J Biswas

Corneoscleral epithelial cysts: evidence of developmental etiology.

PURPOSE To describe the clinical features, histopathology, surgical management and possible etiopathogenesis of corneoscleral epithelial cysts. METHODS Three patients with corneoscleral epithelial cysts underwent surgical ablation of the cysts. Material obtained during surgery was subjected to histopathologic analysis. RESULTS At last follow-up (mean, 6.3 months), none of the cysts had recurred. All patients had improved visual acuity. Histopathology revealed the occurrence of glandular elements suggestive of lacrimal tissue in one of the cysts. CONCLUSION The presence of ectopic lacrimal tissue suggests a developmental etiology for such cysts. Marsupialization of the scleral portion of the cyst and chemical ablation of the lining epithelium of the corneal cyst with 20% trichloroacetic acid appears to be a safe and effective technique in the surgical management of corneoscleral epithelial cysts.

Necrotizing nocardial scleritis with intraocular extension: a case report.

Nocardial scleritis is an uncommon but potentially sight-threatening condition with only four cases reported in the literature. Predisposing factors in these patients included cataract surgery in two (1,2), scleral buckling in one (3), and trauma with vegetable matter in the other (4). We report here a case of nocardial scleritis in the absence of predisposing ocular surgery or trauma. Despite intensive medical and surgical therapy, the necrotizing scleritis progressed with intraocular extension of the infection.

Ligneous Conjunctivitis: A Clinicopathologic Study of 3 Cases

The clinical, histopathologic features, and treatment outcomes in 3 patients with ligneous conjunctivitis are described. Bilateral, idiopathic membranes occurred in the palpebral conjunctiva in 2 patients. In 1 patient, unilateral conjunctival changes occurred in the bulbar conjunctiva, at the site of pterygium excision. Treatment included topical hyaluronidase, chymotrypsin, heparin, and cyclosporine and surgical excision with limited or no success. In one patient, conjunctival autografting from the normal fellow eye resulted in pseudomembrane formation at the donor site in the previously unaffected eye. Histopathological evaluation of excised membranes revealed the presence of amorphous eosinophilic hyaline material and chronic inflammatory cells. Immunohistochemical study revealed a predominance of T-lymphocytes. This case series confirms the recalcitrant clinical course of ligneous conjunctivitis. Conventional treatment modalities described in literature were not useful in the management of this condition. Surgical manipulation of the unaffected fellow eye in patients with unilateral disease can result in pathologic conjunctival changes, and is best avoided.

Cytomegalovirus retinitis in a seronegative patient with systemic lupus erythematosus on immunosuppressive therapy

AimThe purpose of this study is to report a rare case of cytomegalovirus (CMV) retinitis in a seronegative patient with systemic lupus erythematosus (SLE) on immunosuppressive therapy.MethodsA seronegative patient with SLE who was on immunosuppressive therapy developed CMV retinitis. The immunosuppressive therapy was tapered, and the patient was given intravitreal ganciclovir and foscarnet in addition to systemic ganciclovir. The follow-up visits were documented.ResultThe patient responded to the treatment and there was complete resolution.ConclusionCMV retinitis is a rapidly progressive condition and patients on immunosuppressive therapy should be referred to an ophthalmologist for periodic check-up for early diagnosis and treatment of this devastating ophthalmic condition. For clinically resistant CMV retinitis in seronegative patients with SLE, a combination therapy of intravitreal foscarnet with oral and intravenous ganciclovir is useful.

Impact of highly active antiretroviral therapy on ophthalmic manifestations in human immunodeficiency virus / acquired immune deficiency syndrome.

Highly active antiretroviral therapy (HAART) has changed the face of human immunodeficiency virus (HIV) acquired immune deficiency syndrome (AIDS) by leading to dramatic decreases in HIV-related morbidity and mortality in the developed as well as developing world. Since the introduction of HAART, the incidence of ocular opportunistic infections causing retinitis has dramatically decreased, and clinicians should be aware of changes in the clinical presentation of ocular manifestations of HIV. As studies of HIV disease after the introduction of HAART continue to become available, more thorough descriptions of treated patients with ocular opportunistic infections will include side-effects and toxicities of therapy. This review focuses on the impact of HAART on the ocular manifestations of HIV.

Ultrasound biomicroscopy in the diagnosis and management of pars planitis caused by caterpillar hairs

PURPOSE To report the use of ultrasound biomicroscopy in the detection of caterpillar hairs in the pars plana in a patient with unilateral pars planitis. METHOD Ultrasound biomicroscopic imaging of the anterior segment of the eye. RESULTS Ultrasound biomicroscopy located a hair in the posterior chamber at the first visit and five more in the pars plana 1 month later. This finding was confirmed intraoperatively. CONCLUSION Ultrasound biomicroscopy is useful in the diagnosis and management of unilateral pars planitis of uncertain cause.

Multiple live subconjunctival dipetalonema: Report of a case

Parasitic infestations of the eye have been reported since centuries, affecting various parts of the eye. Some are subtle, coexisting with vision, while many others damage and destroy, in part or totally, the gift of sight. This report describes a patient with live subconjunctival dipetalonema infestation of the right eye, with 22 parasites removed live in one sitting from one eye.

Efficacy of reduced dose of intravitreal triamcinolone acetonide in a case of active serpiginous choroiditis

Active serpiginous choroiditis (SC) is a vision-threatening condition which requires intensive treatment using corticosteroids and/or immunosuppressives, especially if the lesions are involving or encroaching on the macula. Use of oral and intravenous high-dose steroids are contraindicated in uncontrolled diabetics. Intravitreal steroid delivers a localized dose in such situations. This case report highlights the efficacy of reduced dose of intravitreal triamcinolone acetonide (2 mg) in the treatment of active SC.