is a reliable method for assessing patients with CC. This tool can be used for clinical documentation and in future studies evaluating CC therapies.1 Ong HS, et al. Mucous membrane pemphigoid with ocular involvement: the clinical phenotype and its relationship to direct immunofluorescence findings. Ophthalmology In press(2017).
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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