Research Papers – Plastic Surgery & Dermatology
OBJECTIVE: To evaluate implant and prosthesis movement after myoconjunctival enucleation and subsequent polymethyl methacrylate (PMMA) implantation, compared with the traditional enucleation with muscle imbrication using a PMMA implant and with enucleation accompanied by porous polyethylene implantation. DESIGN: Randomized, controlled, observer-masked, interventional study. PARTICIPANTS: One hundred fifty patients, equally and randomly allocated to the 3 groups. INTERVENTION: Group 1 consisted of patients in whom a PMMA implant was used after enucleation with muscle imbrication (traditional PMMA group). Group 2 consisted of patients in whom a PMMA implant was used after enucleation with a myoconjunctival technique (myoconjunctival PMMA group). Group 3 consisted of patients in whom a porous polyethylene implant was used after enucleation by the scleral cap technique (porous polyethylene group). Fifty patients were included in each group. Patients were allocated to 1 of the 3 groups using stratified randomization. Informed consent was obtained. Acrylic prostheses custom made by a trained ocularist were fitted 6 weeks after surgery in all patients. A masked observer measured implant and prosthesis movement 6 weeks after surgery using a slit-lamp device with real-time video and still photographic documentation. Analysis of implant and prosthesis movement was carried out using the Mann-Whitney U test, and a P value of
We are reporting a case of recalcitrant fungal tunnel infection treated with intrastromal injection of voriconazole. A 50-year-old woman underwent an uneventful phacoemulsification through a temporal corneal tunnel incision for age-related cataract in her right eye. One month post-surgery, she developed tunnel infection. Microbiological investigations revealed Aspergillus flavus as the offending pathogen. Despite intensive medical treatment, the corneal and anterior chamber infiltrate progressively enlarged. At the end of three and a half weeks, 0.1 ml of 0.05% voriconazole was injected intra-stromally surrounding the central end of the corneal infiltrate. On the subsequent follow-ups, a gradual improvement was noted and slowly it resolved completely. Topical therapy along with a judicious use of intrastromal administration of antifungal drugs may be of immense benefit in such cases prior to embarking on the surgical treatment.
Abstract An unusual case of vernal shield ulcer with superadded fungal keratitis caused by Aspergillus fumigates is reported. A 26-year-old man, a known case of vernal keratoconjunctivitis (VKC) presented with the complaint of diminution of vision in the right eye. Patient was on topical steroids and anti-allergic treatment for the past two months. In the right eye, a shield ulcer with an elevated plaque was seen. Scrapings from the right cornea revealed fungal filaments on a wet KOH mount and culture revealed growth of Aspergillus fumigatus. The patient was diagnosed as VKC with shield ulcer with secondary fungal keratitis. The patient was treated with topical cyclosporine, topical moxifloxacin, topical natamycin, and topical amphotericin eye drops. The patient responded well and finally recovered to a best spectacle-corrected visual acuity of 20/20 at the end of nine months. The chronic ocular surface changes and induced inflammation in VKC, and the instillation of topical steroids for therapy, may create an environmental milieu favorable for fungal keratitis. Microbiological evaluation should be considered, even in cases of suspected sterile keratitis, to prevent possible worsening of an associated infective corneal condition. This warrants patient education, periodic reviews and a very cautious approach to indiscriminate use of topical corticosteroids in cases of VKC with shield ulcer. In the event of any secondary fungal infection, use of steroid sparing topical agent, for example cyclosporine may be considered.
G, Ingle A, Sarin R, Banavali S, Dikshit R, Jain V, Honavar SG, Bellare J.
Purpose: To compare intravitreal concentration (VC) of commercially available carboplatin (CAC) & novel nanomolecule carboplatin (NMC), following periocular injection. Design: Experimental,comparative, animal study. Participants: Twenty-four white Sprague-Dawley rats. Intervention: CAC was bound with a nanoparticulate carrier by co-acervation with a bio-compatible & biodegradable protein BSA (bovine serum albumin). The particulate size, binding and tructure of the carrier was analyzed with dynamical light scattering, electron microscopy, FTIR spectroscopy & SDS gel electrophoresis. Twenty-four white rats were anaesthetized. The right eye of each rat was injected with periocular CAC (1 ml) & the left eye with NMC (1 ml) by a trained ophthalmologist. Four mice each were euthanized at days 1, 2, 3, 5, 7, 14 & 21 & both eyes enucleated. The intra-vitreal concentrations of commercial carboplatin & that of nano-molecule carboplatin were determined with HPLC (high performance liquid chromatography). Analysis of data was done with the paired t test. Main Outcome Measure: Intravitreal concentrations CAC & NMC over time. Results: The NMC vitreal concentration was higher than the CAC concentrations in all animals, until day 7 (P = 0.0001). On days 14 and 21, the CAC vitreal concentration was higher than the NMC concentrations in all animals (P = 0.0002). Overall, the mean vitreous concentration of NMC was greater than CAC. Conclusion: Nano-particulate bound carboplatin has greater transscleral transport than commercially available carboplatin, especially in the first week. This may help enhance the proven adjuvant efficacy of periocular carboplatin over and above systemic chemotherapy in treating human retinoblastoma, especially those with vitreous seeds
Natarajan S. The purpose of this study was to report our experience of an attempted Descemet’s stripping automated endothelial keratoplasty (DSAEK) in a patient with congenital hereditary endothelial dystrophy (CHED). A 7-year-old boy presented with the complaints of decreased vision in his right eye. The left eye had undergone penetrating keratoplasty at the age of 5 years. He was diagnosed as a case of CHED, and a DSAEK was planned for him. Due to technical difficulties during Descemet’s membrane scoring and stripping and poor visualization, the procedure had to be abandoned and converted to a full thickness penetrating keratoplasty. To the best of our knowledge, this is the first reported case of an attempted DSAEK in a patient with CHED. Proper DSAEK case selection should include adequate visualization of the endothelium and anterior chamber. Severe stromal haze and edema may prevent necessary surgical observation during the procedure, and a full thickness penetrating keratoplasty may be required.
In order to report fungal keratitis in patients of ocular rosacea, a retrospective review of all cases of fungal keratitis was undertaken. Cases in which ocular rosacea coexisted were identified and included in the study. The clinical course of patients thus identified was studied from the medical records and outcomes were evaluated. A total of three cases of fungal keratitis with coexisting ocular rosacea were identified. All three patients were known cases of acne rosacea with an intermittent, irregular treatment for the same. Previous history of contact lens use, ocular surgery or trauma was not present in any of the cases. Microbiological evaluation revealed Aspergillus flavus as the causative organism in two patients and an unidentified hyaline fungus in the third. Patients received simultaneous therapy for fungal keratitis and ocular rosacea. The ocular surface completely stabilized and the infiltrate resolved in all three cases. The chronic ocular surface changes and induced inflammation in ocular rosacea, along with the instillation of topical steroids for therapy, may create an environmental milieu favorable for fungal keratitis. Microbiological evaluation should be considered, even in cases of suspected sterile keratitis, prior to treatment with topical steroids, so as to prevent the possible worsening of an associated infective corneal condition.
BACKGROUND: Prostaglandin E2 (PGE2) has stimulant and immunomodulatory effects on melanocytes and regulates their proliferation. OBJECTIVES: To study the efficacy and safety of topical PGE2 in treating stable vitiligo patches involving <5% body surface area. METHODS: Fifty-six consecutive patients with clinically diagnosed stable vitiligo of types vulgaris, focal, segmental, lip and genital applied a translucent PGE2 (0.25 mg g(-1)) gel twice daily for 6 months. Evaluation was fortnightly for 3 months and monthly thereafter up to 6 months. Assessment was based on degree of repigmentation in treated patches ranging from 0% (no change) to 100% (complete repigmentation). Overall response was graded as: poor, 1-25% repigmentation; moderate, 26-50%; good, 51-75%; excellent, >75%. RESULTS: Vitiligo vulgaris was the most common type (n=22; 39%), followed by focal and lip vitiligo, with lesions being mostly on the face (25%) and lips. Repigmentation was seen in 40 of 56 patients (71%), with mean onset at 2 months. Patients with disease duration of 6 months or less repigmented best, with face and scalp responding earliest (1-1.5 months). Complete clearance occurred in eight of 40 patients, six of the eight having face lesions. Excellent response was seen in 22 of 40 patients. All neck, scalp and trunk lesions, 33% genital, 29% lip vitiligo, 100% segmental and 63% focal patches showed moderate to excellent response. Incidence of side-effects was 18%, mainly a transient burning sensation especially on the lips. CONCLUSIONS: The efficacy and safety of topical PGE2 make it a promising therapy for localized stable vitiligo.
PURPOSE OF REVIEW: The goal of this review is to update
ophthalmologists and orbital and adnexal specialists with the emerging
role of targeted monoclonal antibody therapy and radioimmunotherapy for
orbital and adnexal non-Hodgkin’s lymphoma and other
lymphoproliferative disorders of the orbit. RECENT FINDINGS: Rituximab
as monotherapy for indolent lymphoma of the orbit and conjunctiva may
be associated with good initial response, but the risk of distant
relapse is about 50%. Rituximab may be used in combination with
conventional chemotherapy, and such combination therapy may be
associated with a higher durable response rate and improved
progression-free survival compared with chemotherapy alone.
Radioimmunotherapy using targeted monoclonal antibodies with
radioactive conjugates is also associated with a more durable response
rate than monotherapy with rituximab alone and may be an alternative
for treatment of ocular adnexal lymphoma. Radioimmunoconjugates are
associated with transient pancytopenia during the first 3 months after
treatment. Rituximab monotherapy may be considered as an alternative to
systemic steroids for treatment of orbital benign lymphoid hyperplasia.
SUMMARY: Targeted monoclonal antibody therapy is an intriguing new
modality for treatment of orbital, eyelid, or conjunctival lymphoma and
can be used in combination with radioimmunotherapy or standard
chemotherapy for a more durable response.
Honavar S, Selva D.
PURPOSE: To provide an up-to-date review of the clinical presentations,
investigations, and management of orbital tuberculosis (OTB). METHODS:
Systematic review of the literature concerning OTB, limiting the
results to English-language peer-reviewed journals. RESULTS:
Seventy-nine patients from 39 publications were identified as cases of
OTB. The condition presents in one of five forms: classical
periostitis; orbital soft tissue tuberculoma or cold abscess, with no
bony involvement; OTB with bony involvement; spread from the paranasal
sinuses; and tuberculous dacryoadenitis. The ocular adnexa, including
the nasolacrimal system and overlying skin, may also be involved.
CONCLUSIONS: Diagnosis can be difficult and may necessitate an orbital
biopsy, in which acid-fast bacilli (AFB) and characteristic
histopathology may be seen. Growth of Mycobacterium tuberculosis (mTB)
from such a specimen remains the gold standard for diagnosis. Ancillary
investigations include tuberculin skin tests and chest radiography, but
more recently alternatives such as whole blood interferon-gamma
immunological tests and PCR-based tests of pathological specimens have
proven useful. The management of OTB is complex, requiring a stringent
public health strategy and high levels of patient adherence, combined
with long courses of multiple anti-tuberculous medications. The
interaction of the human immunodeficiency virus (HIV) with TB may
further complicate management.
PURPOSE: To report a case of surgically induced necrotizing scleritis
(SINS) as a complication of conjunctival autograft after pterygium
excision. METHODS: A 52-year-old man had undergone nasal pterygium
excision with conjunctival autograft in the right eye at another
facility. He was treated for suspected infective scleritis before
presentation. RESULTS: The sclera, at the site of prior pterygium
excision, showed significant thinning with uveal show. There was active
inflammation adjacent to the site of thinning. Systemic studies and the
examination were noncontributory. The patient was suspected of having
SINS and received pulsed injections of methylprednisolone 1000 mg/d for
3 days. The patient also underwent an emergency scleral patch graft
with amniotic membrane graft. Over the next 2 weeks, the scleral graft
showed vascularization and was taken well. CONCLUSIONS: SINS may
develop after pterygium surgery with conjunctival autograft. Evidence
of connective tissue disease may or may not be found on clinical
examination and on laboratory studies. Early diagnosis, prompt
immunosuppression, and scleral patch grafting prevents progression and
further devastating complications.
We report a 25-year-old systemically healthy male who presented with
periocular necrotizing fasciitis (NF) in the left eyelid. This was
associated with the presence of immunologically mediated marginal
kerato-conjunctivitis, in the same eye. This potentially dangerous lid
infection and the associated ocular surface infection resolved
successfully, with medical management. We report this case to highlight
the successful conservative management of periocular NF and the
hitherto unreported anterior segment involvement.
PURPOSE: To report a case of nevirapine-induced Stevens-Johnson
syndrome (SJS) misdiagnosed as viral keratitis. METHODS: A 35-year-old
AIDS patient, on antiretroviral therapy (ART) with stavudine,
nevirapine, and lamivudine, developed bilateral ocular congestion and
irritation. He was being treated elsewhere for bilateral herpetic
epithelial keratitis. On progressive worsening of symptoms, he
presented with complaints of severe photophobia and foreign-body
sensation in both eyes. RESULTS: The patient’s history was evaluated in
detail. The patient had apparently been on multidrug ART until he
developed SJS 3.5 months ago. Nevirapine was subsequently discontinued.
No ophthalmologic opinion was sought until a month before. He was
diagnosed and was treated for bilateral herpetic epithelial keratitis
for 1 month. Ocular surface examination revealed bilateral severe dry
eyes, with multiple corneal erosions. The inferior fornices showed
cicatricial bands. The patient was suspected to have SJS-induced dry
eyes, with associated epithelial defects. The epithelial defect edges
were debrided and subjected to viral cell culture and polymerase chain
reaction for herpes simplex. The patient was started on hourly
preservative-free tear substitutes. Amniotic membrane transplantation
(as a patch graft) was performed. A successful response to therapy
within 10 days, along with a negative viral culture and polymerase
chain reaction report, confirmed our diagnosis. CONCLUSIONS:
Ophthalmologists need to be aware of the high risk of development of
ocular adverse reactions in AIDS patients on ART before ascribing the
ocular symptoms to more severe opportunistic infections.
A 41-year-old woman was examined for left upper eyelid retraction.
Remaining ocular and systemic examination was unremarkable. Orbital CT
demonstrated an ill-defined, extraconal, superior orbital soft-tissue
mass involving the levator palpebrae superioris muscle. Incisional
biopsy with histopathology demonstrated idiopathic orbital
inflammation. The patient was started on a gradually tapering dose of
oral steroids, for 6 weeks. On follow-up, the eyelid retraction had
resolved. We report this case to demonstrate that idiopathic
inflammatory orbital disease, localized to the superior orbit, may
cause isolated upper eyelid retraction without associated proptosis.
This condition resolves with medical therapy, leading to symmetrical
PURPOSE: To report a case of chronic keratouveitis caused by a missed
bee sting injury. METHODS: A 17-year-old boy was referred for
management of unresponsive viral keratouveitis. Ocular examination
revealed corneal edema and scarring, atrophic patches on the iris, and
anterior polar cataracts. Surprisingly, examination also revealed a
retained intracorneal bee stinger. A retrospective inquiry confirmed a
bee sting injury 2 years ago. RESULTS: The patient was started on
medical treatment and underwent operative removal of the bee stinger.
Postsurgery, visual acuity improved, and the corneal edema regressed
over a 1-month follow-up. CONCLUSIONS: In cases of chronic
keratouveitis, a meticulous examination is mandatory to rule out
unusual causes like a retained corneal bee stinger. A retained
intracorneal bee stinger may result in long-term corneal inflammation,
which may not be controlled adequately with topical steroids. It should
be removed, irrespective of the duration since the injury.
We report a case of a 55-year-old male patient with breast carcinoma,
who developed choroidal metastasis. The patient had undergone
mastectomy for carcinoma of right breast, five years ago. The patient
was advised close follow-up for the left eye, as he was already on
tamoxifen therapy (started a month ago) for spinal metastasis. On last
follow-up, a year later, the choroidal lesion had completely scarred,
with no recurrences. Systemic hormonal therapy like tamoxifen given for
the breast primary and other systemic metastases may cause regression
of the choroidal metastasis, thereby avoiding ocular radiotherapy.
Medline search revealed only one published case of regression of
choroidal metastasis from a male breast primary, on tamoxifen therapy.
We report a case of a 52-year-old female patient who developed
overcorrection, due to brow overuse, post surgery for bilateral
aponeurotic ptosis. The patient had undergone levator palpebrae
superioris plication bilaterally. Due to brow overuse habituated by
long standing ptosis, the patient presented with superior scleral show,
post ptosis surgery. The lid contour was normal in both eyes and when
brow overaction was blocked mechanically, the palpebral fissure heights
were normal, comparable, with no scleral show bilaterally. Despite
repeated instructions, when the patient continued brow overuse
subconsciously, an injection of botulinum toxin was given just above
both brows. This led to elimination of brow overuse within a month,
with elimination of superior scleral show. The patient maintained lid
and brow symmetry with no overaction, eight months post injection.
PURPOSE: To report a case of Aspergillus flavus-induced keratomycotic
malignant glaucoma. METHODS: A 48-year-old woman presented with a
severe corneal ulcer. She had received topical steroids for 10 days
before presentation. RESULTS: Microbiological studies revealed A.
flavus as the offending pathogen. Nonresponsive high intraocular
pressure with associated shallow anterior chamber was present. With a
diagnosis of keratomycotic malignant glaucoma, the patient underwent
therapeutic keratoplasty with cataract extraction with posterior
chamber wash. However, there was a recurrence of malignant glaucoma in
the postoperative period. Patient underwent limited pars plana
vitrectomy. CONCLUSIONS: Keratomycotic malignant glaucoma is a rare
complication of severe fungal ulcer. We believe that the use of topical
steroids in this case probably led to increased fungal penetration,
with the formation of a lens-iris fungal mass and subsequent malignant
glaucoma. Nonresponse to medical therapy warrants urgent surgical
intervention. To the best of our knowledge, Aspergillus-induced
keratomycotic glaucoma has never been reported previously. This report
also highlights that therapeutic keratoplasty with cataract extraction
alone may not be sufficient for management of such cases, and a limited
pars plana vitrectomy may be needed.
H, Mehta H, Jayadev C, Borse N.
AIM: To describe the results of a combined procedure including
phacoemulsification, insertion of posterior chamber intraocular lens
(PCIOL) and pars plana vitrectomy (PPV) in eyes with vitreoretinal
pathology and coexisting significant cataract. DESIGN: Retrospective,
consecutive, noncomparative, interventional case series. MATERIALS AND
METHODS: Medical records of patients who had undergone
phacoemulsification, PPV and PCIOL implantation as a combined procedure
between January 2000 and December 2004 were retrospectively reviewed.
The main outcome measures were the anatomical success of retina,
defined as reattached retina, intraoperative and postoperative
complications and functional success in terms of final best corrected
visual acuity. RESULTS: In all, 65 eyes of 64 patients were included.
The mean age of the patients was 50.9 years +/- 17.1 (range, five to 82
years). Vitreous hemorrhage with or without retinal detachment (19
eyes, 29.2%) was the most common indication for the vitreoretinal
procedure. Primary anatomical success of retina was achieved in 59 eyes
(90.7%). Visual acuity improved in 48 eyes (73.8%), was unchanged in 12
eyes (18.5%) and deteriorated in five eyes (7.7%). Postoperative
inflammation was significantly more in the subgroup of previously
vitrectomized eyes (42%) (P =0.014, Fisher exact test) compared to
those which underwent primary vitrectomy. CONCLUSIONS: Combined surgery
is a feasible option for patients with vitreoretinal diseases and
A 20-month-old child with systemic features of neurofibromatosis type 1
presented with sudden-onset proptosis. Biopsy and histopathology
confirmed the diagnosis of an embryonal rhabdomyosarcoma. The tumor
regressed completely with chemotherapy and external beam radiotherapy.
This case highlights the association of rhabdomyosarcoma with
neurofibromatosis type 1.
We report three cases of renal cell carcinoma metastatic to the eye and
orbit and review the relevant literature. The case reports of a
67-year-old man, a 58-year-old man, and a 23-year-old woman with
metastatic renal cell carcinoma are described. The iris mass occurred
in a 67-year-old man, a known case of renal cell carcinoma. Whereas the
orbital metastasis in the 58-year-old man was the initial presenting
sign in a hitherto undiagnosed patient, the orbital metastasis in the
23-year-old female patient was detected following nephrectomy for renal
cell carcinoma. Renal cell carcinoma metastasizing to the eye and orbit
are very rare, with only 68 cases reported previously. In patients
presenting with atypical orbital or ocular masses, the possibility of
renal cell carcinoma metastasis should be considered, especially if
there is a history of previous renal disorder. Incisional biopsy with
histopathological evaluation may be an important means to diagnose this
condition and facilitate appropriate therapy.
Implant and prosthetic motility are key aspects of good cosmesis in an
anophthalmic socket. Various techniques have been attempted to improve
implant and prosthesis motility. However, the attempts at comparing
these techniques are incomplete without a simple, objective,
reproducible method of motility measurement. We describe a novel,
simple, inexpensive, custom-made slit-lamp measurement device and a new
technique to measure implant and prosthetic motility objectively for
documentation. To the best of our knowledge, no such device or method
has been documented or described in the literature.
PURPOSE: To report an unusual, spectacle-related injury. METHODS: A
16-year-old boy wearing spectacles with polycarbonate lenses presented
with an unusual, spectacle-related injury. Impact with the ball during
a ball sport (cricket) led to extreme torsion of the frame with
resultant direct blunt trauma to the right eye by the spectacle arm. On
examination, the patient had a 10 x 10-mm area of conjunctivalized
scleral dehiscence superiorly in Zones 2 and 3, with uveal prolapse.
Superior retinal detachment was also noted. RESULTS: Patient underwent
wound repair with a scleral patch graft with transscleral cryotherapy
and sulfur hexafluoride injection. CONCLUSION: Although increased
impact resistance of newer spectacle lens materials is assumed to
reduce the incidence of ocular trauma, such unusual mechanisms may
still lead to severe ocular trauma. We report this case to highlight an
unusual mechanism of spectacle injury, hitherto unreported, and to show
the continued need for use of eye protection while wearing spectacles.
A 60-year-old woman with no known systemic disease was referred with a
hard mass in the left orbit and enophthalmos of two months duration.
Differential diagnoses of metastasis from an undetected scirrhous
carcinoma and sclerosing nonspecific orbital inflammatory disease were
considered and a biopsy was performed. Histopathology demonstrated
granulomatous inflammation with fibrosis. Subsequent polymerase chain
reaction was positive for Mycobacterium tuberculosis deoxyribonucleic
acid. There was no evidence of systemic tuberculosis. The patient was
treated with four-drug combination anti-tubercular therapy for 6
months. The mass regressed and there was no local recurrence at two
years follow-up. Orbital tuberculosis generally manifests with
proptosis or osteomyelitis. However, enophthalmos may be caused by the
fibrosing variant. Biopsy with histopathologic and microbioloic
evaluation is essential to distinguish it from other more common causes
of an orbital mass with paradoxical enophthalmos such as metastatic
scirrhous carcinoma and sclerosing nonspecific orbital inflammatory
PURPOSE: To describe the preoperative characteristics, intraoperative
details, management, and postoperative in patients with bilateral
epithelial defects after laser in situ keratomileusis (LASIK). METHODS:
Retrospective non-comparative case series. RESULTS: Six patients with
bilateral epithelial defects after LASIK were part of a cohort of 605
patients undergoing bilateral LASIK at our center from December 2001 to
April 2003. The mean age of the patients (5M:1F) was 28.5 +/- 7.9
years, and the average pretreatment myopic spherical equivalent (SE)
refraction was 7.3 +/- 0.7 D (-4, -12.25D). An epithelial flap was
present in 6 eyes and an epithelial defect with a mean diameter of 3 mm
(2mm, 6mm) was seen in 6 eyes. In four patients the epithelial
disturbance was bilaterally similar. All defects occurred in the
inferior cornea and the epithelial flaps had the hinge positioned
superiorly. None of the patients had ocular or systemic risk factors
that could have resulted in this complication. A bandage contact lens
was used in 6 eyes. At last follow-up of 5.5 +/- 9.5 months (0.25, 21
months), unaided visual acuity was 6/9 or better in 10 eyes. Best
spectacle-corrected visual acuity (BSCVA) was maintained in 8 eyes,
while 4 eyes lost one line of BSCVA. Recurrent corneal erosions were
not reported in the follow-up period. CONCLUSIONS: These patients
represent a hitherto unrecognised group of individuals who appear to
have a subclinical weakness of adhesion of the corneal epithelium to
the underlying structures, which is not evident on clinical
examination. This results in bilateral epithelial disturbances after
LASIK. Appropriate management results in satisfactory clinical
outcomes. Other options for treatment of the fellow eye of such
patients include the use of a different microkeratome, release of
suction during the reverse pass of the Hansatome microkeratome, and
photorefractive keratectomy if the refractive error is low.
Krishnakumar S, Biswas J, Noronha OV.
A thrombosed varix in the orbit is comparatively rare. Clinical
examination alone is often inadequate for diagnosis. Radio-logical
examination, such as a computed tomography (CT) scan of the orbit, is
extremely important. Histopathological examination (HPE) after excision
biopsy can confirm the diagnosis. The present authors describe a case
of proptosis in the left eye of a 45-year-old man. CT-scan and HPE
supported the diagnosis of a thrombosed orbital varix. This paper
discusses the use of radiological investigations to supplement a
clinical suspicion and make the diagnosis. This entity needs to be
included in the differential diagnosis of proptosis and requires a
coordinated approach for establishment of the diagnosis.
PURPOSE: Disseminated tuberculosis occurs due to the hematogenous
spread of pulmonary tuberculosis systemically. Polymerase chain
reaction (PCR) of various body fluids has been found to be beneficial
in the diagnosis of disseminated tuberculosis, including intraocular
tuberculosis. We describe the role of PCR of the aqueous aspirate in a
case of disseminated tuberculosis involving the choroid. METHODS:
Single-step PCR fusing primers coding for the IS6110 gene and nested
PCR (nPCR) for the detection of the MPB64 gene were performed on the
aqueous aspirate in a case of disseminated tuberculosis with miliary
involvement of the choroid. RESULTS: On PCR, the aqueous aspirate
showed the Mycobacterium tuberculosis genome, thereby confirming the
diagnosis of intraocular tuberculosis. CONCLUSION: PCR is a highly
sensitive and specific diagnostic test and PCR of intraocular specimens
like the aqueous can be supportive of the diagnosis of miliary
tuberculosis of the choroid.