Clinical Severity Classification using Automated Conjunctival Hyperemia Analysis Software in Patients with Superior Limbic Keratoconjunctivitis

Figures & data

Table 1a. Number and characteristics of the subjects.

	SLK group	SS group	p-Value
No. of patients (eyes)	6	8
Age(mean±SD) (years)	61.0 ± 12.0	59.0 ± 13.6	0.495
Sex (male:female)	1:5	0:8	0.429
Background of dry eye disease
TBUT(mean±SD) (seconds)	2.60 ± 2.27	3.25 ± 1.30	0.278
Fluorescein score(mean±SD) (points)	4.80 ± 3.0	3.25 ± 2.11	0.152

SLK, superior limbic keratoconjunctivitis; TBUT, tear break-up time; SS, Sjögren syndrome; SD, standard deviation

Table 1b. Check list of objective finding scores for superior limbic keratoconjunctivitis.

Objective finding score	0	1	2
Papillary formation of the superior palpebral conjunctiva	No findings	Only papillary hyperplasia	Velvet-like papillary hyperplasia
Superior limbal swelling and hyperemia	No findings	Only hyperemia	Limbal swelling and hyperemia
Upper corneal epitheliopathy	No findings	Only SPK	SPK with filamentary keratitis

SPK, superficial punctate keratopathy.

Table 2. The clinical scores and SHI of patients in the SLK and SS groups categorized according to age, sex, and diagnosis.

Patient	Age (years)	Sex	Diagnosis	Clinical scores				SHI
				Papillary hyperplasia	Superior limbic	Corneal epitheliopathy	Total
SLK group
1	63	Female	Secondary SS	1	2	1	4	1.64
2	64	Female	Secondary SS	2	2	1	5	1.92
3	78	Female	Ocular pemphigoid	0	1	1	2	0.65
4	64	Male	GVHD	1	1	2	4	1.07
5	51	Female	Adult-onset Still’s disease	1	1	1	3	1.36
6	48	Female	Secondary SS	2	1	0	3	0.53
Median				1	1	1	3.5	1.22
SS group
1	77	Female	SS	0	1	1	2	0.79
2	66	Female	SS	1	1	2	4	0.50
3	66	Female	SS	1	1	2	4	0.82
4	65	Female	SS	1	0	1	2	0.52
5	76	Female	SS	1	0	2	3	1.08
6	45	Female	SS	1	1	0	2	0.93
7	37	Female	SS	1	1	0	2	0.28
8	58	Female	SS	1	1	0	2	0.60
Median				1	1	1	2	0.69

SHI, superior hyperemia index; SLK, superior limbic keratoconjunctivitis; SS, Sjögren syndrome; GVHD, graft versus host disease

Figure 1. Anterior photographs of a representative patient and the relationship between the clinical scores and superior hyperemia index (SHI).

a, b, and c: Slit-lamp photographs of the patient with superior limbic keratoconjunctivitis show that the patient’s eye scores one point each for papillary formation of the superior palpebral conjunctiva, superior limbal swelling and hyperemia, and superior corneal epitheliopathy.

d, e, and f: Relationship between the SHI and papillary formation of the superior palpebral conjunctiva (d), superior limbal hyperemia (e) and swelling, and superior corneal epitheliopathy (f). The SHI shows a tendency to indicate the severity of the superior limbal hyperemia and swelling score.

Table 3. Diagnostic usefulness of the superior hyperemia index (SHI).

	SHI
	≧1.0	<1.0	p-Value (Fisher’s exact test)
SLK group	4	2	0.036
SS group	1	7
Sensitivity	4/6 (66.7%)
Specificity	7/8 (87.5%)
PPV	4/5 (80.0%)
NPV	7/9 (77.8%)

SLK, superior limbic keratoconjunctivitis; SS, Sjögren syndrome; SHI, superior hyperemia index;

PPV, positive predictive value; NPV, negative predictive value