Diagnostic algorithm in small pigmented choroid tumors (less than 3 mm thick)

Objectives: The aim of this paper is to present a diagnostic algorithm for a controversial topic in ophthalmic oncology, small pigmented choroidal tumors (<3 mm thick). Material and Methods: Nineteen consecutive patients with a clinical diagnosis of small choroidal pigmented tumors were included in the study. The group of patients studied consisted of 9 patients (47.36%) female and 10 patients (52.64%) male, the age range was 14–68 years. All cases were ophthalmologically evaluated, including best-corrected visual acuity, anterior and posterior segment biomicroscopy, intraocular pressure, binocular indirect ophthalmoscopy, and as additional complementary examinations, ocular ultrasound was performed, which in 100% of the cases was inconclusive, optical coherence tomography, autofluorescence, and angiography in selected cases according to location and symptomatology. In 13 patients (68.50%), transvitreous puncture was performed with or without vitrectomy. Trans-scleral puncture was performed in 6 patients (31.50%), located at the equator (4 patients) and ciliary body (2 patients). Post-surgical follow-up was performed within the first 3 weeks after the procedure and then controlled every 3 months within the 1st year. The material obtained by fine-needle aspiration (FNA) was placed in non-hemolytic preservative liquid. Hematoxylin and eosin, Pas, Masson’s trichrome, and immunohistochemistry (HMB 45, MELAN A, PROT. S-100 base) were performed. Results: The yield of cytologic material was 100% in the sampled patients. The most frequent complication was subretinal hemorrhage in three patients with transvitreous access and two patients with trans-scleral access, in all cases, there was a favorable evolution without requiring further action. In three patients, there were mild vitreous hemorrhages that resolved spontaneously, all of them had undergone transvitreous access. Conclusion: In TPPC of less, we propose a diagnostic algorithm with FNA to obtain cytological sample which allows not only the diagnosis of certainty to indicate treatment but also to determine cytological and molecular prognostic factors that allow classifying melanoma of high or low grade and potentially in case of metastatic disease to indicate systemic treatments. We believe that it is essential to diagnose this type of lesions in which a diagnosis of certainty is required. The alternative is the observation that we consider potentially dangerous in these cases.

Sebaceous gland carcinoma of ocular region in India: A brief literature review for disease management

Sebaceous gland carcinoma (SGC) is slow growing, but the most aggressive and lethal eyelid malignancy. Histologically, SGC can be classified based on cell types, cytoarchitecture, and growth patterns. A previously published article illustrates the molecular genetic framework stating the drivers of sebaceous carcinoma. Today, every effort has been made to treat and eradicate ocular disease, therefore, early diagnosis and appropriate management are required to use a multimodal approach that can reduce the mortality rate in patients with SGC. Treatment with the conventional technique has improved visual and systemic prognosis, however, therapeutic target to treat cancer is a much better option than other modalities. Thus, new insight into the natural and molecular-oriented treatment modalities may lead to the development of new effective strategies, along with the conventional method.

Optical coherence tomography angiography findings in diabetic macular edema

Optical coherence tomography angiography (OCT-A) was developed as an extension of OCT imaging. This technology allowed for the visualization of retinal microvasculature in vivo, without the need for contrast dye, provides depth-resolved images of blood flow in the retina and choroid with levels of detail far exceeding that obtained with older forms of imaging. OCT-A has been recently used for noninvasive evaluation of macular and peripapillary capillary network alterations in diabetic retinopathy, and the ability to clearly visualize microvascular changes has allowed for a better assessment of the microvascular retinal alterations, retinal ischemia, and neovascularization in diabetic macular edema (DME) patient. The present paper aims to review the most recent information about the findings for diagnostic interpretation in DME using OCT angiography.

Estimation of conjunctival swab and nasopharyngeal swab specimens for viral nucleic acid detection in Coronavirus disease 2019 patients to compare the viral load

Objectives: The purpose of the study was to detect the presence of viral ribonucleic acid of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in conjunctival swab along with nasopharyngeal swab specimens of Coronavirus disease 2019 (COVID-19) patients. Material and Methods: Thirty COVID-19 patients with at least one sample positive for real-time reverse transcription-polymerase chain reaction for SARS-CoV-2 in nasopharyngeal swab with the presence or absence of ocular manifestations were included in the study. The conjunctival swab along with nasopharyngeal swab of each patient was collected and sent to microbiology lab for evaluation and analysis of viral nucleic acid to assess the viral load. Results: Out of 30 patients, 21 patients (70%) were males and the remaining nine patients (30%) were females. Mean age of the patients in the study was 44.80 ± 15.37 years. One patient had conjunctivitis as ocular manifestation. Two (6.7%) out of 30 patients were positive for RT-PCR SARS-CoV-2 in the conjunctival swab. There was no statistical correlation between nasopharyngeal swab and conjunctival swab positivity using Pearson’s correlation coefficient (r) = 0.010; P = 0.995 (>0.05). Conclusion: The results of the study revealed that SARS-CoV-2 can also be detected in conjunctival swabs of confirmed cases of COVID-19 patients. Although, in comparison to nasopharyngeal and throat swabs the rate of detection of SARS-CoV-2 in conjunctival swabs is relatively less, still diligent care and precautions should be practiced during the ophthalmic evaluation of COVID-19 patients.

Incomplete posterior vitreous detachment despite vitrectomy with silicone oil tamponade

The fundamental step of a successful vitrectomy is posterior vitreous detachment induction; however, incomplete induction sometimes occurs. It may not be well seen barely by ophthalmoscopy examination, but emulsified silicone oil droplets act as the agent highlighting out the two natural retro-hyaloid spaces. The emulsified silicone oil droplets float according to gravity, but were entrapped over the pre-optic disc and the pre-macular bursa, giving the funny double inverse hypopyon-like pattern over the posterior segment.

Merkel cell carcinoma of the cornea and conjunctiva

A 58-year-old woman presented with a corneoconjunctival tumor, first diagnosed as a squamous neoplasia. An excisional biopsy was performed. Histopathology revealed signs of MCC, which is a rare malignant tumor of the skin. It can affect the eyelids and is a differential diagnose of recurrent chalazion. The patient had a history of multiple chalazia excision. MCC is known to be highly aggressive and tends to metastasize early to regional lymph nodes. It is believed to originate from Merkel cells, which have not been identified in the conjunctiva or cornea. However, the tumor may originate from integration of Merkel cell polyomavirus (MCPyV) in other epithelial cells. Metastatic compromise of the conjunctiva by this tumor has been reported as well. We herein report a case of both corneal and conjunctival involvement by a previously misdiagnosed MCC. A correct histopathological analysis, including immunohistochemistry techniques oriented by clinical suspicion, is crucial for the diagnosis. Prognosis of this tumor is known to be poor, that is the reason why an accurate diagnosis and an early referral to an oncologist are essential to a successful management of the disease.

Treatment of bilateral punctal stenosis and nasolacrimal duct obstruction in an 11-year-old case with dyskeratosis congenita

The purpose of this study was to report the external dacryocystorhinostomy (ext-DCR) using silicone intubation in a child with dyskeratosis congenita (DC) who had presented by bilaterally acquired nasolacrimal duct obstruction (NLDO), punctal stenosis, and mucocutaneous changes. We report the 13-month results of an 11-year-old boy with DC who underwent bilateral ext-DCR with silicone stenting under general anesthesia. Ophthalmic examination revealed bilateral punctal stenosis and NLDO with normal fundus examination. He was referred to pediatrics and was diagnosed as DC, based on classic reticular skin pigmentation, nail dystrophy, and oral leukoplakia, without any other systemic involvement. Treatment consisted of bilateral ext-DCR using silicone stenting by 6 months. Management of surgery and post-operative 13-month follow up results was observed. DC is a rare heterogeneous multisystem disorder of telomere maintenance, which may present with ophthalmologic features. Although the lacrimal system abnormalities have been reported most frequently ocular findings in DC, this is the first case to present the management and long-term results of DCR using silicone intubation. This case aims to raise awareness of the various systemic and ocular manifestations and possible complications of DC and to present long-term results of ext-DC in a patient with DC.

Ultrasound biomicroscopy evaluation of pseudophakic pupillary block by vitreous prolapse after Nd:YAG laser posterior capsulotomy

Intraocular pressure rise is a common complication after neodymium:yttrium-aluminum-garnet (Nd-YAG) laser posterior capsulotomy. Although in most cases it is related to an inflammatory response, there are other possible mechanisms such as misdirection syndrome and pupillary block. The authors report two cases of pupillary block by vitreous prolapse after Nd-YAG laser posterior capsulotomy evaluated by ultrasound biomicroscopy (UBM). UBM allows to differentiate possible causes of intraocular pressure rising after laser capsulotomy even in cases of corneal opacity. It also allows to detect intraocular lens dislocation, sometimes associated with this situation. This is the first report that describes the characteristics of UBM images of this complication.

Intraocular tuberculosis, a challenge in diagnosis and treatment

Ocular tuberculosis (TB) is an extrapulmonary tuberculous condition and has variable manifestations. The incidence of TB is still high in developing countries, and a steady increase in new cases has been observed in industrial countries as a result of the growing number of immunodeficient patients and migration from developing countries. Choroidal granuloma is a rare and atypical location of TB. We present a case of a presumptive choroidal granuloma. This case exposes that diagnosis can be remarkably challenging when there is no history of pulmonary TB. The recognition of clinical signs of ocular TB is extremely important since it provides a clinical pathway toward tailored investigations and decision making for initiating anti-TB therapy and to ensure a close follow-up to detect the development of any complication.

Late-onset malignant glaucoma

A case report on a 49-year-old female with diagnoses of ocular hypertension in her left eye (LE) treated with 250 mg/day acetazolamide for 2 years. During the slit-lamp examination, complete occlusion of both iridocorneal angles was detected. Intraocular pressure (IOP) was 10 and 35 mmHg in the right eye and LE, respectively. Phacotrabeculectomy was performed in the LE. After 1 month of the procedure, the patient developed a slowly progressive miopization from −1 to −3 diopters (D) the following months. Approximately 3 months after surgery, the patient developed an episode of acute pain, athalamia, and IOP 45 mmHg in her LE. Late-onset malignant glaucoma was suspected and the patient was treated with topical hypotensive and cycloplegic agent until a prompt vitrectomy was performed. Deepening of the anterior chamber and restoration of IOP to normal range was obtained after surgery.