Application and validation of a novel inflammatory score in the clinical grading of infectious endophthalmitis: The endophthalmitis management study - Report 2.

This study was conducted to describe and validate a novel inflammatory score (IS) system in the management of infectious endophthalmitis. This was a prospective comparative non-interventional observational study. The study included the patients with clinical signs and symptoms of acute post-cataract surgery endophthalmitis (surgery within 6 weeks) with visual acuity from 6/18 to light perception. IS was scored by the clinical picture at two-levels of four ocular tissues on a scale of 0 (normal) to 4 (severe). Four masked graders of different levels of experience evaluated slit-lamp photographs. The concordance correlation coefficient was assessed between the slit-lamp clinical grading and photographic grading. We measured the concordance correlation coefficient, Pearson's correlation (indicating precision), and the bias correction factor (indicating the accuracy). The study included 43 eyes of 43 patients. The concordance correlation coefficient was 0.99 (95% CI 0.995 to 0.998). Both Pearson's correlation coefficient and the bias correction were 0.99. The interclass correlation coefficient (ICC) was measured. The intra-rater ICC was 0.833 with good agreement (95% CI, 0.711 to 0.906; P < 0.001). Inter-rater ICC for consistency was 0.92 (95% CI 0.87 to 0.95). Inter-rater ICC for absolute agreement was 0.86 (95% CI 0.66 to 0.93). Currently used IS scoring in the study is a reliable, reproducible, and easy-to-apply scale to measure inflammation severity in endophthalmitis. We propose that it can have applications in decision-making for primary treatment and monitoring progression in acute infectious endophthalmitis.

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