Md. Shahid Alam

Polymerase chain reaction for Mycobacterium tuberculosis DNA detection from ocular fluids in patients with various types of choroiditis in a referral eye center in India

Aims: The aim of this study was to detect Mycobacterium tuberculosis (MTB) DNA with polymerase chain reaction (PCR) in aqueous or vitreous samples of patients suffering from choroiditis presumed to be infectious origin. Settings and Design: Hospital-based, retrospective case–control study. Subjects and Methods: In all, forty eyes of forty patients with choroiditis divided into two groups – Group A (serpiginous-like choroiditis, ampiginous choroiditis, multifocal choroiditis) and Group B (choroidal abscess, miliary tuberculosis (TB), choroidal tubercle) were analyzed retrospectively. In 27 controls (patients without uveitis undergoing phacoemulsification), anterior chamber aspirate was done and sample subjected to real-time PCR. Patients underwent nested PCR for MTB using IS6110 and MPB64 primers from aqueous (n = 39) or vitreous (n = 1). All patients underwent detailed ophthalmological examination by slit-lamp biomicroscopy, fundus examination by indirect ophthalmoscopy, and fundus photograph and fundus fluorescein angiography if required. Statistical Analysis: Positive results of PCR for MTB within the group and between two groups were statistically analyzed using Chi-square test. Results: There were 25 males and 15 females. Mean age at presentation was 34.66 years (range, 14–62). PCR positivity rates were 41.3% (n = 12/29) and 81.82% (n = 9/11) in Groups A and B, respectively. No controls had PCR-positive result. Comparison of PCR positivity rates showed statistically significant difference between Groups A and B (P = 0.028). Systemic TB was detected in 57.14% (n = 12/21) of all PCR-positive cases (Group A - 33.3%, n = 4/12; Group B - 88.9%, n = 8/9). Systemic antitubercular treatment (ATT) for 9 months and oral steroids were successful in resolution of choroiditis in all PCR-positive patients (n = 21) without disease recurrence. Conclusions: Eyes with choroiditis of suspected/presumed tubercular origin should be subjected to PCR for diagnosis of TB and subjected to ATT for prevention of recurrences.

An innovative method of ocular prosthesis fabrication by bio-CAD and rapid 3-D printing technology: A pilot study

ABSTRACT Ocular prosthesis is either a readymade stock shell or custom made prosthesis (CMP). Presently, there is no other technology available, which is either superior or even comparable to the conventional CMP. The present study was designed to fabricate ocular prosthesis using computer aided design (CAD) and rapid manufacturing (RM) technology and to compare it with custom made prosthesis (CMP). The ocular prosthesis prepared by CAD was compared with conventional CMP in terms of time taken for fabrication, weight, cosmesis, comfort, and motility. Two eyes of two patients were included. Computerized tomography scan of wax model of socket was converted into three dimensional format using Materialize Interactive Medical Image Control System (MIMICS)software and further refined. This was given as an input to rapid manufacturing machine (Polyjet 3-D printer). The final painting on prototype was done by an ocularist. The average effective time required for fabrication of CAD prosthesis was 2.5 hours; and weight 2.9 grams. The same for CMP were 10 hours; and 4.4 grams. CAD prosthesis was more comfortable for both the patients. The study demonstrates the first ever attempt of fabricating a complete ocular prosthesis using CAD and rapid manufacturing and comparing it with conventional CMP. This prosthesis takes lesser time for fabrication, and is more comfortable. Studies with larger sample size will be required to further validate this technique.

Double Jeopardy: Blepharophimosis Syndrome with Congenital Nasolacrimal Duct Obstruction in Twins

ABSTRACT Purpose: Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is an autosomal dominant disorder characterized by bilateral ptosis with poor levator function, epicanthus inversus and shortened horizontal palpebral fissures. Method: Eighteen -month -old twin sisters presented with history of watering from their left eyes since birth. Examination revealed features of BPES with left congenital nasolacrimal duct obstruction in both. Result: the twins underwent therapeutic probing, which was successful in one and failed in the other. the second child was subsequently managed by external dacryocystorhinostomy. Conclusion: To our knowledge, this is the first report of Blepharophimosis syndrome with congenital nasolacrimal duct obstruction occurring in twin sisters.

A rare case of giant multicystic solitary fibrous tumor of the orbit

ABSTRACT Solitary fibrous tumor (SFT) is a rare spindle cell tumor of the orbit of mesenchymal origin. Though these tumors are mostly solid, partial or complete cystic changes can rarely occur. Only six such previous cases of cystic fibrous tumor of the orbit have been mentioned in the literature. We report a case of an elderly male who presented with a huge left sided medial orbital mass. Magnetic resonance imaging showed a predominant cystic orbital mass separated by septae and suggested a diagnosis of Hydatid cyst. The patient underwent complete excision of the mass and histopathology and immunohistochemistry were suggestive of cystic SFT. Cystic degeneration in SFT is extremely rare and can be a harbinger of malignancy, and pose risk of recurrence. Close follow up and monitoring is required for all such cases.

Mesenchymal chondrosarcoma of the orbit: A case report with 5 years of follow-up

ABSTRACT Mesenchymal chondrosarcoma is a rare orbital tumor. Several case reports of this rare tumor have been published in the literature but only 6 cases have documented a follow up of 5 years or more. We report a case of 28 year-old female who presented with left orbital mass. Computed Tomography (CT) revealed a lobulated mass in the superior extraconal space with dense intralesional calcification. Patient underwent complete resection of the mass and histopathology was suggestive of mesenchymal chondrosarcoma. He was given adjuvant radiotherapy and there was no recurrence or metastasis at 5 years of follow-up. The case highlights that a complete resection with adjuvant radiotherapy in cases of orbital mesenchymal chondrosarcoma offers excellent prognosis.

Orbital angioleiomyoma: A rare orbital neoplasm

ABSTRACT A 44-year-old male patient presented with painless progressive proptosis of left eye for the last 20 years. Examination revealed a purplish vascular mass extending from the medial orbital region to the surface of the globe. He underwent complete excision of the mass via an anterior orbitotomy approach. Histopathology and immunohistochemistry revealed a diagnosis of angioleiomyoma. No recurrence was noted at 1 year of follow-up. Angioleiomyomas are benign smooth muscle tumors with an additional vascular component. Their occurrence in the orbit is extremely rare with only three cases reported in literature till date. We report a fourth case of angioleiomyoma of the orbit with the longest duration of presentation of 20 years.

Clozapine-induced cataract in a young female

A variety of systemic drugs including corticosteroids, amiodarone and antipsychotics have been known to cause cataract formation. Typical antipsychotics such as chlorpromazine have been reported to cause cataract formation in varying rates ranging from 22% to 80%. Cataract as an adverse effect resulting from the long term use of atypical antipsychotic has rarely been mentioned in literature, and there is only a single case report of cataract formation from prolonged use of clozapine. We report a rare case of clozpine induced cataract in a young female. The patient was advised to consult her psychiatrist for a change of drug and to undergo cataract surgery.

Fungal infections of the orbit

Fungal infections of the orbit can lead to grave complications. Although the primary site of inoculation of the infective organism is frequently the sinuses, the patients can initially present to the ophthalmologist with ocular signs and symptoms. Due to its varied and nonspecific clinical features, especially in the early stages, patients are frequently misdiagnosed and even treated with steroids which worsen the situation leading to dire consequences. Ophthalmologists should be familiar with the clinical spectrum of disease and the variable presentation of this infection, as early diagnosis and rapid institution of appropriate therapy are crucial elements in the management of this invasive sino-orbital infection. In this review, relevant clinical, microbiological, and imaging findings are discussed along with the current consensus on local and systemic management. We review the recent literature and provide a comprehensive analysis. In the immunocompromised, as well as in healthy patients, a high index of suspicion must be maintained as delay in diagnosis of fungal pathology may lead to disfiguring morbidity or even mortality. Obtaining adequate diagnostic material for pathological and microbiological examination is critical. Newer methods of therapy, particularly oral voriconazole and topical amphotericin B, may be beneficial in selected patients.

Giant pleomorphic adenoma of the lacrimal gland: A surgical challenge

ABSTRACT Pleomorphic adenoma is the most common epithelial neoplasm of the lacrimal gland. The tumor typically presents with a superotemporal mass with inferonasal displacement of the globe. They generally measure less than 3 cm in size and can be removed comfortably via a lateral orbitotomy approach. Pleomorphic adenoma left unattended for a long period grows up to humongous proportions and poses a surgical challenge both for its complete removal and globe salvage. We report a rare case of pleomoprphic adenoma of the lacrimal gland in an adult male, who did not seek any medical advice for 20 years allowing the tumor to expand enormously in all dimensions, with complete obscuration of the globe. The tumor was excised completely and globe could be salvaged.

Anatomical and functional outcomes of canalicular laceration repair with self retaining mini-MONOKA stent

Aim To evaluate the anatomical and functional outcomes of canalicular laceration repair with self retaining monocanalicular intubation system (Mini-MONOKA). Materials and methods The data of 29 patients undergoing canalicular laceration repair from 2010 to 2014 were retrospectively analyzed. Operative details and complications were noted. The stent was removed earliest at 3 months. Anatomical and functional success was defined by a patent syringing and the absence of epiphora respectively. Results Out of 29 patients, 23 (79.3%) were males. Mean age at presentation was 19.3 ± 13.8 years. Lower canaliculus was involved in 19 (65.5%), upper in 8 (27.5%) and both canaliculi in 2 (6.8%). Ten patients presented later than 11 days after trauma (range 12–168 days), and repair was attempted successfully in all. Fourteen (48.2%) cases reported for stent removal, at a mean follow-up period of 4.64 ± 2.12 months. Anatomical success was noted in 12 (85.71%) and functional success in 13 (92.85%) cases. Four patients had stent related complications. Conclusion Canalicular injuries are more common in young males. Mini-MONOKA stents are easy to insert and retrieve, and yield excellent anatomical and functional outcome. Canalicular laceration repair can be attempted successfully irrespective of the delay in presentation.