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Corneal staining patterns in vernal keratoconjunctivitis: the new VKC-CLEK scoring scale
  1. Andrea Leonardi,
  2. Daniela Lazzarini,
  3. Alvise La Gloria Valerio,
  4. Tania Scalora,
  5. Iva Fregona
  1. Ophthalmology Unit, Department of Neuroscience, University of Padua, Padua, Italy
  1. Correspondence to Dr Andrea Leonardi, Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua 35128, Italy; andrea.leonardi{at}


Aim To propose a new scoring system in the assessment of ocular surface epithelial damage in vernal keratoconjunctivitis (VKC).

Methods 25 consecutive patients with VKC (50 eyes) were evaluated using the Quality of Life in children with VKC (QUICK) questionnaire and objective clinical measures: fluorescein and lissamine green staining and cornea confocal microscopy (Heidelberg Retina Tomography 3). Oxford, Van Bljsterweld and a new system, the VKC-Collaborative Longitudinal Evaluation of Keratoconus study (CLEK) (VKC-CLEK) scores, were used to evaluate the epithelial damage after staining.

Results Mean Oxford and VKC-CLEK scores were significantly different after fluorescein staining (P<0.001), but significantly correlated (P<0.001; r=0.649). The same data were obtained comparing Van Bljsterweld and VKC-CLEK after lissamine green staining (P<0.001; r=0.760). In patient with limbal VKC, a statistically significant difference was found comparing new VKC-CLEK scores and Oxford or Van Bljsterweld scores (P<0.001), but not in tarsal VKC. A statistically superior concordance was found between QUICK and VKC-CLEK scores compared with standard staining scores values (P<0.001).

Conclusions Oxford and Van Bijsterveld scores are not adequate for the evaluation of the epithelial damage in patients with limbal VKC because the staining patterns considered for these tests do not correspond to the staining patterns in patients with VKC. We propose a new scoring system, VKC-CLEK, to better evaluate both limbal and tarsal epithelial damage in patients with VKC.

  • conjunctiva
  • cornea
  • inflammation
  • ocular surface

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  • Contributors Conception and design: AL, DL. Analysis and interpretation: AL, DL, ALGV, IF. Writing the article: AL, DL. Critical revision of the article and final approval of the article: all authors. Data collection; provision of materials, patients or resources: AL, DL, ALGV, TS. Statistical expertise: IF.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

  • Ethics approval Local Institution IRB, Padova University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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