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Title: Grading fluorescein angiograms in malarial retinopathy
Authors: Ian J.C. MacCormick
Richard J. Maude
Nicholas A.V. Beare
Shyamanga Borooah
Simon Glover
David Parry
Sophie Leach
Malcolm E. Molyneux
Baljean Dhillon
Susan Lewallen
Simon P. Harding
University of Liverpool
Malawi-Liverpool-Wellcome Trust Clinical Research Programme
University of Edinburgh
Mahidol University
Nuffield Department of Clinical Medicine
University of Edinburgh, College of Medicine and Veterinary Medicine
Royal Liverpool and Broadgreen University Hospitals NHS Trust
Princess Alexandra Eye Pavilion
University of St Andrews, School of Medicine
Liverpool School of Tropical Medicine
Kilimanjaro Centre for Community Ophthalmology
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Dec-2015
Citation: Malaria Journal. Vol.14, No.1 (2015)
Abstract: © 2015 MacCormick et al. Background: Malarial retinopathy is an important finding in Plasmodium falciparum cerebral malaria, since it strengthens diagnostic accuracy, predicts clinical outcome and appears to parallel cerebral disease processes. Several angiographic features of malarial retinopathy have been described, but observations in different populations can only be reliably compared if consistent methodology is used to capture and grade retinal images. Currently no grading scheme exists for fluorescein angiographic features of malarial retinopathy. Methods: A grading scheme for fluorescein angiographic images was devised based on consensus opinion of clinicians and researchers experienced in malarial retinopathy in children and adults. Dual grading were performed with adjudication of admission fluorescein images from a large cohort of children with cerebral malaria. Results: A grading scheme is described and standard images are provided to facilitate future grading studies. Inter-grader agreement was >70 % for most variables. Intravascular filling defects are difficult to grade and tended to have lower inter-grader agreement (>57 %) compared to other features. Conclusions: This grading scheme provides a consistent way to describe retinal vascular damage in paediatric cerebral malaria, and can facilitate comparisons of angiographic features of malarial retinopathy between different patient groups, and analysis against clinical outcomes. Inter-grader agreement is reasonable for the majority of angiographic signs. Dual grading with expert adjudication should be used to maximize accuracy.
ISSN: 14752875
Appears in Collections:Scopus 2011-2015

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