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著者: John P Whitcher, Caroline H Shiboski, Stephen C Shiboski, Ana Maria Heidenreich, Kazuko Kitagawa, Shunhua Zhang, Steffen Hamann, Genevieve Larkin, Nancy A McNamara, John S Greenspan, Troy E Daniels, Sjögren's International Collaborative Clinical Alliance Research Groups
雑誌名: Am J Ophthalmol. 2010 Mar;149(3):405-15. doi: 10.1016/j.ajo.2009.09.013. Epub 2009 Dec 29.
Abstract/Text
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 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).
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.
(c) 2010 Elsevier Inc. All rights reserved.
PMID 20035924 Am J Ophthalmol. 2010 Mar;149(3):405-15. doi: 10.1016/j.ajo.2009.09.013. Epub 2009 Dec 29.
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