Plaque brachytherapy – Radiating positivity

Background: Plaque brachytherapy is an evolving, yet effective globe and vision-sparing modality for the treatment of intraocular tumors by transscleral irradiation of the tumor base with a radioactive implant. The American Brachytherapy Society (ABS) along with the collaboration of the international multicenter Ophthalmic Oncology Task Force (OOTF) was assembled to reach a consensus regarding establishing practice guidelines and setting standards of care for intraocular tumors. The advent of plaque brachytherapy has revolutionized the outcomes of intraocular tumors, thus ensuring globe salvage, reducing morbidity and mortality, and avoiding cosmetic disfigurement. A well-planned dosimetry for plaque brachytherapy results in achieving local tumor control and excellent prognosis. Purpose: This technique provides the advantage of focal radiation, thus eliminating the damage to the adjacent structures, minimal periorbital tissue damage, absence of cosmetic disfigurement owing to lack of retarded bone growth as seen in external beam radiotherapy. Thus, it reduces the risk of metastasis, and with the recent advances, it provides a shorter duration of treatment. Synopsis: In this video, we shall display the concept of plaque brachytherapy, the various types of plaques available, different radiations sources, planning dosimetry and calculations, target disease spectrum, surgical placement, and post-radiation outcomes in terms of local tumor control and prognosis. Highlights: This video highlights the history, basic principles and techniques of plaque brachytherapy and provides an understanding of its applications in the world of ocular oncology.

Pigmented lesions of the conjunctiva: The sheep and the wolf

Background: Pigmented lesions in the conjunctiva can be baffling to both the patients and the treating ophthalmologist because of their varied range of presentation and overlapping clinical features. The lesions range from incidental pigment deposition such as mascara and complexion?associated melanosis to malignant melanoma which poses a risk to life. Similarly, the management ranges from observation at regular intervals to aggressive surgery like exenteration. Purpose: We wanted to present a crisp and precise video of the good, bad, and ugly pigmented lesions of the conjunctiva, highlighting their specific clinical features important for the diagnosis and their management. Synopsis: This video describes the myriad of pigmented conjunctival lesions, their diagnostic characteristics, and management based on oncological principles. Link: https:// drive.google.com/file/d/1BYJ51rQtqjwM6e73BwrrLqdC1EoX A8Eu/view?usp=sharing. Highlights: Pigmented lesions can have variable presentation and close mimics, therefore, it is important to differentiate and identify the lesions accurately. This video highlights different pigmented lesions and their individual characteristic features

Good anesthetic for good esthetic: Blocks in oculoplasty

Background: A good anesthesia not only makes the patient comfortable during surgery, but also has a huge impact on the postoperative recovery. It also makes the operating surgeon carry out each step of the surgery precisely and beautifully. The art of giving a good local anesthesia is to be learnt and practiced not only by anesthetists, but also by the practicing ophthalmologists. Purpose: This video gives an overview of anatomy in terms of the nerve supply of the orbit, the surface marking, and the techniques of giving regional and nerve blocks. Synopsis: In this video, we describe the anatomy, the surface marking, the technique of regional anesthesia including peribulbar, retrobulbar, and subtenon blocks and of nerve blocks, specifically of facial, frontal nerve and its branches, infraorbital, nasociliary, infratrochlear, and dorsal nasal nerves, with their application in ocular plastic surgery. Highlights: This video highlights the essence of providing appropriate and good anesthesia so that the surgeon works in an optimal field with maximum comfort to the patients.

The eyes see what the mind knows – Interpretation of magnetic resonance imaging

Background: In 1978, the advent of magnetic resonance imaging (MRI) was a remarkable volte-face in the world of diagnostics. Employing the phenomenon of nuclear resonance enables us to exploit the properties of differential protons in living tissues. The ability of providing higher and variable contrast and the absence of ionizing radiations make it superior to computed tomography. Being the diagnostic tool of choice, it is an indispensable part of assessment of the location and characteristics of different ocular and orbital pathologies (vascular, inflammatory, and neoplastic). Purpose: The intrinsic and extrinsic properties of MRI provide multi-parametric imaging, making it of paramount importance in ophthalmological evaluation. Also, MRI-dynamic color mapping provides non-invasive and quantitative assessment of soft tissues in motion. An in-depth knowledge of the basic principle and technique of MRI aids in diagnosing as well optimal planning of surgical interventions. Synopsis: In this video, we shall be displaying the anatomical, clinical, and radiological aspects of MRI with an overlap to make it easier to understand the implications of this miraculous invention. Highlights: A good understanding of MRI analysis makes the ophthalmologists independent and helps in ruling out the differential diagnoses, exact extent and invasion, precise surgical planning and therefore, avoiding tragic outcomes. This video is an attempt to simplify and emphasize on the importance of MRI interpretation for an ophthalmologist.

Is There Really A Need Of Vacuum Tubes In Blood Specimen Collection?

Introduction – Pre–analytical phase consists of large proportion of laboratory errors. Proper blood collection and timely processing are critical and first pre–analytical steps required for integrity of laboratory results. The influence of blood collection devices on laboratory tests is often overlooked. In this review, we aim to study the effect of blood collection devices on biochemistry test results. Materials and method – All samples examined were collected from patients that had been referred to laboratories for various clinical chemistry assays. In total 100 patient’s samples were monitored at our institute. Venous blood samples were collected of the same patient using two different modes 1) In vacuum tubes 2) In non–vacuum tubes Parameters analysed were LFT (SGOT, SGPT, ALP, Bilirubin) KFT (urea, creatinine) in plain tubes and Blood Glucose in fluoride tubes. Results and Conclusion – It was observed that there was no significant difference in the results of biochemical parameters analysed from vacuum and non–vacuum tubes. The p–value was not significant. (p>0.05). Thus although incidence of hemolysis, contamination etc. are less in vacuum tubes, non–vacuum tubes have their own advantage of being cost–effective which can be favourable for a government setup where patient load is huge.

Tumors of the ocular surface: A review.

Tumors of the Ocular Surface clinically manifest with a very wide spectrum and include several forms of epithelial, stromal, caruncular, and secondary tumors. As a group, these tumors are seen commonly in the clinical practice of a comprehensive ophthalmologist, cornea specialist, and an ocular oncologist. This review is aimed to discuss the common tumors of the ocular surface and emphasize on their clinical diagnosis and appropriate management.

Primary vitreoretinal lymphoma.

Primary vitreoretinal lymphoma (PVRL) is an uncommon, but potentially fatal intraocular malignancy, which may occur with or without primary central nervous system lymphoma (PCNSL). Considered to be a subset of PCNSL, it is mostly of diffuse large B‑cell type. The diagnosis of PVRL poses a challenge not only to the clinician, but also to the pathologist. Despite aggressive treatment with chemotherapy and/or radiotherapy, relapses or CNS involvement are common.

Lacrimal gland CDS-positive, primary, extra-nodal marginal zone lymphoma of mucosa associated lymphoid tissue [MALT] -Type

Mucosa-associated lymphoid tissue [MALT] lymphoma of the ocular adnexae is rare. A 39-year-old woman presenting with proptosis was diagnosed to have non-Hodgkin's lymphoma with intermediate-sized cells and lymphoepithelial lesion. Unlike most MALT lymphomas, this lymphoma was found to be CD5-positive. Small lymphocytic lymphoma/chronic lymphocytic leukemia and lymphoplasmacytic lymphoma are two other entities that are CDS-positive and have a morphological pattern similar to MALT lymphoma. The case report and approach to the diagnosis is discussed

Occult oncocytoma of the lacrimal sac

Oncocytoma of the lacrimal sac is a rarely encountered clinical entity. We report the case of a 72-year-old female patient who was diagnosed to have bilateral nasolacrimal duct obstruction during a pre-cataract surgery screening. Subsequently, she underwent bilateral dacryocystectomy. Histopathological examination of the left lacrimal sac revealed a tumour composed of acini lined by oncocytic cells; features consistent with those of a lacrimal sac oncocytoma. Although rare, oncocytomas arising from the lacrimal sac may co-exist with a nasolacrimal duct obstruction. This report describes the histological and immunochemistry characteristics of oncocytomas and underscores the need to subject all excised lacrimal sacs to histopathological examination

Orbital solitary fibrous tumor with multinucleate giant cells: Case report of an unusual finding in an uncommon tumor.

Solitary fi brous tumor (SFT) is a rare soft-tissue neoplasm which may occur at any site although it is more frequent in the pleura, mediastinum and lung. Orbital involvement by SFT is uncommon. Giant cells are extremely rare to be seen in a SFT and have been described to be immunoreactive for CD34. We present a case of orbital SFT with multinucleate giant cells expressing CD68 and lacking immunoreactivity for CD34. The differential diagnosis is discussed.

Distant metastatic retinoblastoma without central nervous system involvement.

Retinoblastoma is the most common intraocular malignancy in children, with a reported incidence ranging from 1 in 15,000 to 1 in 18,000 live births. Metastatic retinoblastoma is rare in developed countries, with a reported range from 4.8% in the United States to 5.8% in the United Kingdom. However, the frequency reported from developing countries varies from 9 to 11% at presentation. The mortality is very high owing to late presentations, delayed diagnosis compounded by socio-economic factors. The management of metastatic retinoblastoma is evolving, but it is still a challenge in pediatric oncology. We present a case of an extensive skeletal metastasis that initially presented as a massive orbital retinoblastoma.

External dacryocystorhinostomy: tips and tricks

Dacryocystorhinostomy or DCR is one of the most common oculoplastics surgery performed. It is a bypass procedure that creates an anastomosis between the lacrimal sac and the nasal mucosa via a bony ostium. It may be performed through an external skin incision or intranasally with or without endoscopic visualization. This article will discuss the indications, goals, and simple techniques for a successful outcome of an external DCR

Bilateral multiple extraocular muscle metastasis from breast carcinoma.

We report a rare presentation of an initially misdiagnosed case of a pseudotumor, which on histopathology was diagnosed as bilateral breast metastases of lobular carcinoma involving multiple extraocular muscles. A 61-year-old lady presented with external ophthalmoplegia and diplopia. Incisional biopsy was performed using a lid crease approach and the patient received radiotherapy and hormonal therapy. Following prolonged hormonal therapy, complete remission was achieved, with improvement in ocular motility and resolution of diplopia, about 18 months after the initial presentation. Multiple extraocular muscle involvement by breast carcinoma metastasis is very rare and should be considered in the differential diagnosis, especially in patients with a prior history of breast carcinoma.

Splicing aberrations caused by constitutional RB1 gene mutations in retinoblastoma.

Analysis of RB1 mRNA from blood leukocytes of patients with retinoblastoma identified the effects of mutations involving consensus splice site, exonic substitution and whole-exon deletions identified in genomic DNA of these patients. In addition, this study identified mutations in cases in which no mutations were detectable in the genomic DNA. One proband had mutation at the canonical splice site at +5 position of IVS22, and analysis of the transcripts in this family revealed skipping of exon 22 in three members of this family. In one proband, a missense substitution of c.652T>G (g.56897T>G; Leu218Val) in exon 7 led to splicing aberrations involving deletions of exons 7 and 8, suggesting the formation of a cryptic splice site. In two probands with no detectable changes in the genomic DNA upon screening of RB1 exons and flanking intronic sequences, transcripts were found to have deletions of exon 6 in one, and exons 21 and 22 in another family. In two probands, RNA analysis confirmed genomic deletions involving one or more exons. This study reveals novel effects of RB1 mutations on splicing and suggests the utility of RNA analysis as an adjunct to mutational screening of genomic DNA in retinoblastoma.

Orbital retinoblastoma: present status and future challenges-a review

Orbital retinoblastoma is a catastrophic event traditionally carrying a dismal prognosis. Although its incidence is less in the developed countries it continues to be one of the major diagnosis at presentation in the developing world. Orbital retinoblastoma encompasses a wide range of distinct clinical entities with varying tumor load. There are no standard treatment protocols as of now but the current preferred management is multimodal with a combination of initial high-dose chemotherapy, surgery, external beam radiotherapy and prolonged chemotherapy for twelve cycles. In spite of progress on all fronts including surgical, medical, diagnostic, genetic and rehabilitative with improving survival rates, however, lack of access to medical facilities, lack of education about the need for early medical attention and cultural resistance to enucleation continue to contribute to an epidemic of extra ocular disease at diagnosis in the developing world. This review introduces the various terminologies used in the spectrum of orbital retinoblastoma, discusses in details the clinical aspects and management protocols, current status and the future directions

Orbital solitary fibrous tumor: a clinicopathologic correlation and review of literature

Orbital solitary fibrous tumor [SFT] is a rare tumor originating from the mesenchyme. Initially described in the pleura and subsequently in other mesenchymal structures, orbit continues to be one of the uncommon extrapleural sites. The diagnosis of orbital SFT cannot be made with certainty on clinical or radiological evaluation and requires histologic studies with immunohistochemical confirmation for which CD 34 is the most specific diagnostic test. We describe clinical presentations, radiological and operative findings, and pathological features of a patient with orbital SFT along with a review of literature