[Reproducibility of the classification of ocular ferning patterns in Sjogren's syndrome patients].
OBJECTIVE
To verify the reproducibility of Rolando's classification of the tear ferning test using five different examiners and to compare the patterns of crystallization found in Sjögren's syndrome patients and normal subjects.


METHODS
Tear ferning analysis of 29 patients with Sjögren's syndrome and of 45 patients without ocular disease were done using polarized light microscopy and the Rolando classification for tear ferning. Five examiners classified the ferning patterns of all the patients. ROC curve (Receiver Operating Characteristic) was used to find out the best score for the correct syndrome diagnosis. Kappa index (p<0.0001) was used to compare the results of the examiners among them and check the test's reproducibility. Charts were drawn to compare the two groups' results.


RESULTS
Throught the ROC curve the score of 2.50 for diagnosis of Sjögren's syndrome was stablished. Considering the aggregated patterns I with II and III with IV, the examiners' level of pattern agreement was excellent (Kappa ranging from 0.82 to 0.97, p<0.0001). The group with Sjögren's syndrome was classified mostly as patterns III and IV and the patients without ocular disease mostly as I and II.


CONCLUSIONS
The patterns associated with Sjögren's syndrome and normal patients matched the ones in the literature. The tear ferning test classification is reproductible when the Rolando classification was used for Sjögren's syndrome patients.
Felberg
Sergio
S
Setor de Córnea e Doenças Externas, Departamento de Oftalmologia, Santa Casa de Misericórdia de São Paulo, SP, Brasil. sergiofelberg@oftalmosantacasa.com.br
Cordeiro
Hamilcar
H
Sato
Elcio Hideo
EH
Martini Filho
Dino
D
Nishiwaki-Dantas
Maria Cristina
MC
Endo
Roberto Mitiaki
RM
Dantas
Paulo Elias Correa
PE
D000328:Adult; D000368:Aged; D003460:Crystallization / Q000145:classification; D003941:Diagnostic Techniques, Ophthalmological; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012859:Sjogren's Syndrome / Q000175:diagnosis*; D013666:Tears / Q000737:chemistry*