title: Quantifying Ocular Surface Inflammation and Correlating It With Inflammatory Cell Infiltration In Vivo: A Novel Method.
abstract: OBJECTIVE
  The purpose of this study was to develop a novel, objective, and semiautomated method to quantify conjunctival redness by correlating measured redness with standard clinical redness and symptom scales and inflammatory cell infiltration.
  
  
  METHODS
  Eleven outpatients presenting with mild to severe conjunctival hyperemia were included in the study. Clinical examination included patient history; visual analogue score (VAS) for ocular symptoms; 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) for quality of life/vision; photographs of the anterior segment graded for conjunctival hyperemia, using Efron, relative redness of image (RRI), and edge feature (EF) scales; and conjunctival impression cytology analyzed by flow cytometry. Differences between affected and unaffected eyes were evaluated, and correlations among questionnaire scores, ocular hyperemia grading scores, and assessment of biological markers were performed.
  
  
  RESULTS
  Visual analogue score (P < 0.0001), Efron scale (P = 0.0003), RRI scores (P = 0.0004), and EF scores (P < 0.0001) and the percentage of granulocytes (defined as cluster of differentiation [CD] 45dim; P = 0.0080) were significantly higher in affected eyes. Conversely, the percentage of CD45bright leukocytes was reduced in affected eyes (P = 0.0054). Both the RRIs and EFs were positively correlated with VAS, Efron scale, percentages of conjunctival granulocytes, and CD45brightCD3neg cells, whereas they were negatively correlated with the percentage of CD45brightCD3pos cells. Edge feature and RRI were correlated (Spearman r = 0.78, P < 0.0001).
  
  
  CONCLUSIONS
  Ocular redness is a cardinal sign driving clinical judgment in highly prevalent ocular disorders; hence, we suggest that our semiautomated and reproducible method may represent a helpful tool in the follow-up of these patients. Italian Abstract.
authors.affiliation: Cornea and Ocular Surface Disease Unit Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Ferrari
authors.affiliation: Cornea and Ocular Surface Disease Unit Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rabiolo
authors.affiliation: Cornea and Ocular Surface Disease Unit Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Bignami
authors.affiliation: Flow Cytometry Resource Advanced Cytometry Technical Applications Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy 3Flow Cytometry Core Facility, Nestlè Institute of Health Sciences, Lausanne, Switzerland.
authors.forename: Federico
authors.initials: F
authors.lastname: Sizzano
authors.affiliation: Flow Cytometry Resource Advanced Cytometry Technical Applications Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy 3Flow Cytometry Core Facility, Nestlè Institute of Health Sciences, Lausanne, Switzerland.
authors.forename: Alessio
authors.initials: A
authors.lastname: Palini
authors.affiliation: Flow Cytometry Core Facility, Nestlè Institute of Health Sciences, Lausanne, Switzerland.
authors.forename: Chiara
authors.initials: C
authors.lastname: Villa
authors.affiliation: Cornea and Ocular Surface Disease Unit Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rama
mesh_terms: D000328:Adult; D000368:Aged; D003228:Conjunctiva / Q000473:pathology*; D003231:Conjunctivitis / Q000473:pathology*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index