Department of Ophthalmology, University of California, San Francisco, San Francisco, California 94143-0422, USA.
Am J Ophthalmol. 2010 Mar;149(3):405-15. doi: 10.1016/j.ajo.2009.09.013. Epub 2009 Dec 29.
To describe, apply, and test a new ocular grading system for assessing keratoconjunctivitis sicca (KCS) using lissamine green and fluorescein.
Prospective, observational, multicenter cohort study.
The National Institutes of Health-funded Sjögren's Syndrome International Registry (called Sjögren's International Collaborative Clinical Alliance [SICCA]) is developing standardized classification criteria for Sjögren syndrome (SS) and is creating a biospecimen bank for future research. Eight SICCA ophthalmologists developed a new quantitative ocular grading system (SICCA ocular staining score [OSS]), and we analyzed OSS distribution among the SICCA cohort and its association with other phenotypic characteristics of SS. The SICCA cohort includes participants ranging from possibly early SS to advanced disease. Procedures include sequenced unanesthetized Schirmer test, tear break-up time, ocular surface staining, and external eye examination at the slit lamp. Using statistical analyses and proportional Venn diagrams, we examined interrelationships between abnormal OSS (>or=3) and other characteristics of SS (labial salivary gland [LSG] biopsy with focal lymphocytic sialadenitis and focus score >1 positive anti-SS A antibodies, anti-SS B antibodies, or both).
Among 1208 participants, we found strong associations between abnormal OSS, positive serologic results, and positive LSG focus scores (P < .0001). Analysis of the overlapping relationships of these 3 measures defined a large group of participants who had KCS without other components of SS, representing a clinical entity distinct from the KCS associated with SS.
This new method for assessing KCS will become the means for diagnosing the ocular component of SS in future classification criteria. We find 2 forms of KCS whose causes may differ.
描述、应用和测试一种使用丽丝胺绿和荧光素评估干燥性角结膜炎（KCS）的新眼部分级系统。
前瞻性、观察性、多中心队列研究。
美国国立卫生研究院资助的干燥综合征国际注册处（称为干燥综合征国际合作临床联盟[SICCA]）正在为干燥综合征（SS）制定标准化分类标准，并正在创建一个生物样本库，用于未来的研究。八名 SICCA 眼科医生制定了一种新的定量眼部分级系统（SICCA 眼部染色评分[OSS]），我们分析了 SICCA 队列中的 OSS 分布及其与 SS 的其他表型特征的关系。SICCA 队列包括从可能早期 SS 到晚期疾病的参与者。程序包括顺序进行未麻醉的 Schirmer 测试、泪膜破裂时间、眼表面染色和裂隙灯下的外眼检查。我们使用统计分析和比例 Venn 图，研究了异常 OSS（>或=3）与 SS 的其他特征（唇腺活检有局灶性淋巴细胞性涎腺炎和焦点评分>1 阳性抗 SS A 抗体、抗 SS B 抗体或两者）之间的相互关系。
在 1208 名参与者中，我们发现异常 OSS、阳性血清学结果和阳性 LSG 焦点评分之间存在很强的关联（P<0.0001）。对这 3 种测量方法重叠关系的分析定义了一大组患有 KCS 而无 SS 其他成分的参与者，代表了一种与 SS 相关的 KCS 不同的临床实体。
这种评估 KCS 的新方法将成为未来分类标准中诊断 SS 眼部成分的手段。我们发现了两种形式的 KCS，其病因可能不同。
