A case of subretinal tubercular abscess presenting as disc edema.

We report a case of ocular tuberculosis (TB) which initially presented with disc edema and was mistaken for optic neuritis. With no definite pathology being identified, the patient was treated on the lines of optic neuritis with intravenous (IV) steroid with beneficial effect. Ocular TB was suspected when he presented later with a subretinal abscess. Based on positive Mantoux, QuantiFERON TB gold results and radiographic findings, a diagnosis of subretinal abscess of presumed tubercular etiology was made. The patient was successfully treated with anti‑tubercular therapy. To the best of our knowledge, this is the first case report of ocular TB presenting as disc edema followed by subretinal abscess.

Quality of life in non-infectious uveitis patients on immunosuppressive therapy

To assess visual function and vision related quality of life in patients with non-infectious posterior or panuveitis treated with immunosuppressives. Forty-three patients with non-inflammatory posterior or panuveitis were enrolled in this prospective study. All subjects underwent a detailed interview, complete ophthalmic examination, quality of life assessment using National Eye Institute Visual Function Questionnaire [VFQ-25], visual function evaluation [visual acuity and visual field] at baseline and at a sixth month follow up visit. The mean NEI-VFQ 25 composite score of the subjects with posterior or panuveitis was 58.0 [ +/- 24.1]. There was a statistically significant improvement [P = 0.004] in the composite score following treatment from 58.0 [ +/- 24.1] to 74.3 [ +/- 22.0] with effect size of 1.03. The psychological well-being and general health subscales showed significant improvement in the mean score following immunosuppressive therapy. While considering the visual function tests, there was a three-line improvement in the visual acuity score and changeover in the visual field severity from moderate to early defect with corresponding improvement in the visual field pattern. Though most of the patients complained of side effects such as tiredness, gastrointestinal upset and weight gain, there was improvement in the general health subscale. The significant improvement in the general health subscale despite side-effects shows that the benefit of immunosuppressive outweighs the risks of the therapy and this may also reflect the relatively low impact of these side-effects on the quality of life. This study shows that the use of immunosuppressives improves the quality of life of the individual

Pediatric uveitis: an update

Because of their varied spectrum of clinical presentation and difficulty in management, pediatric uveitis remains a challenge to the ophthalmologist. Variations in clinical presentation, difficulties in eye examination, extended burden of the inflammation over quality of life, limited treatment modalities, risk of amblyopia are the main challenges in the management of pediatric uveitis. Pediatric uveitis is a cause of significant ocular morbidity and severe vision loss is found in 25-33% of such cases. This article summarizes the common causes of uveitis in children with special approach to the evaluation and diagnosis of each clinical entity

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

To correlate the clinical presentation, tumor characteristics, and histopathological findings of choroidal melanoma in the Indian population 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. 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. 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

rare case of adult onset retinoblastoma

Retinoblastoma usually manifests before five years of age. Retinoblastoma in an adult is extremely rare. Twenty-three cases of retinoblastoma in adults 20 years or older have been reported in world literature. We report a case of adult onset retinoblastoma in a 29-year-old female. Our patient had unilateral endophytic retinoblastoma with vitreous seeds and calcification on ultrasonography. She underwent enucleation with silicone ball implantation and the diagnosis was confirmed histopathologically. The diagnosis of retinoblastoma should be kept in mind in cases presenting with a white mass lesion of unknown etiology, in the fundus of an adult

Unilateral Vogt-Koyanagi-Harada disease: report of two cases

In this retrospective report, we present two cases of unilateral Vogt-Koyanagi-Harada [VKH] disease. These patients were evaluated with clinical, ophthalmological and laboratory examinations. Their response following corticosteroid administration was evaluated. Both patients had the characteristic clinical features of VKH involving only one eye, including disc edema, choroidal striae, multiple sub retinal yellow lesions and exudative retinal detachment. These cases indicate that the clinical and angiographic features were typical of VKH disease despite the unilateral involvement

Biopsy pathology in uveitis

Uveitis is fraught with speculations and suppositions with regard to its etiology, progress and prognosis. In several clinical scenarios what may be perceived as due to a systemic infection may actually not be so and the underlying etiology may be an autoimmune process. Investigations in uveitis are sometimes the key in identification and management. Invasive techniques could be of immense value in narrowing down the etiology and help in identifying the cause. This article updates one on the invasive techniques used in biopsy such as anterior chamber paracentesis, vitreous tap and diagnostic vitrectomy, iris and ciliary body biopsy, choroidal and retinochoroidal biopsy and fine needle aspiration biopsy [FNAB]. In populations where certain infections are endemic, the clinical scenario does not always respect a known presentation and the use of biopsy is resorted to as a sure way of confirming the etiology. Biopsies have a role in diagnosis of several inflammatory and infectious conditions in the eye and are pivotal in diagnosis in several dilemmas such as intraocular tumors and in inflammations. Appropriate and timely use of biopsy in uveitis could enhance the diagnosis and provide insight into the etiology, thus enabling precise management

Update in pathological diagnosis of orbital infections and inflammations

Orbital infections and inflammations include a broad spectrum of orbital diseases that can be idiopathic, infectious, from primary or secondary inflammatory processes. Being able to properly diagnose and manage these orbital diseases in a timely manner can avoid permanent vision loss and possibly save a patient's life. When clinicians are faced with such patients, quite often the exact diagnosis cannot be made just based on clinical examination, various laboratory tests and imaging are needed. Moreover, orbital biopsies with histopathological analyses are often required, especially for the atypical cases. Thus, it is important for the clinicians to be familiar with the pathological features and characteristics of these orbital diseases. This review provides a comprehensive update on the clinical and pathological diagnosis of these orbital infections and inflammations

Molecular pathology of retinoblastoma

Retinoblastoma [RB] is an embryonic neoplasm of retinal origin. For many years, scientists have sought the fundamental origins of tumorigenesis, with the ultimate hope of discovering a cure. Indeed, these efforts have led to a significant understanding that multiple molecular and genetic aberrations, such as uncontrolled proliferation and the inhibition of apoptosis that contribute to the canonical characteristics of tumor biology. Despite these advances, a thorough understanding, such as the precise cells, which are the targets of neoplastic transformation, especially in solid tumors, is currently lacking. The focus of this review is to emphasize the molecular defects involved in the RB tumor progression and mechanisms associated with inhibition of tumor cell apoptotic processes. This review also discusses the importance of target molecules characterization and their potential therapeutic or prognostic use in RB disease