Classification Criteria for Syphilitic Uveitis

Abstract

Purpose: To determine classification criteria for syphilitic uveitis.

Design: Machine learning of cases with syphilitic uveitis and 24 other uveitides.

Methods: Cases of anterior, intermediate, posterior, and panuveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were analyzed by anatomic class, and each class was split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the different uveitic classes. The resulting criteria were evaluated on the validation set.

Results: Two hundred twenty-two cases of syphilitic uveitis were evaluated by machine learning, with cases evaluated against other uveitides in the relevant uveitic class. Key criteria for syphilitic uveitis included a compatible uveitic presentation (anterior uveitis; intermediate uveitis; or posterior or panuveitis with retinal, retinal pigment epithelial, or retinal vascular inflammation) and evidence of syphilis infection with a positive treponemal test. The Centers for Disease Control and Prevention reverse screening algorithm for syphilis testing is recommended. The misclassification rates for syphilitic uveitis in the training sets were as follows: anterior uveitides 0%, intermediate uveitides 6.0%, posterior uveitides 0%, panuveitides 0%, and infectious posterior/panuveitides 8.6%. The overall accuracy of the diagnosis of syphilitic uveitis in the validation set was 100% (99% confidence interval 99.5, 100)-that is, the validation set's misclassification rates were 0% for each uveitic class.

Conclusions: The criteria for syphilitic uveitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.

Figure 1.

Red-free fundus of a case of ocular placoid syphilis, demonstrating the placoid-appearing area of abnormality.

Figure 2.

Optical coherence tomogram of a case of ocular placoid syphilis, demonstrating the irregular appearance to the retinal pigment epithelium.

Figure 3.

Fundus photograph of necrotizing retinitis in a patient with ocular syphilis.

Figure 4.

Fluorescein angiogram of multifocal retinal/retinal pigment epithelium inflammation in a patient with ocular syphilis.

Figure 5.

Optical coherence tomogram of a case of multifocal retinitis in a patient with ocular syphilis, demonstrating multiple, variably sized areas of ellipsoid zone and outer retinal damage.