Caruncular late-onset junctional nevus: apropos of an anatomo-clinical observation.

Conjunctival nevi are benign tumors, most often located at the nasal or temporal limbus, and rarely in the fornix or tarsus. The vast majority of caruncular tumors are benign and only few are malignant. Most of the caruncular tumors (either benign or malignant) are nevi. We report a case of a 75-year-old female patient presenting caruncular atypical late-onset junctional nevus that clinically arose malignancy suspicion. Ophthalmologic macroscopic examination and slit lamp examination of the right eye were performed. Further blood tests were performed. Carunclectomy was performed two days after admission to hospital. Microscopy revealed the junctional localization, diffuse proliferation of the nevocytes. Immunoreactions with S100 and human melanoma black 45 (HMB45) antibodies were performed. Differential diagnosis of these lesions represents a great challenge. The greatest challenge represents the differential diagnosis between a benign tumor and a malignant life-threatening one, the malignant melanoma, especially with unusual presentation. The presence of a late-onset caruncular tumor with uncertain evolution requires excision biopsy to determine the diagnosis and to establish the best management.

Ossification of the choroid: three clinical cases and literature review of the pathogenesis of intraocular ossification.

OBJECTIVE: A presentation of the clinical and pathogenic aspects of choroidal ossification. CASES PRESENTATION: We report three clinical cases of choroidal ossification: choroidal osteoma, ossified choroidal hemangioma and total ossification of the choroid. The three patients underwent complete eye examination. The optical microscopy of a sample of ossified choroidal tissue revealed a spongy, osseous structure consisting of circular osseous lamellae, osteocytes, canaliculi and adipose tissue with microfoci of calcification. DISCUSSION: Choroidal ossification is characterized by reduced frequency of occurrence, accessible clinical diagnosis, and unspecified pathogenesis. Several of the factors identified in the pathogenesis of intraocular ossification may play a role in the ossification of the choroid: chronic inflammatory cells, bone morphogenetic proteins, growth factors and mesenchymal stem cells. In addition to these factors, pericytes have a special role in the pathogenesis of choroidal ossification. Under the influence of bone morphogenetic proteins and growth factors, mesenchymal stem cells differentiate into osteoblasts. They secrete bone matrix (osteoid), whose regeneration and remodeling lead to the formation of bone tissue. The spongy bone structure of choroidal tissue points to a model of endoconjunctive/desmal ossification. CONCLUSIONS: The knowledge of the clinical aspect of ossification of the choroids is required for the differential diagnosis with the posterior pole affections, and also for the prevention and treatment of secondary complications.

Myxoid/round cell conjunctival liposarcoma. A case report.

PURPOSE: To present a rare case of conjunctival myxoid liposarcoma, subtype round cells, that had a seven years follow up. CLINICAL OBSERVATION: A 61-year-old female patient presents with a palpable, non-painful tumor, on the superior temporal bulbar conjunctiva of the right eye. The initial examination detects a fleshy tumor, orange in color, under the superior temporal bulbar conjunctiva, as well as two oval-shaped hyperpigmented conjunctival lesions, near the limbus at 10 o'clock, causing moderate blepharoptosis. Vision was normal, there was no diplopia, proptosis, afferent pupillary defect or lymphadenopathy; there was no orbital involvement in MRI. An isolated 15/15 mm tumor, with no connections with the eye socket, was excised. Histopathology revealed a poorly differentiated myxoid liposarcoma. Five recurrences occurred, of which four were treated by local excision and the last required exenteration. Repeat histopathology detects lipoblasts, small round cells, with immunohistochemistry positive for CD34, S100 and vimentin. The last two rapidly evolving and large recurrences, as well as pulmonary metastasis and finally death of the patient, underlined the aggressive character of round cell conjunctival liposarcoma. CONCLUSIONS: Conjunctival myxoid liposarcoma is characterized by numerous local recurrences, but the speed of the succession and volume of the recurrences may suggest a change in the underlying histopathological aspect, that is definitory for the therapeutical and prognostic approach of the case.

[Serous macular detachment associated with circumscribed choroidal hemangioma: a case report]. / Decolare seroasa maculara asociata hemangiomului coroidian circumscris--apropo de un caz clinic.

INTRODUCTION: Choroidal hemangiomas are benign vascular hamartomas that typically present from second to fourth decade of life, when they can cause visual disturbance due to exudative retinal detachment. They represent uncommon benign choroidal vascular tumors, usually occuring sporadically in the absence of systemic disease. MATERIAL AND METHODS: We report the case of a young female patient, presenting a juxtapapillary circumscribed choroidal haemangioma complicated with serous macular detachment. The patient underwent photodynamic therapy with verteporfin (PDT). Systematic follow-up using ophthalmoscopy, ultrasonography, Fluorescein angiography and Indocyanine green angiography was performed. RESULTS: The patient presented regression with flattening of tumour, resolution of the subretinal fluid, and significant improvement of vision. DISCUSSIONS, CONCLUSIONS: Mostly asymptomatic, the choroidal hemangiomas can be associated with serous retinal detachment, leading to reduced vision and metamorphopsia; in those cases, the long term visual prognosis is poor, even in adequately treated patients. PDT is effective in eliminating the subretinal fluid and improving vision in patients with circumscribed choroidal hemangioma.

[Idiopatic parafoveolar telangiectasia associated with pseudoviteliform lesion, basal laminar drusen and optic nerve head drusen]. / Telangiectazia parafovieolara idiopatica asociata cu leziune pseudoviteliforma, drusen laminar bazal si drusen papilar.

BACKGROUND: We present a case with bilateral optic disc drusen, associated in one eye with idiopathic parafoveal telangiectasis (Group 1B), basal laminar drusen, and foveal pseudovitelliform lesion. PATIENT: A 45-years old female patient, which complained about a deterioration of vision at the right eye, was ophthalmologically examined. RESULTS: The examination revealed a bilateral optic disc drusen, and on the right eye a macular haemorrhage. An examination after 2 months revealed a good vision, the resorption of the macular haemorrhage, idiopathic parafoveal telangiectasis, basal laminal drusen, and a foveal pseudovitelliform lesion. CONCLUSIONS: The association is of importance because of the rarity of the haemorrhagic complication in the idiopathic parafoveal telangiectasis (Group IB), the possibility of a pathogenic correlation, and the difficulty of differential diagnosis with the optic disc drusen complicated with retinal haemorrhages. This association was not found in the literature we consulted.

[Multiple optic disc--myth or reality]. / Papila optica supranumerara: mit sau realitate.

OBJECTIVE: To study the clinical aspects of multiple optic papilla. CLINICAL OBSERVATION: We present 2 cases with multiple optic papilla. First case, with an aspect of duplicated double papilla, where at the supranumerary papilla we noticed a cilioretinal artery. The second case, with pseudo-double papilla, in context of a medium myopia, with visualization of the choroidal circulation. DISCUSSIONS AND CONCLUSIONS: The diagnosis of multiple optic papilla is difficult. Its support requires the presence of multiple conditions: double papillary margins, central vascularization with separate emergence, synchronous vascular pulsation, imagistic and morphopathologic arguments. So far no clinical case with those required conditions was ever published.

[Diffuse choroidal hemangioma associated with serous retinal detachment]. / Hemangiomul coroidian difuz partial osificat, asociat cu decolare retiniana seroasa exsudativa.

A 53-years old patient, with the diagnosis of diffuse choroidal hemangioma, partially ossified, associated with serous exudative retinal detachment, secondary to the choroidal neovessels, is presented. Aspects of differential diagnosis with the choroidal osteoma associated with serous exudative retinal detachment are discussed.

[Wyburn-Mason syndrome]. / Sindromul Wyburn-Mason.

INTRODUCTION: The Wyburn-Mason or Bonnet, Dechaume, and Blanc syndrome is a rare congenital anomaly formed of malformations of the retinal vessels, orbito-cerebral vessels, and, rarely, facial vessels. CASE REPORT: Male patient, 19 years old, examined because of a severe visual loss and exophthalmos at the left eye. The ophthalmoscopic examination reveals extensive retinal arterio-venous malformations, also confirmed at orbito-cerebral level by ultrasound and MRI DISCUSSION: The Wyburn-Mason syndrome is due to arterio-venous anastomosis, being included in the phakomatosis group. Clinically we describe 3 groups of severity. Aspects of differential diagnosis, pathogeny, and treatment are discussed. CONCLUSIONS: The Wyburn-Mason syndrome can be suspected in cases of facial angioma, exophthalmos, or decreased visual acuity. The diagnosis imposes additional examinations with orbito-cerebral imagery.

[Combined hamartoma of pigment epithelium and retina]. / Hamartomul combinat al epiteliului pigmentar si retinei.

This is the description of the case of a 36 year old male, who developed a combined hamartoma of the pigment epithelium and retina in the left eye. The location of the lesion in the macular zone, as well as the peculiar aspect of disease, raised some issues related to differential diagnosis. Attention was paid to the diseases of the posterior pole of eyeball, which, given their aspect of disease, result of a secondary hyperplastic reaction of the EPR, can embody a type of combined pseudohamartoma: retraction syndrome, retinal angiomatosis, pseudohistoplasmosis and others. A 5 years clinical supervision of the patient didn't show major changes.

[Congenital retinal macro-vessel]. / Macro-vas retinian congenital.

This is to show the case of a 40 year old patient, where a congenital retinal macro-vessel was found, the peculiarities of which are increased calibre, intersection of the macular area, arteriovenous shunts and lack of functional disturbances. The disease is rare and its lesional and functional stability is remarkable.

[Unilateral myelinated nerve fibers associated with myopia or amblyopia]. / Fibrele nervoase retiniene mielinizate unilaterale asociate cu miopia anisometropica, ambliopie si strabism.

There are described a number of 9 clinical cases with unilateral myelinated nerve fibers, associated with myopia or amblyopia. Four cases developed extended myelinated areas, anisometropia with increased values, accentuated amblyopia and macular changes. Patients underwent treatment for amblyopia through correction with spectacles lenses and the occlusion of the congenerous eye. The obtained functional results differentiated the casemix in two groups: with therapeutic failure, 4 cases, characterized by extended myelination, anisometropia with an average of over -10 diopters and macular changes. with therapeutic success, 5 cases, characterized by reduced myelination, anisometropia with an average of over -4 diopters and normal maculae. It has been found a significantly statistical difference between the two groups as regarding the value of the anisometropia. However, the macular aspect has been an important factor in order the therapeutic effect to succeed. This clinical syndrome is differentiated from the unilateral simple myopia with amblyopia and from the myelinated nerve fibers without myopia or amblyopia.

[Neosynephrine mydriasis combined with general anesthesia with halothane in ocular surgery]. / Oportunitatea asocierii midriazei prin neosinefrin cu anestezia generala cu halotan în chirurgia oculara.

Ophthalmologic surgical interventions are performed in numerous cases under general anaesthesia with halothane, many of which requiring a preoperatory mydriasis. Neosinerfin is alpha-adrenoceptive sympathomimetic. Local use, in a 10% concentration produces a strong mydriasis, resistant to the opening of the aqueous chamber during the intervention. Its systemic effects are remarkable: it induces a peripheral blood vessel constriction which can unleash a reflex bradycardia followed by a shortcoming of the cardiac flow. The halothane has various effects upon the heart: reduces the cardiac frequency, reduces the conduction speed of the cardiac impulse stimulating rhythm disorders, sensitizes the myocardium to the action of adrenaline, diminishes the heart's contraction force and the cardiac flow. The cumulative effects of seosinefrin and halothane cause major cardio-vascular changes: sinus bradycardia, ventricular arrhythmia, arterial hypotension. These are reasons for which the pre- and intraoperatory use of neosinefrin is unadvisable. Under this circumstances the collaboration between the ophthalmologist and anesthesiologist is very important, each of them having specific tasks. The ophthalmologist: preoperatory, the optimal pupillary dilatation may be obtained with tropicamide and diclofenac 0.1%, preoperatory, if the general anesthesia must be combined with local anesthesia, anesthetics in association with adrenalin should not be used; immediately postoperatory local use of atropine should be applied with cautiousness. The anesthesiologist: preoperatory he will not interrupt anti-hypertensive, anti-arrhythmia, anti-angina medication, with the mention that adrenoceptive alpha blockers (Prazosin) are indicated in comparison to adrenoceptive beta blockers because they diminish the risk of rhythm disorders; the use of clonidine and avoiding of phenobarbital in the premedication of the patient. As far as it is possible, it is recommended that halothane is replaced with izofluran or enfluran or enfluran which have a great tolerance to exogenous adrenoceptives.