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evaluate the 3-point measurement (OCT-CET3) stemmed from our clinical observation that CET could vary within the central 2 mm zone in eyes with sectoral LSCD and the 1-point measurement (OCT-CET1) might not be as accurate.We showed that the inter-observer measurements of CET were highly consistent (<5% variation) between the 2 masked observers. We calculated the repeatability coefficient of OCT-CET1 and OCT-CET3 measurements to be 11.15 mm and 3.58 mm, respectively. The intraclass correlation coefficient of OCT-CET1 and OCT-CET3 was 0.859 and 0.985, respectively. These results support a higher degree of reliability and smaller measurement error of OCT-CET3 than OCT-CET1.Limit of Agreement (LOA) would be necessary if the purpose of the study was to establish OCT as a surrogate of a gold standard test. We did not consider IVCM as the gold standard for CET measurement but as a control. Nevertheless, we performed the analysis and found that LOA of OCT-CET1 was larger than that of OCT-CET3 (-11.96 6 11.61 mm vs -9.78 6 9.67 mm), which is consistent with the correlation analysis.The area under the receiver operator characteristics curve (AUC) of OCT-CET3 was evaluated in our study, which was higher than that of the maximum limbal epithelial thickness in all four limbal regions. The AUC of OCT-CET1 (0.932) and IVCM-CET (0.911) were smaller than that of OCT-CET3 (0.973), which supports our conclusion that OCT-CET3 is a reliable value of CET as a diagnostic parameter to confirm LSCD.We agree with Dr. Wan and colleague that appropriate statistical analyses is necessary to support the conclusion of all research. In depth knowledge of the subject of investigation and correct data acquisition are equally important in conducting a sound and meaningful study.

Direct leukemic infiltration of the eye is most frequently associated with acute lymphoblastic leukemia (ALL), probably due to its well-known central nervous system (CNS) tropism. Systemic treatment alone may not be sufficient for intraocular leukemia. Data on local treatment are scarce. Here, we present two cases of intraocular ALL treated with intravitreal methotrexate (MTX). Initially, anatomical improvement and visual stability were observed. The first patient experienced anatomical and visual worsening after a year of treatment. Treatment was withheld after 2 months for the second patient due to poor systemic conditions. Corneal toxicity and intraocular pressure elevation were observed in the first case. In both cases, eye involvement was associated with CNS or systemic relapse. This highlights the importance of incorporating ocular disease management in a comprehensive approach to therapy. Our experience corroborates previous findings on MTX injections as an effective and safe therapeutic option for intraocular leukemia. Further evidence is needed to consolidate the use of intravitreal MTX to treat such a debilitating localization of leukemia.

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