Prognostic value of a classification and regression tree model in patients with open-globe injuries

Objective@#To evaluate the accuracy of the Classification and Regression Tree (CART) model in prognosticating visual outcomes of patients with open-globe injuries@*Methods@#This was a retrospective, single-center, cohort study of patients with open-globe injuries seen over a two-year period. Purposive sampling of hospital medical records was done to collect data from both in- and out-patient cases. The CART algorithm was utilized to determine the predicted visual outcome for each case, and the accuracy of prognostication was measured by computing for sensitivity, specificity, positive predictive value, and negative predictive value. The area under the receiver operating characteristic curve was used to check its discriminatory capability.@*Results@#A total of 65 eyes (65 patients) with the following diagnoses based on the Birmingham Eye Trauma Terminology (BETT) classification were included: penetrating eye injury (n=58), globe rupture (n=2), and intraocular foreign body (n=5). Majority were male patients (81.5%) in the 17-39 year age group (40%). The sensitivity and specificity of CART were 100% (95% CI 93.6 to 100%) and 77.8% (95% CI 40 to 97.2%), respectively, with an overall accuracy of 96.9% (95% CI 89.3 to 99.6%). Area under the curve (AUC) was statistically significant at 0.89 (95% CI 0.79 to 0.95), indicating that the CART model can discriminate vision survival versus no vision.@*Conclusion@#The CART model demonstrated high accuracy in prognosticating visual outcomes after an openglobe injury in the local setting. It may be used as a helpful tool to guide treatment decisions in open-globe injuries.

Methotrexate for sympathetic ophthalmia: A report of 3 cases

@#OBJECTIVE: To describe the visual and clinical outcomes of 3 patients with sympathetic ophthalmia treated with a combination of systemic steroids and methotrexate. METHODS: This was a small, descriptive case series. RESULTS: We reported 3 cases of post-traumatic sympathetic ophthalmia treated with steroids and methotrexate. Two patients had inciting eyes with no light perception on presentation, while one had a best-corrected visual acuity (BCVA) of counting fingers. The initial BCVA of the sympathizing eyes ranged from 20/20 to 20/50. Control of ocular inflammation was achieved using methotrexate (12.5 to 15 mg weekly) in addition to oral steroids and topical therapy. The final BCVA of the sympathizing eyes ranged from 20/20 to 20/30, indicating that good visual outcomes were attainable with steroids and methotrexate as part of the maintenance regimen. None of the patients developed adverse side-effects from methotrexate. CONCLUSION: This small case series demonstrated the effectiveness and safety of methotrexate for control of intraocular inflammation in sympathetic ophthalmia.

A review article on neuroretinitis

@#Neuroretinitis is an inflammatory optic neuropathy with a classic fundoscopic appearance of optic disc swelling and hard exudates on the macula in a star formation. It can be a manifestation of systemic, infectious or autoimmune disease. In nearly half of cases, the etiology is idiopathic. This review aims to summarize the clinical presentation, fundoscopic mimics, etiologies, investigation, and treatment of neuroretinitis. Cat-scratch disease, the most common cause of infectious neuroretinitis, and recurrent idiopathic neuroretinitis, which can cause ocular morbidity, are discussed in detail.