Dhivya Ashok Kumar

Abstract

A rare case of a 16year old female, diagnosed elsewhere as chronic uveitis in the left eye positive antinuclear antibodies and Anti-SSA antibodies, treated with steroids and referred for cyclocryotherapy for a painful blind eye. On examination, the patient denied perception of light. There was proptosis, limitation of extraocular movements and corneal melting with no view of the posterior segment. Ultrasound B scan showed dense vitritis with doubtful specks of calcification. Magnetic resonance imaging revealed a soft tissue mass obliterating the vitreous and anterior chamber with retroscleral extension and involvement of the optic nerve. Extended enucleation was performed under General anaesthesia. Histopathological examination confirmed a well differentiated retinoblastoma with extrascleral and optic nerve involvement. Metastatic work up was normal. Intravenous Chemotherapy and post surgery radiotherapy to the socket was advised for further management. Late onset retinoblastoma mimicking ocular inflammation with positive antibody serology is rare and the report shows the need for imaging in refractory uveitis.   Keywords: Retinoblastoma, Late onset retinoblastoma, Chronic uveitis, Panuveitis, Painful blind eye

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Abstract

Purpose: To report the role of optical biopsy where the preoperative spectral domain optical coherence tomography (SD OCT) features were used for surgical margin clearance in ocular surface squamous neoplasia (OSSN) excision. Materials and Methods: In this prospectiveinterventional studypatients with clinically diagnosed OSSNundergopreoperative SD OCT and mass was excised with 3mm clearance with respect to the extent on OCT. Corneal, conjunctival margins and lamellar sclera was evaluated histopathologically. Results: Twelve eyes of 11 patients with mean age of 59.2 ± 12.2 were studied. Hyper reflective epithelium, increased thickness, abrupt transition of corneal epithelium and increase back shadow were the features of OSSN noted. The mean functional epithelial thickness and epithelial thickness were 137.5± 60.6µm and 58.5±10.8 µm respectively. The histopathology confirmed as squamous cell carcinoma (SCC) (n=4, 33.3%), carcinoma in situ (CIN) (n=8, 66.6%). In CIN 2 eyes were severe dysplasia and 6 were moderate dysplasia. Corneal clearance was noted as 100 %. Of 36 conjunctival margins, the positive margin noted in 6 eyes (50%). Nasal margin (n=3) and temporal (n=3) were the common margins. There was no difference in clearance between CIN (50%) or SCC (50%) on conjunctival side. Two eyes with recurrence required and revision excision subsequent topical chemotherapy Conclusion: Optical biopsy by SD OCT though is an effective method for OSSN removal. Corneal margins showed better margin clearance than conjunctival.   Keywords: Histopathologically, Conjunctival

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