Introduction: The primary treatment for active thyroid eye disease (TED) is immunosuppressive therapy with intravenous steroids. In this study, we attempted to predict responsiveness to steroid treatment in TED patients using eXtreme Gradient Boosting (XGBoost). Factors associated with steroid responsiveness were also statistically evaluated.Methods: Clinical characteristics and laboratory results of 89 patients with TED who received steroid treatment were retrospectively reviewed. XGBoost was used to explore responsiveness to steroid treatment, and the diagnostic performance was evaluated. Factors contributing to the model output were investigated using the SHapley Additive exPlanation (SHAP), and the treatment response was investigated statistically using SPSS software.Results: The eXtra Gradient Boost model showed high performance, with an excellent accuracy of 0.861. Thyroid-stimulating hormone, thyroid-stimulating immunoglobulin (TSI), and low-density lipoprotein (LDL) cholesterol had the highest impact on the model. Multivariate logistic regression analysis showed that less extraocular muscle limitation and high TSI levels were associated with a high risk of poor intravenous methylprednisolone treatment response. As a result of analysis through SHAP, TSH, TSI, and LDL had the highest impact on the XGBoost modelConclusion: TSI, extraocular muscle limitation, and LDL cholesterol levels may be useful in predicting steroid treatment response in patients with TED. In terms of machine learning, XGBoost showed relatively robust and reliable results for small datasets. The machine-learning model can assist in decision-making for further treatment of patients with TED.

Park J, et al. J Korean Med Sci. 2020 Nov;36(1):e5. https://doi.org/10.3346/jkms.2021.36.e5

To determine the effects of synthetic bone glass particulate (BG) on the fibrovascular ingrowth that occurs in porous polyethylene orbital implants (PP). Forty-eight rabbits were divided into 4 groups, according to the different surgical techniques and implanted materials used. Group 1 was enucleated and implanted with PP, group 2 underwent evisceration and was implanted with PP, group 3 was enucleated and implanted with BG, and group 4 underwent evisceration and was implanted with BG. All of the implants in each group were histologically assessed at postoperative weeks 1, 2, 4, and 8. There was no statistically significant difference with regard to fibrovascular ingrowth in the 4 groups. A greater number of vessels per unit area and mature fibrous tissue were found in the outermost zone for a longer time after implantation, but we found no statistically significant differences among the 4 groups. We conclude that inclusion of synthetic bone glass particulate did not result in any significant increases in the rates of fibrovascular ingrowth in porous polyethylene orbital implants in rabbits.

Purpose: To evaluate the results of lower eyelid epiblepharon correction combined with skin redraping epicanthoplasty. Methods: The medical records of 17 consecutive patients who underwent a rotating suture technique combined with skin redraping epicanthoplasty for symptomatic bilateral lower eyelid epiblepharon were retrospectively reviewed. The outcomes evaluated included correction of cilia touch, surgical complications, recurrence, and subjective satisfaction. Results: All patients demonstrated satisfactory results during the 9.5 months of average follow-up. Recurrence and surgical complications, such as hypertrophic scar or lower eyelid crease formation, were not observed in any patient. Cosmetic results of the surgical intervention were considered satisfactory by all patients or their parents. Conclusions: This surgical technique is an effective method for the correction of coexistent epiblepharon and epicanthal fold without significant complications.

Kim NM, et al. Korean J Ophthalmol. 2010 Dec;24(6):325-330. https://doi.org/10.3341/kjo.2010.24.6.325

Background: We investigated the ocular manifestations in patients with Kabuki syndrome(KS). Methods: A retrospective chart review was performed in 10 patients with KS were referred to the Department of Ophthalmology for evaluation of ocular manifestations. Data were collected from patient interviews, clinical examinations, and laboratory investigations. Ophthalmologic examinations included best-corrected visual acuity, intraocular pressure, anterior segment, adnexal examination, and dilated fundus examination. Results: Mutations in the KMT2D gene were identified in all of the 10 patients with KS. No deletion or point mutation was found in the KDM6A gene. In our patients, 20% had ptosis, 60% had strabismus, 90% had lid changes and 10% had amblyopia. Five patients did not undergo the visual acuity test due to intellectual disability. Conclusions: Ophthalmic abnormalities are frequently associated with KS. The importance of ophthalmological examination in all patients with KS for early detection of ocular anomalies to prevent visual impairment cannot be underemphasized. Abbreviations: KS: Kabuki syndrome