Proposal And Validation Of A New Grading System For Pterygium (Slit2)

Background/aims To propose and validate a new pterygium grading system based on slit-lamp evaluation.Methods This prospective cross-sectional study included 217 patients with pterygium. All patients underwent slit-lamp examination, and slit-lamp photographs were independently graded by two graders twice. A total of eight parameters were evaluated and all parameters were assigned with a score of 1-4 (normal-severe). Intra-rater and inter-rater reliability as determined by weighted Cohen's kappa analysis.Results A total of 868 independent assessment, based on 217 slit-lamp images, were performed by two graders. For conjunctival assessment, the intra-rater reliability was excellent for body thickness (kappa=0.81-0.89) and size at limbus (kappa=0.87-0.92), substantial-to-excellent for body vascularity (kappa=0.72-0.86), and moderate-to-excellent for body length (kappa=0.57-0.81), whereas the inter-rater reliability was excellent for size at limbus (kappa=0.86), substantial for body thickness (kappa=0.72-0.73) and body vascularity (kappa=0.66-0.75), and moderate for body length (kappa=0.54-0.57). For corneal assessment, the intra-rater reliability was excellent for all four parameters (kappa=0.84-0.90) whereas the inter-rater reliability was excellent for head length (kappa=0.86-0.87), substantial-to-excellent for head vascularity (kappa=0.78-0.82), substantial for Stocker's line (kappa=0.79-0.80) and head thickness (kappa=0.67-0.69). The grading system was named SLIT2, which included SStocker's line, Size at limbus, Length of head/body, Injection/vascularity of body/head, and Thickness of body/head.Conclusion The proposed SLIT2 grading system, consisting of eight components, may serve as a reliable tool to standardise the reporting of pterygium severity and disease recurrence for clinical and research applications.