Download Prospective Correlation of Symptoms and Clinical Grading in Vernal

Prospective Correlation of Symptoms
and Clinical Grading in Vernal
Keratoconjunctivitis Patients
Srikant K Sahu, Shraddha Pawan Sureka, Sujata Das,
Apurva Hardas
L V Prasad Eye Institute, Patia,
Bhubaneswar, India.
None of the authors have any
financial disclosure to make
Introduction
• Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, inflammatory
disease of the ocular surface
• Characterized by intense ocular itching, redness, stringy discharge &
photophobia
 Palpebral VKC
 Limbal VKC
 Mixed VKC
Problem
•
The grading of VKC is subjective
•
There is a mismatch between symptoms and signs –
Leads to confusion in the allotment of a clinical grade
•
There is no universal way of grading the disease
Objective of the study
• To assess of the symptoms by Visual analogue scale and correlate it
with disease severity graded by Bonini
Methods
•
Visual analogue scale:
Redness, itching, watering, photophobia, burning sensation,
foreign body sensation, decreased vision
Each symptom given score of 0 to 10 – Added
•
Disease severity by Bonini claassification
Grades 1, 2A, 2B, 3, 4
Limbal, tarsal or mixed form
•
Allergic tendency
Ref: Bonini S, et al. Vernal keratoconjunctivitis revisited. A case series of 195 patients with long-term follow
up. Ophthalmology. 2000;107:1157–1163.
Methods - Statistics
•
Symptom score was correlated with disease severity as per Bonini
classification
•
Spearman’s rank correlation coefficient
•
Multiple regression analysis
Results
Age at
presentation
10.7 ± 5.0 years
(Mean ± SD),
Range, 3-25
years
Median 10 years
Males: Females 49:11
Duration
between
3.2 ± 2.9 years
onset &
presentation
Median 2 years
(Mean ± SD),
Range, 0-12
years
Bonini grade - No. of
disease severity patie
nts
1
2A
2B
3
19
15
15
9
4
2
Form of
disease
No. of
patients
Palpebral
Limbal
Mixed
16
20
24
Results – Symptom score & Correlation
with disease severity
Symptom
Spearman r P
Burning
Itching
Photophobia
Mean Median Std.
Deviation
2.9
3
2.8
6.7
7
2.3
3.3
3
3.2
0.225
-0.003
0.316
0.084
0.981
0.014*
Watering
Redness
FB sensation
5.4
7.2
2.0
6
8
0
2.8
1.8
2.8
0.126
0.172
0.109
0.338
0.189
0.407
Decreased
vision
1.4
0
2.7
0.182
0.164
* Significant correlation
Results – Symptom score & Correlation
with disease severity – Multivariate
analysis
Symptom
Burning
Itching
Photophobia
Watering
Redness
FB sensation
Decreased vision
Coefficient 95% Confidence P values
intervals
0.062
-0.066-0.191
0.335
-0.080
-0.231-0.071
0.292
0.102
-0.001-0.206
0.053
0.030
-0.088-0.149
0.609
0.012
-0.168-0.191
0.898
-0.015
-0.149-0.118
0.819
0.028
-0.095-0.151
0.652
Discussion
• Demographic data suggests that clinical profile of the disease in our
setting varies as compared to the studies reported world wide
• Complications like keratoconus, limbal stem cell deficiency and
corneal scarring is seen more commonly in our setting
• Photophobia is an important symptom
• Tendency for increased symptom score of photophobia to be
associated with increased disease severity
• No other symptoms showed any correlation with disease severity
• Thus patients symptoms need separate grading
Conclusions
•
Clinical symptoms of VKC do not correlate with signs and need to
be graded separately for objectively treating and prospectively
assessing management.
•
VAS scores can be easily used for grading symptoms and Bonini
classification for grading signs. Allergy tendency would be recorded
separately.
•
This classification would need further studies for validation and
and considering prospective plotting of each of the scores on a
graph every 6 months.
Thank you!
L V Prasad Eye Institute
www.lvpei.org
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