A Simplified Quantitative Method for Assessing Keratoconjunctivitis Sicca From the Sjogren's Syndrome International Registry

作者：Whitcher, John P.; Shiboski, Caroline H.; Shiboski, Stephen C.; Maria Heidenreich, Ana; Kitagawa, Kazuko; Zhang, Shunhua; Hamann, Steffen; Larkin, Genevieve; McNamara, Nancy A.; Greenspan, John S.; Daniels, Troy E.^*

来源：American Journal of Ophthalmology, 2010, 149(3): 405-415.

DOI：10.1016/j.ajo.2009.09.013

• LISSAMINE-GREEN
• DRY EYE
• STAINING CHARACTERISTICS
• TESTS
• SENSITIVITY

PURPOSE: To describe, apply, and test a new ocular grading system for assessing keratoconjunctivitis sicca (KCS) using lissamine green and fluorescein.
DESIGN: Prospective, observational, multicenter cohort study.
METHODS: The National Institutes of Health-funded Sjogren's Syndrome International Registry (called Sjogren's International Collaborative Clinical Alliance [SICCA]) is developing standardized classification criteria for Sjogren 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 (>= 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).
RESULTS: 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.
CONCLUSIONS: 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. (Am J Ophthalmol 2010;149:405-415.

• 出版日期2010-3
• 单位中国医学科学院北京协和医院