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Edoardo Villani, Elisa Cantalamessa, Saverio Luccarelli, Stefano Lucentini, Maurizio Rolando, Paolo Nucci; Failure to Validate the Fluorescein Breakup Patterns Classification in an Italian Sample of Dry Eye Patients. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4887.
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A recent Japanese research on Dry Eye patients proposed 5 different fluorescein break-up patterns (FBUPs), related to different pathophysiologies.The aim of our cross-sectional study was to test the FBUPs classification in an Italian sample of Dry Eye patients.
We included 210 eyes of 105 patients with Dry Eye diagnosed on the basis of the Tear Film and Ocular Surface Society Dry Eye Workshop II recommendations. Exclusion criteria were eyelid disorders, history of ocular surgery, ocular surface co-morbidities and Meibomian Gland Dysfunction.Each patient underwent an examination including accurate anamnesis, standardized assessment of symptoms, ocular surface inspection, FBUPs classification (strictly based on the methodology described by Yokoi N and colleagues, paying attention to the moment of appearance, to the shape and to the position of the dark spot), FBUT, corneal and conjunctival staining, and Schirmer test without anesthesia.FBUPs’ inter-observer and inter-visit reproducibility and relationship between FBUPs and clinical manifestations were investigated.
FBUPs showed almost perfect inter-observer agreement and substantial inter-visit reproducibility (Cohen's kappa =0.88 and 0.74, respectively).We classified 102 eyes (48%) into spot break (SB), 70 eyes (33%) into line break (LB), 30 eyes (14%) into dimple break (DB), and 8 eyes (4%) into random break (RB). No eyes were classified into area break (AB).BUPs showed poor agreement between the right and the left eye of the same patient (Cohen's kappa =0.15, Spearman =0.10; P=0.32).Ocular Surface Disease Index, symptoms Visual Analogue Scales, FBUT, corneal and conjunctival staining and Schirmer test showed no significant BUPs-related differences (Kruskal-Wallis test; P>0.05 in all cases).
We failed in validating this FBUPs classification in our sample of dry eye patients. Differences between our results and those reported by Yokoi N and colleagues might be due to several factors, including ethnicity, diagnostic dry eye criteria, and sampling and procedural errors. However, although its intriguing rationale, this BUPs classification doesn’t seem to be ready for use in clinical practice.
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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