Document Detail

A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry.
MedLine Citation:
PMID:  20035924     Owner:  NLM     Status:  MEDLINE    
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.
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;
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2009-12-29
Journal Detail:
Title:  American journal of ophthalmology     Volume:  149     ISSN:  1879-1891     ISO Abbreviation:  Am. J. Ophthalmol.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-22     Completed Date:  2010-03-11     Revised Date:  2013-03-27    
Medline Journal Info:
Nlm Unique ID:  0370500     Medline TA:  Am J Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  405-15     Citation Subset:  AIM; IM    
Copyright Information:
(c) 2010 Elsevier Inc. All rights reserved.
Department of Ophthalmology, University of California, San Francisco, San Francisco, California 94143-0422, USA.
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MeSH Terms
Aged, 80 and over
Cohort Studies
Coloring Agents / diagnostic use*
Fluorescein / diagnostic use
Fluorescent Dyes / diagnostic use*
International Classification of Diseases
Keratoconjunctivitis Sicca / classification,  diagnosis*
Lissamine Green Dyes / diagnostic use
Middle Aged
Prospective Studies
Sjogren's Syndrome / classification,  diagnosis*
Young Adult
Grant Support
N01 DE032636-23/DE/NIDCR NIH HHS
Reg. No./Substance:
0/Coloring Agents; 0/Fluorescent Dyes; 0/Lissamine Green Dyes; 2321-07-5/Fluorescein
K Sack / ; D Lee / ; E Strauss / ; M Chan / ; A Wu / ; D Greenspan / ; D Cox / ; R Jordan / ; Y DeSouza / ; D Drury / ; L Scott / ; H Lanfranchi / ; C Vollenweider / ; I Adler / ; A Smith / ; M Gandolfo / ; P M Bisio / ; A Keszler / ; A Chirife / ; S Daverio / ; V Kambo / ; Y Dong / ; Y Zhao / ; M Li / ; W Zhang / ; W Zheng / ; Y Jiang / ; D Xu / ; J Su / ; J Zhao / ; D Du / ; J Xiao / ; H Wang / ; Q Wu / ; C Zhang / ; W Meng / ; M Schiødt / ; S Johansen / ; P Helin / ; H Holm / ; P Ibsen / ; A M Manniche / ; S P Kreutzmann / ; H Umehara / ; Y Masaki / ; M Tanaka / ; T Sawaki / ; K Hagiwara / ; T Nojima / ; N Kurose / ; M Hondo / ; T Kawanami / ; K Fujimoto / ; S Challacombe / ; P Shirlaw / ; B Jacobs / ; F Barone / ; E Odell / ; P Morgan / ; L Fernandes-Naglik /

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