Dipankar Das

Pattern of uveitis in North East India: A tertiary eye care center study

We conducted an institutional-based retrospective study on 308 uveitic patients and analyzed the pattern of uveitis in Northeastern India. Anterior uveitis was the most common type (47.07%) followed by posterior (29.87%), intermediate (12.98%) and panuveitis (10.06%). Toxoplasmosis (40.21%) had the highest incidence among posterior uveitis cases. Haradas form of Vogt Koyanagi Haradas disease is a frequent occurrence in this subset of the population.

Histopathologic analysis of 232 eyes with retinoblastoma conducted in an Indian tertiary-care ophthalmic center

Purpose: To study the histopathologic features of 232 enucleated eyes with retinoblastoma. Materials and Methods: Two hundred thirty-two enucleated eyes with retinoblastoma in a tertiary-care institute from 1982 to 2001 were reviewed. Data were collected and analyzed about the type of growth and the presence or absence of vitreous or subretinal seeding, rosettes and fleurettes, necrosis, calcification, iris neovascularization, and invasion of the anterior chamber, iris, choroid, optic nerve, and sclera. Choroidal invasion was graded using a new system. Results were analyzed for statistical significance. Results: The endophytic growth pattern was common in 118 (51%) of the eyes. Vitreous seeds were present in 109 (47%) of the tumors, 23 (10%) of the tumors had subretinal seeds, and 14 (6%) of the tumors had both. Poorly differentiated tumors were present in 134 (58%) of the eyes. Iris neovascularization was noted in 71 (31%) of the eyes and choroidal invasion was observed in 78 (34%) of the eyes. Of these 78 eyes, full-thickness (stage 4) choroidal invasion was present in 51 (65%). Optic nerve invasion was observed in 75 (32%) of the eyes, of which prelaminar involvement occurred in 40 (53%) and postlaminar involvement occurred in 22 (29%). Conclusion: A higher incidence of choroidal and optic nerve infiltration was noted among Asian Indian children than among children from the West. This could be due to delayed diagnosis or to a difference in the biological behavior of tumors occurring in the Asian Indian population.

Intravitreal gnathostomiasis and review of literature.

Intravitreal gnathostomiasis is a rare disease. To our knowledge, only five case reports are available in the literature wherein the parasites were surgically removed from the vitreous cavity and the species were identified. In this report, we document the clinical features of intravitreal gnathostomiasis along with the route of entry and parasitic migration pattern in ocular tissue, surgical management, and electron microscopic features of the retrieved advanced third-stage larva of Gnathostoma spinigerum (aL3) for a 48-year-old Indian woman with excellent postsurgical visual recovery.

Indirect optic nerve injury in two-wheeler riders in northeast India.

Purpose: To investigate the association of posterior indirect traumatic optic neuropathy and superior temporal orbital rim injury in two-wheeler riders and documentation of the clinical profile of such cases. Design: Retrospective observational study. Materials and Methods: Records of all patients reporting with cranio-orbital injury and vision loss following road traffic accidents between October 1994 and April 2006 were reviewed and from them cases with vision loss solely from indirect optic nerve injury were taken up for study. The prognostic significance of different presenting features, role of intravenous methyl prednisolone (IVMP) and relative risk of superior orbital rim injury to posterior indirect traumatic optic neuropathy (at 95% confidence interval) was calculated. Results: Out of 129 consecutive cases of cranio-orbital injury, 35 had posterior indirect traumatic optic neuropathy with minor ipsilateral superior temporal orbital rim trauma and none used any protective headwear. Presenting clinical features like relative afferent pupillary defect (P= 0.365), optic disc status (P= 0.518) and visual evoked potential (VEP) (P= 0.366) were disproportionate to visual loss. Only VEP had prognostic significance. The IVMP did not provide any added therapeutic benefit. The remaining 94 cases sustained direct blinding ocular trauma and 28 of them had associated intracranial pathology. The relative risk of superior temporal orbital rim injury to posterior indirect optic nerve trauma was 2.25. Conclusion: Superior temporal orbital rim injury, even when minor, carries a potential risk for development of blindness from indirect posterior indirect traumatic optic neuropathy in two-wheeler drivers. Presenting signs do not correlate with visual status. Only VEP has prognostic significance and the condition is untreatable.

Chloroma of the orbit in a non-leukemic adult: A case report

Granulocytic sarcoma has been reported as an isolated lesion in non-leukemic patients. However, the majority of these subjects develop acute leukemia within a mean interval of 10.5 months from the time of diagnosis. We present a case of granulocytic sarcoma of the orbit in a non-leukemic patient who was treated with chemotherapy and is doing well after a 2-year period. Patients who do not develop leukemia have a better prognosis. Appropriate treatment is delayed in most cases because of a high rate of misdiagnosis.

A rare case of adult onset retinoblastoma

Retinoblastoma usually manifests before five years of age. Retinoblastoma in an adult is extremely rare. Twenty-three cases of retinoblastoma in adults 20 years or older have been reported in world literature. We report a case of adult onset retinoblastoma in a 29-year-old female. Our patient had unilateral endophytic retinoblastoma with vitreous seeds and calcification on ultrasonography. She underwent enucleation with silicone ball implantation and the diagnosis was confirmed histopathologically. The diagnosis of retinoblastoma should be kept in mind in cases presenting with a white mass lesion of unknown etiology, in the fundus of an adult.

Subconjunctival urate crystals: a case report.

Purpose: To report a case of localized subconjunctival urate crystals in a patient with gout. Design: Single observational case report. Methods: Case report. Results: An 80-year-old woman who came for cataract surgery was incidentally found to have subconjunctival crystal deposits near the superior limbus in her left eye (OS). She was taking medications for gout and hypertension. Multiple conjunctival crystals were excised from the area before cataract surgery. Light microscopy under polarization revealed crystals, and histopathological examination confirmed gouty tophi. Conclusion: Because subconjunctival urate crystals occur only rarely, ophthalmologists should be aware of this potential, particularly in patients with gout.

Eccrine duct carcinoma of the eyelid mimicking meibomian carcinoma: clinicopathological study of a case.

Eccrine duct carcinoma belongs to a group of malignant sweat gland tumors showing de novo eccrine differentiation, but without features of benign adnexal counterparts. They are therefore likely to be confused with visceral adenocarcinomas that have metastasized to the lid. These tumors require important diagnostic considerations when adenocarcinoma is encountered in the lid in the absence of a known primary tumor. We present the case of a 60-year-old man with a nodule in the right upper eyelid that was histopathologically diagnosed as eccrine duct carcinoma of the lid. The differential diagnosis of eccrine carcinomas based on light microscopy, enzyme histochemistry, and immunohistochemistry is discussed, and a list of the various malignant eccrine tumors reported in the lid is presented.

Cataract surgery and intraocular lens implantation in a retinoblastoma case treated by external-beam radiation therapy

We report a case of extracapsular cataract extraction with posterior chamber intraocular lens implantation in a pediatric patient with a radiation-induced cataract that developed after combined external-beam radiation therapy and chemotherapy for retinoblastoma. A 12-year follow-up revealed effective tumor regression and sustained visual recovery.

Neuro and intraocular cysticercosis: A clinicopathological case report

Cysticercosis is one of the most common parasitic infestations in humans. Neurocysticercosis (NCC) is the commonest parasitosis of the central nervous system (CNS), endemic in developing countries and is also seen in developed nations with high rates of immigration from prevalent areas. Co-infection of ocular tissue is also significant and often ophthalmologists come across these lesions in their clinical practice. The mode of treatment in NCC and that of intraocular cysticercosis is somewhat different as far as antiparasitic treatment is concerned. This case report highlights the proper management of this parasitic infestation which involved both eye and brain.