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

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

• 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 claassificationGrades 1, 2A, 2B, 3, 4Limbal, tarsal or mixed form

• Allergic tendency

Methods - Statistics

• Symptom score was correlated with disease severity as per Bonini classification

• Spearman’s rank correlation coefficient

• Multiple regression analysis

ResultsBonini grade - disease severity

No. of patients

1 19

2A 15

2B 15

3 9

4 2Form of disease

No. of patients

Palpebral 16

Limbal 20

Mixed 24

Age at presentation

10.7 ± 5.0 years

(Mean ± SD),

Median 10 years

Range, 3-25 years

Males: Females

49:11 

Duration between

onset & presentation

3.2 ± 2.9 years

(Mean ± SD),

Median 2 years

Range, 0-12 years

Results – Symptom score & Correlation with disease severity

Symptom Mean

Median

Std. Deviation

Spearman r

P

Burning 2.9 3 2.8 0.225 0.084

Itching 6.7 7 2.3 -0.003 0.981

Photophobia

3.3 3 3.2 0.316 0.014*

Watering 5.4 6 2.8 0.126 0.338

Redness 7.2 8 1.8 0.172 0.189

FB sensation

2.0 0 2.8 0.109 0.407

Decreased vision

1.4 0 2.7 0.182 0.164* Significant correlation

Results – Symptom score & Correlation with disease severity

– Multivariate analysisSymptom Coefficie

nt95% Confidence intervals

P values

Burning 0.062 -0.066-0.191 0.335Itching -0.080 -0.231-0.071 0.292Photophobia 0.102 -0.001-0.206 0.053Watering 0.030 -0.088-0.149 0.609Redness 0.012 -0.168-0.191 0.898FB sensation -0.015 -0.149-0.118 0.819Decreased vision

0.028 -0.095-0.151 0.652

• 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

Discussion

• 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.

Conclusions

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