Anju Rastogi

Fine needle aspiration biopsy in orbital lesions

PURPOSE . The study was performed to evaluate the efficacy of fine needle aspiration biopsy (FNAB) in orbital lesions. METHODS . Seventeen patients with orbital masses who had been fully investigated by non-invasive techniques participated in this study. FNAB was performed by standard technique, as an outpatient procedure, with ultrasound guidance in lesions posterior to the equator. A trained cytologist analysed all the smears. RESULTS . Specific results were obtained in 14 of the 17 (82%) patients studied by FNAB. Ten cases were neoplastic (8 malignant and 2 benign), 3 were inflammatory and 1 was a case of histiocytosis X. In 3/17 cases the results were non-specific. These were treated as pseudotumours and responded well to systemic steroids. In 7 cases the clinical and radiological diagnosis was confirmed by FNAB. Non-invasive investigations like USG, CT and MRI, however, failed to provide accurate diagnosis in the other 7 (41%) cases. In these patients, FNAB yielded a pathological diagnosis (histiocytosis X, cryptococcosis, non Hodgkins lymphoma, adenocarcinoma, pleomorphic adenoma, Schwannoma and cysticercosis), helping us to modify treatment with an excellent response. No significant complications were encountered following the aspiration biopsies. CONCLUSION . FNAB proved to be a reliable method for distinguishing between malignant and non-malignant lesions. It was found to be rapid, accurate, cost-effective, safe and a valuable addition to ultrasound, CT scan and MRI in the diagnosis of orbital lesions. This tool may help in avoiding a traumatic surgical intervention.

Microspherophakia associated with Axenfeld-Rieger syndrome

We report a 13-year-old girl with Axenfeld-Rieger syndrome who was also found to have microspherophakia. She developed glaucoma in both eyes and was treated with bilateral pars plana lensectomy. To the best of our knowledge, no such association has been reported previously in the literature.

Phenotypic overlap between Blepharo-naso-facial syndrome and Nablus mask-like syndrome. Report from the first Indian family.

We describe two siblings with epiphora, telecanthus, expressionless face, thick facial skin, bulky nose and profound sensorineural hearing loss. Constellation of these features presented a phenotypic overlap withBlepharo-naso-facial syndrome (BNFS) and Nablus mask-like syndrome (NMLS). They in addition hadposterior helical pits. The molecular basis of NMLS is known, while BNFS remains an elusive disorder. We report the first Indian family with features having significant overlap between the two but we attempt to summarize the frequency of reported features and bring out the most consistent features for these two syndromes for the treating clinician.

Congenital accessory palpebral aperture – An addition to the spectrum of Delleman syndrome

Delleman syndrome (oculocerebrocutaneous syndrome, MIM 164180) is characterized by orbital cysts, microphthalmia/anophthalmia, focal skin defects, skin appendages and multiple cerebral malformations. We herein describe a case of an 8-month-old male child with features suggestive of Delleman syndrome along with a rare congenital lid anomaly – an accessory palpebral aperture, not reported so far to the best of our knowledge.

Comparison of adjustable sutures versus nonadjustable sutures in intermittent exotropia

Purpose: To compare adjustable sutures versus nonadjustable sutures for intermittent exotropia. Methods: In this randomized prospective interventional study, 40 adult patients with intermittent exotropia were randomly divided into 2 equal groups. Both groups underwent bilateral lateral rectus recession. In group A, adjustable suture recession was performed, and in group B, nonadjustable suture recession was performed. Patients were followed up for 6 months and outcome measures were residual deviation, binocular status, and need for resurgery. Results: Success was defined as alignment of 2 eyes <10 prism diopters (PD) of deviation at the end of 12 weeks. Need for resurgery in a 12-week follow-up period was considered to be failure. At the end of the study, 90% of the patients in group A and 85% of the patients were within 10 prism diopters of orthophoria (p = 0.316). At the end of 6 months, mean deviation in group A was 6.20 PD and in group B it was 5.60 PD (p = 0.31). No patient underwent resurgery. Conclusions: Adjustable hang-back recession has no definite added advantage over nonadjustable hang-back recession in intermittent exotropia.

Extraneural Cryptococcosis: An Unusual Presentation

Cryptococcosis is a potentially life-threatening disease with neurological, cutaneous and ocular manifestations, usually affecting immunosuppressed individuals. An unusual case of cryptococcosis with isolated cutaneous and orbital masses, in a non-immunocompromised patient, is reported. Fine-needle aspiration cytology established a rapid definitive diagnosis. Prompt treatment with oral fluconazole resulted in complete resolution of the lesions.