S. Krishna Kumar

Detection of mycobacterium Tuberculosis by Nested Polymerase Chain Reaction in a Case of Subconjunctival Tuberculosis

Purpose. To highlight the importance of nested polymerase chain reaction (PCR) in the detection of Mycobacterium tuberculosis in a case of subconjunctival tuberculosis. Methods. We report a case of a 60-year-old man with subconjunctival nodule in the right eye for duration of 6 weeks. Biopsy of the nodule showed a granuloma with extensive caseation necrosis. Ziehl Neelsen staining for acid-fast bacilli (AFB) was negative. However, because of a strong suspicion of Mycobacterium infection, PCR for M. tuberculosis genome was done, using the nested PCR technique. Results. Polymerase chain reaction for M. tuberculosis showed amplification of Mycobacterium tuberculosis genome with the nested PCR technique. Conclusion. Our case indicates that PCR can be a valuable tool in the diagnosis of conjunctival tuberculosis from paraffin sections.

Leiomyoma of the ciliary body extending to the anterior chamber : Clinicopathologic and ultrasound biomicroscopic correlation

Leiomyoma of the ciliary body is a rare tumor that often causes a diagnostic dilemma. Sclerouvectomy has been found to be beneficial in the management of iris and ciliary body leiomyoma. We treated a case of leiomyoma of the ciliary body presenting as a fleshy mass in the anterior chamber, removed by partial lamellar sclerouvectomy. Ultrasound biomicroscopic and histopathologic features, including light microscopic, immunohistochemistry, and transmission electron microscopic features, were studied and the literature was reviewed.

Clinicopathological correlation of choroidal melanoma in Indian population: A study of 113 cases

Aim: To correlate the clinical presentation, tumor characteristics, and histopathological findings of choroidal melanoma in the Indian population Materials and Methods: A retrospective analysis of 113 patients of choroidal melanoma over a period of 10 years was done. Patient demography, clinical presentation, tumor characteristics, and histopathological findings were correlated. Results: Among 113 patients histopathologically diagnosed with choroidal melanoma over 10 years, most were males. The mean age was 45.9 ± 14.84 years among which 6 (5.3%) patients were less than 20 years. Thirty-six (31.8%) patients were misdiagnosed. The mean basal diameter was 12.41 ± 1.4 mm. Mixed cell type was seen in 71 (63%) patients, while 28 (25%) patients had spindle cell type. Epithelioid cell type was present in 11 (10%) patients and necrotic cell type was seen in 3 (2%) patients. Enucleation was the primary treatment modality in 107 (94.6%) patients, while exenteration was done in 6 (5.3%) patients. Three patients with epithelioid cell type with orbital extension underwent exenteration. The mean follow-up period was 14 months. No mortality was reported at the end of 5 years in patients with longer follow-up. Conclusions: Malignant melanoma of the choroid is a rare occurrence. They can occur in younger age group and can be misdiagnosed. Mixed cell type is commonest. Diffuse tumors with epithelioid cell type are likely to have orbital extension.

Detection of Mycobacterium tuberculosis by polymerase chain reaction in a case of orbital tuberculosis

Orbital tuberculosis is quite uncommon. We report a case of orbital tuberculosis in a 3-year-old child from Bangladesh who presented with swelling and discharging sinus in the lower part of the orbit. Histopathology revealed a granulomatous inflammation with caseation necrosis. Polymerase chain reaction (PCR) showed amplification of the Mycobacterium tuberculosis genome. The patient responded to a course of antituberculous treatment. Mycobacterium tuberculosis should be considered in the differential diagnosis of inflammatory orbital disease in the Indian subcontinent where tuberculosis is prevalent.

Late recurrence of tumor necessitating enucleation in an adult onset retinoblastoma

Retinoblastoma is the most common primary intraocular malignancy in children. Although rare cases of adult onset retinoblastoma have been reported, the numbers are very few worldwide. We report a case where tumor recurrence following a quiescent period of 3½ years led to enucleation of the eye in an adult onset retinoblastoma. A 33-year-old female was noted to have an intraocular mass lesion in the inferonasal quadrant of the retina. Computed Tomography, B-scan and vitreous biopsy confirmed the diagnosis of retinoblastoma. The patient underwent plaque brachytherapy, cryotherapy, and laser indirect ophthalmoscopy which resulted in complete regression of the tumor mass with no areas of activity. At the last follow up 3½ years after the treatment the right eye showed anterior chamber infiltration with a tumor-like mass. Fundus examination showed vitreous hemorrhage, vitreous seedings and a small focus of tumor reactivation. B-scan, ultrasound biomicroscopy and MRI confirmed the mass lesion. In view of the tumor infiltrating the anterior chamber and involving the ciliary body prompt enucleation of the right eye was performed. The diagnosis of retinoblastoma was confirmed by histopathology. It is important that even after complete regression of the tumor frequent surveillance with fundus examination is necessary to detect early recurrences and to institute prompt management.

Cytopathology of explanted intraocular lenses and the clinical correlation

Purpose: To study the cytopathological features of explanted intraocular lenses (IOLs) and correlate the features with their clinical presentation. Setting: Ocular Pathology Department, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India. Methods: The study comprised 61 explanted IOLs (48 posterior chamber IOLs and 13 anterior chamber IOLs) removed for the following reasons: pseudophakic bullous keratopathy (36), recalcitrant uveitis (7), retinal detachment (10), endophthalmitis (5), uveitis (7), IOL subluxation (2), and painful blind eye (1). The IOLs were stained with hematoxylin and eosin using a simple cytological technique. The cytopathological features were studied and correlated with the clinical presentations. Results: The mean time of IOL explantation was 10.1 months after surgery. Twenty‐one IOLs had granulomatous and nongranulomatous inflammations and 4, nongranulomatous inflammations. One IOL had fungal filaments on the surface. Conclusion: Intraocular lenses can produce both granulomatous and nongranulomatous inflammation. Granulomatous inflammation was the most common in this series. The surface of IOLs explanted because of intraocular infection may show infective agents.

Bilateral Conjunctival Granulomas in A Young Lady with Hypereosinophilic Syndrome - A Case Report

ABSTRACT Purpose: To report an interesting case of bilateral conjunctival granulomas in a young lady with hypereosiniophilic syndrome. Materials & Methods: Retrospective interventional case report Results: A 37-year-old lady presented with irritation and redness in both eyes of 15-day duration. She had a history of abdominal pain and diarrhea since 8 months for which she has been extensively investigated including a positron emission tomography (PET) scan and an ileal biopsy which showed chronic granulomatous inflammation with eosinophils. Ocular examination revealed multiple bilateral conjunctival granulomas. Conjunctival biopsies revealed granulomatous inflammation with plenty of eosinophils and flame figure configuration. Peripheral blood smear showed increased absolute eosinophil count and eosinophilia. Stool analysis was normal. She did not have abdominal symptoms or recurrence of granulomas. Conclusion: The rare association of bilateral conjunctival granulomas with hypereosinophilic syndrome has been described in this report.

Failure of globe conservation in a case of adult onset retinoblastoma

Adult onset retinoblastoma is a rare intraocular malignancy. The majority of the cases are treated with enucleation, due to late presentation and advanced-stage tumors. Here we report a case of a 30-year-old female who presented with an intraocular mass with exudative retinal detachment in her right eye. B-scan ultrasound and magnetic resonance imaging (MRI) confirmed the diagnosis of retinoblastoma. In an attempt to salvage the globe, she was treated with chemotherapy, which resulted in excellent regression of the tumor mass by the end of 8 months follow-up. The patient was followed-up regularly with focal treatment whenever necessary. Two years later, she developed a massive recurrence necessitating enucleation. Histopathologic examination revealed a moderately differentiated retinoblastoma with choroidal invasion. Attempt to salvage the globe in adult onset retinoblastoma with chemoreduction and focal therapy may be possible; however, regular long-term follow-up is necessary for recurrence which warrants timely intervention.