Logistic Regression Classification of Primary Vitreoretinal Lymphoma versus Uveitis by Interleukin 6 and Interleukin 10 Levels.

PURPOSE: To assess the diagnostic performance and generalizability of logistic regression in classifying primary vitreoretinal lymphoma (PVRL) versus uveitis from intraocular cytokine levels in a single-center retrospective cohort, comparing a logistic regression model and previously published Interleukin Score for Intraocular Lymphoma Diagnosis (ISOLD) scores against the interleukin 10 (IL-10)-to-interleukin 6 (IL-6) ratio. DESIGN: Retrospective cohort study. PARTICIPANTS: Patient histories, pathology reports, and intraocular cytokine levels from 2339 patient entries in the National Eye Institute Histopathology Core database. METHODS: Patient diagnoses of PVRL versus uveitis and associated aqueous or vitreous IL-6 and IL-10 levels were collected retrospectively. From these data, cytokine levels were compared between diagnoses with the Mann-Whitney U test. A logistic regression model was trained to classify PVRL versus uveitis from aqueous and vitreous IL-6 and IL-10 samples and compared with ISOLD scores and IL-10-to-IL-6 ratios. MAIN OUTCOME MEASURES: Area under the receiver operating characteristic curve (AUC) for each classifier and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at the optimal cutoff (maximal Youden index) for each classifier. RESULTS: Seventy-seven lymphoma patients (10 aqueous samples, 67 vitreous samples) and 84 uveitis patients (19 aqueous samples, 65 vitreous samples) treated between October 5, 1999, and September 16, 2015, were included. Interleukin 6 levels were higher and IL-10 levels were lower in uveitis patients compared with lymphoma patients (P < 0.01). For vitreous samples, the logistic regression model, ISOLD score, and IL-10-to-IL-6 ratio achieved AUCs of 98.3%, 97.7%, and 96.3%, respectively. Sensitivity, specificity, PPV, and NPV at the optimal cutoffs for each classifier were 94.2%, 96.9%, 97%, and 94% for the logistic regression model; 92.7%, 100%, 100%, and 92.9% for the ISOLD score; and 94.2%, 95.3%, 95.6%, and 93.9% for the IL-10-to-IL-6 ratio. All models achieved complete separation between uveitis and lymphoma in the aqueous data set. CONCLUSIONS: The accuracy of the logistic regression model and generalizability of the ISOLD score to an independent patient cohort suggest that intraocular cytokine analysis by logistic regression may be a promising adjunct to cytopathologic analysis, the gold standard, for the early diagnosis of primary vitreoretinal lymphoma. Further validation studies are merited.

Cytomegalovirus retinitis complicating combination therapy with rituximab and fludarabine.

Cytomegalovirus (CMV) retinitis is exceptionally rare outside the clinical context of acquired immunodeficiency syndrome and organ allografting. In a population where seropositivity for past CMV infection exceeded 90 %, CMV retinitis was observed in five of 138 patients (3.6 %) receiving fludarabine-containing regimens together with rituximab, which was significantly more frequent than in 141 patients receiving fludarabine-containing regimens alone, where no case was observed (P = 0.029). Treatment of CMV retinitis comprised both intravitreal and systemic ganciclovir/foscarnet. Upon recovery, secondary retinal atrophy occurred in all patients, leading to blindness in 86 % of affected eyes. CMV retinitis is an important complication in patients receiving concomitant rituximab and fludarabine-containing regimens.

Occlusion therapy in amblyopia: an experience from Hong Kong.

OBJECTIVES. To review the results of patching for amblyopia management in Hong Kong. DESIGN. Retrospective case series. SETTING. Regional hospital, Hong Kong. PATIENTS. Records of all patients attending Paediatric Ophthalmology Clinic at United Christian Hospital, Hong Kong from 1 January 2009 to 31 March 2009 were retrospectively reviewed. Records of all children who underwent patching for amblyopia in the study period were evaluated. RESULTS. The mean age of 50 children (50 eyes) was 4 (standard deviation, 1; range, 2-7) years and mean pretreatment visual acuity was 0.35 (0.15; 0.02-0.63) [~20/60]. The values for mean, standard deviation, and range of treatment duration were 27, 16, 4-67 months respectively, and corresponding values for prescribed patching per day were 4, 1, 2-8 hours. The mean, standard deviation, and range of visual acuity at final post-treatment assessment were 0.66, 0.16, 0.1-1.0 (~20/30), respectively. The overall success rate (ie final visual acuity >0.7 or 20/30) was 62%. Children with moderate amblyopia (20/40-20/80) and severe amblyopia (20/100-20/400) had success rates of 74% and 55%, respectively. The mean visual acuity improvements for moderate and severely amblyopic children were 2.3 lines and 5.8 lines, respectively. The mean, standard deviation, and range of patching prescriptions for moderate and severely amblyopic children were 5, 1, 2-7 hours and 5, 1, 3-6 hours, respectively. Recurrence ensued in 7% of the children with moderate amblyopia and 46% of those with severe amblyopia. Reported compliance was good (>75% of the time) in 68% of the children. CONCLUSION. Occlusion therapy is the mainstay of treatment in Hong Kong. The overall success rate was comparable to that achieved in the Amblyopia Treatment Study. Recurrence was more common in patients with severe amblyopia, for whom maintenance therapy may reduce the risk of recurrence. The duration of treatment was much longer in our locality than in western countries. Reported compliance was suspicious possibly due to traditional cultural contexts. It is important to emphasise compliance to all parents.

Photorefractive keratectomy (PRK) versus laser assisted in situ keratomileusis (LASIK) for hyperopia correction.

BACKGROUND: Hyperopia, or hypermetropia (also known as long-sightedness or far-sightedness), is the condition where the unaccommodating eye brings parallel light to a focus behind the retina instead of on it. Hyperopia can be corrected with both non-surgical and surgical methods, among them photorefractive keratectomy (PRK) and laser assisted In situ keratomileusis (LASIK). There is uncertainty as to whether hyperopic-PRK or hyperopic-LASIK is the better method. OBJECTIVES: The objectives of this review were to determine whether PRK or LASIK leads to more reliable, stable and safe results when correcting a hyperopic refractive error. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2008), MEDLINE (January 1950 to January 2009), EMBASE (January 1980 to January 2009) and LILACS (January 1982 to January 2009). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 13 January 2009. We also searched the reference lists of the studies included in the review for information about further trials and used the Science Citation Index to search for papers that cite any studies included in this review. We did not handsearch journals or conference proceedings specifically for this review. SELECTION CRITERIA: We planned to include only randomised controlled trials (RCTs) comparing PRK against LASIK for correction of hyperopia and then perform a sensitivity analysis of pre- and post-millennial trials since this is the mid-point in the history of both PRK and LASIK. DATA COLLECTION AND ANALYSIS: We did not identify any studies that met the inclusion criteria for this review. MAIN RESULTS: As no studies met the inclusion criteria for this review, we discussed the results of non-randomised trials comparing hyperopic-PRK with hyperopic-LASIK. AUTHORS' CONCLUSIONS: No robust, reliable conclusions could be reached, but the non-randomised trials reviewed appear to be in agreement that hyperopic-PRK and hyperopic-LASIK are of comparable efficacy. High quality, well-planned open RCTs are needed in order to obtain a robust clinical evidence base.

Gradient Boosted Decision Tree Classification of Endophthalmitis Versus Uveitis and Lymphoma from Aqueous and Vitreous IL-6 and IL-10 Levels.

PURPOSE: To investigate the effectiveness of gradient boosting to classify endophthalmitis versus uveitis and lymphoma by intraocular cytokine levels. METHOD: Patient diagnoses and aqueous and vitreous levels of interleukin (IL)-6 and IL-10 were retrospectively extracted from a National Eye Institute Histopathology Core database and compared by Kruskal-Wallis and post hoc Dunn tests. A gradient-boosted decision tree classifier was trained to differentiate endophthalmitis versus uveitis and lymphoma from vitreous IL-6 and IL-10, vitreous IL-6 only, and aqueous IL-6 only data sets; and was tested with 80-20 train-test split and 3-fold cross-validation of the training set. RESULTS: Seven endophthalmitis, 29 lymphoma, and 49 uveitis patients were included. IL-6 was higher in endophthalmitis than uveitis (P = 0.0713 aqueous, 0.0014 vitreous) and lymphoma (P = 0.0032 aqueous, 0.0001 vitreous). IL-10 was significantly higher in lymphoma than uveitis (P = 0.0017 aqueous, 0.0014 vitreous). Three-fold cross validation demonstrated 95% ± 5%, 95% ± 4%, and 97% ± 5% predictive accuracy for vitreous IL-6 and IL-10, vitreous IL-6 only, and aqueous IL-6 only data sets. Upon validation with the testing set, vitreous IL-6 and IL-10 and aqueous IL-6 only data sets achieved 100% predictive accuracy and vitreous IL-6 only data achieved 93% predictive accuracy with 100% sensitivity, 92% specificity, and an area under the receiver operating characteristic curve (ROC/AUC) of 96%. CONCLUSIONS: With limited sample size, gradient boosting can differentiate endophthalmitis from uveitis and lymphoma by IL-6 and IL-10 with high sensitivity and specificity; however, a larger cohort is needed for further validation.

Higher order aberrations with aspheric ablations using the Nidek EC-5000 CX II laser.

PURPOSE: To analyze the change in higher order aberrations in myopic and myopic astigmatic eyes following an aspheric ablation profile for laser in situ keratomileusis (LASIK) using a Nidek EC-5000 CX II excimer laser system. METHODS: We performed a retrospective audit of 38 eyes (19 patients) with myopia and myopic astigmatism. A customized aspheric transition zone profile (CATz) was used in all eyes (profile 4) with an ablation zone of 5 mm and a transition zone of 9 mm using FinalFit software and a Nidek EC-5000 CX II excimer laser system. RESULTS: Mean higher order aberrations (RMS) increased from 0.42 microm at baseline to 0.57 microm at 6-month follow-up. Mean spherical aberrations (Z12) increased from 0.02 microm at baseline to 0.33 microm after LASIK. Mean spherical aberration defocus equivalent (DEQ) increased from 0.56 microm at baseline to 1.54 at 6 months after surgery. Mean trefoil (Z6) was -0.11 microm at baseline and -0.14 microm at the 3-month examination. Mean coma (Z7) was -0.09 microm at baseline and -0.10 microm after surgery. Mean coma (Z8) was -0.03 at baseline and 0 at the 3-month examination. Mean trefoil (Z9) was -0.03 at baseline and -0.12 at the 3-month examination. CONCLUSION: The amount of postoperative higher order aberrations in these myopic eyes was acceptable. However, the clinical significance of these numerical changes in aberrations is not known.

Correlation of Nidek OPD-Scan objective refraction with subjective refraction.

PURPOSE: The aim of this study was to quantify how closely the Nidek OPD-Scan objective refraction correlated with subjective refraction. METHODS: A retrospective audit of the preoperative refraction of 80 myopic and myopic astigmatic eyes before laser in situ keratomileusis (LASIK) or laser supepithelial keratomileusis (LASEK) was performed. Objective refraction in the 5-mm zone was performed using a Nidek OPD-Scan. Subjective refraction was performed by a senior optometrist. Statistical analysis of sphere, cylinder, and spherical equivalent refraction measurements was then performed. RESULTS: Spherical measurements correlated well with a linear regression equation, with a correlation coefficient of 0.97. Cylinder measurements correlated less well, with a correlation coefficient of 0.85. Spherical equivalent refraction measurements correlated well, with a correlation coefficient of 0.97. Analyzing the numerical difference between each objective refraction and its corresponding subjective refraction, the majority of values were only 0.50 D apart for sphere, cylinder, and spherical equivalent refraction. CONCLUSION: There was good correlation between objective OPD-Scan and subjective refraction, especially for sphere and spherical equivalent refraction measurements, with regression gradients and correlation coefficients close to 1.

Simultaneous spectral domain OCT and fundus autofluorescence imaging of the macula and microperimetric correspondence after successful repair of rhegmatogenous retinal detachment.

BACKGROUND/AIMS: To evaluate the ultrastructural changes in the macula after successful repair of rhegmatogenous retinal detachment (RRD) using simultaneous spectral domain optical coherence tomography (sdOCT) and fundus autofluorescence (FAF) imaging and to perform functional correlations with microperimetry. METHODS: Simultaneous sdOCT and FAF imaging were performed using a combined sdOCT-confocal scanning laser ophthalmoscope (cSLO) system. Microperimetry was performed in a subgroup of these patients. RESULTS: 17 patients with macular-on RRD and 20 with macular-off RRD were recruited. sdOCT images revealed disruption of the external limiting membrane, inner segment/outer segment junction or the Verhoeff membrane in 16 eyes (43.2%). The presence of any or more of these disruptions was significantly associated with a poor postoperative best-corrected visual acuity (BCVA) (p<0.001). Patients with abnormal FAF were also associated with poor postoperative BCVA (p<0.001). However, there was a generally poor correspondence between the localisation of ultrastructural abnormalities as detected by sdOCT and FAF changes. Areas of decreased microperimetric sensitivity corresponded well with the ultrastructural changes and abnormal FAF. CONCLUSIONS: FAF changes may lag behind ultrastructural changes in the OCT, some of which may reverse with the passage of time. The present study demonstrates the ultrastructural changes assessed with simultaneous FAF and sdOCT and their relation with visual outcome.