Oman Journal of Ophthalmology最新文献

Purpose: The purpose of this study was to evaluate the role of anterior segment optical coherence tomography (ASOCT) in the diagnosis and management of anterior scleritis.

Patients and methods: In this retrospective study, we examined 58 eyes of 44 patients with anterior scleritis. The unaffected eye served as a control. In bilateral cases, the less affected eye was taken as the control. ASOCT image over the inflamed area and over the corresponding same area in the control eye was taken. The images were analysed for the presence or absence of hyporeflective areas, and the mean total scleral thickness (MTST) was measured. Both the images were then compared.

Results: The mean age of our cohort was 51 ± 14.57 years. There were 14 males and 30 females. 68.18% (n = 30) were unilateral cases. The mean duration of anterior scleritis was 55.3 months, with 50% (n = 22) of patients having diffuse anterior scleritis. The majority of patients were treated with oral steroids (97.7%, n = 43) with or without the combination of immunosuppressant and biologics. The MTST during active disease (922.17 μm ± 252.03 μm) was statistically higher than the control group (798.05 μm ± 150.61 μm) (P = 0.005). The MTST in unilateral cases during active disease was 929.88 μm, which was significantly higher than in the control eyes (801.65 μm) (P = 0.02). There were 31 recurrent cases, of which 41.9% (n = 13) showed scleral thinning, and the mean scleral thinning in recurrent cases after treatment was 86.71 μm.

Conclusion: ASOCT serves as a useful qualitative and quantitative tool for monitoring of patients with anterior scleritis under treatment.

A 27-year-old male with pain, redness, and vision loss in the right eye was diagnosed with acute anterior uveitis with hypopyon and treated with topical corticosteroid and cycloplegic eyedrops. Two weeks later, he developed severe vitritis. Then, after 1 month of oral corticosteroid treatment, his condition did not improve; therefore, he underwent pars plana vitrectomy with intravitreal antimicrobial injection in the right eye with suspicion of endogenous endophthalmitis. Polymerase chain reaction (PCR) from vitreous aspirate were negative for herpes viruses, eubacterial and panfungal genomes. After 3 months, the patient developed a painful blind eye and was eviscerated. Histopathology and PCR from ocular specimens confirmed the presence of Mycobacterium tuberculosis. High-resolution computed tomography chest showed calcific nodules in the upper lobe of the right lung, and the Mantoux test was positive. Further inquiry revealed that the patient's father had pulmonary tuberculosis (TB) 4 years earlier. Ocular TB remains a great masquerader; the clinicians in the TB-endemic region must bear a high index of suspicion of TB while managing a case of endogenous endophthalmitis.

Parry-Romberg syndrome (PRS) is a rare, acquired condition characterized by progressive atrophy of the skin and soft tissue of one side. A 35-year-old female with a 4-year history of recurrent uveitis and hypotony in the right eye, previously diagnosed with granulomatous anterior uveitis and pars planitis, was referred to our clinic. Despite treatment, she continued to develop recurrences of inflammation, with intraocular pressure dropping to 0 mmHg twice. She was managed with periocular injection triamcinolone acetonide with systemic anti-inflammatory treatment. A dermatology consultation was sought based on a general examination that revealed hyperpigmented lesions on the right side of the forehead and scalp, as well as alopecia patches. The dermatologist diagnosed her with PRS. She was managed with oral methotrexate and subsequently did not develop any further recurrence of inflammation or hypotony. A literature search revealed 23 cases of PRS with uveitis. Most cases reported an early onset of PRS preceding a uveitis episode. The most common subtypes of uveitis were retinal vasculitis and Coats'-like response that were associated with inflammation in the anterior chamber and vitreous. PRS can be a rare cause of uveitis but can be often overlooked by clinicians. Such patients should be monitored closely, as they may develop ocular hypotony over time, but can be managed with aggressive treatment.

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare indolent tumor with predilection for periocular skin of elderly women. Although recurrences may occur, metastases are uncommon with EMPSGC. We present a case of EMPSGC of the eyelid as a presenting feature of invasive carcinoma of the breast in a male patient. A 71-year-old male presented with a right eyelid mass from the past 6 months. A wide excision biopsy with intraoperative frozen section margin control and reconstruction was done. Histopathology and immunohistochemistry (IHC) were suggestive of EMPSGC. On systemic examination, the patient had a breast mass 2 cm × 3 cm × 1 cm which he did not reveal at presentation. A Trucut biopsy was performed, and the histopathology was similar to the eyelid tumor. On positron emission tomography (PET) scan, there was uptake in the breast mass, axillary and mediastinal lymph nodes, and multiple nodular lesions in the lungs were noted. The patient underwent BRCA1/2 mutation test which revealed a variance of uncertain significance. In view of hormone receptor positivity, the patient was then started on hormonal therapy and the tumor showed significant regression on serial examination and successive PET scans. We discuss the management of the eyelid lesion and compare the histopathology and IHC of the primary and metastatic tumor.

Background: Congenital nasolacrimal duct obstruction (CNLDO) is a common condition in neonates, often requiring intervention when conservative treatments and simple probing fail. This study aimed to explore the efficiency and safety of endoscopic-guided bicanalicular (BC) and monocanalicular (MC) Ritleng intubation in treating CNLDO.

Methodology: This multicenter, prospective, nonrandomized comparative study was conducted between 2007 and 2022. The study included a total of 90 patients aged 24-53 months who had either failed probing or presented late with CNLDO. The participants were divided into two groups: 45 treated with BC and the other 45 with MC Ritleng intubation. Surgical procedures were performed under general anesthesia. Follow-up visits were scheduled at 1 week postoperatively, then at 1 month, and 3 months after stent removal. Finally, postoperative outcomes were analyzed.

Results: The clinical success rates were comparable, with BC achieving 93.3% and MC achieving 92.2% (P = 0.68). BC intubation was associated with a higher complication rate (28.9%) compared to MC (4.4%), with a statistically significant difference (P = 0.004). The study also revealed the absence of significant associations between the incidence of complications and age, gender, or preexisting conditions (P = 0.90).

Conclusions: Both BC and MC Ritleng intubation are effective treatments for late-presenting CNLDO and cases following failed probing. However, MC intubation stands out as a safer and quicker option, significantly reducing the risk of complications. This study emphasizes the advantages of MC Ritleng intubation for pediatric patients with CNLDO.

Juvenile xanthogranuloma (JXG) is a rare, benign granulomatous disorder predominantly affecting young children, characterized by the presence of Touton giant cells. While typically presenting as cutaneous lesions, JXG can also involve the eyes, potentially leading to severe complications such as hyphema and glaucoma. Here, we present the case of an 11-month-old girl with multifaceted systemic and ocular manifestations of JXG. She presented with unilateral redness, watering, photophobia, and hyperpigmented nodules distributed across her body. Ocular examination revealed hyphema, heterochromia iridis, fibrinous reaction, and elevated IOP with signs of glaucomatous optic neuropathy. Despite initial treatment with topical steroids and antiglaucoma medications, the patient experienced recurrent hyphema. Further evaluation identified peripheral anterior synechiae and delicate vessels spanning the trabecular meshwork. Histopathological analysis of the skin nodules confirmed the diagnosis of JXG, with systemic involvement noted in the spleen and other organs. Multidisciplinary management, including chemotherapy, resulted in the regression of hyphema and the fibrinous reaction. This case underscores the importance of comprehensive evaluation and a multidisciplinary approach in managing JXG, highlighting the challenges faced by ophthalmologists in preventing complications such as rebleeding and refractory glaucoma.