Hem Narayan Singh, Natasha Dogra, Divya Shelly, Amit Kumar Das, Manoj Pant
Eccrine hidrocystomas are a rare, benign cystic lesion of the skin primarily found in the head and neck region, with a predilection for the periorbital area in adult females. These cysts typically present as small, tense, thin-walled structures ranging from 1 to 6 mm in size, occurring either as solitary entities or in multiples. Despite their benign nature, eccrine hidrocystomas pose diagnostic challenges due to their resemblance to malignant lesions both clinically and in imaging studies. This study aims to explore the varied clinical presentations of eccrine hidrocystoma and discuss the complexities associated with its diagnosis. Five cases were included in the study along with a comprehensive review of the existing literature. We emphasize the importance of accurate and early diagnosis for appropriate management. The clinical manifestations of eccrine hidrocystoma often overlap with features suggestive of malignancy, underscoring the necessity for meticulous histopathological examination to definitively differentiate between these entities. This differentiation is crucial as it impacts treatment decisions and patient outcomes. In conclusion, our study underscores the diagnostic dilemmas posed by eccrine hidrocystoma, highlights its potential mimicry of malignancy, and emphasizes the significance of histopathological evaluation in achieving accurate diagnosis and guiding management strategies.
{"title":"Eccrine hidrocystomas: A distinct clinicopathologic entity and a potential mimicker of malignancy—A case series with a review of the literature","authors":"Hem Narayan Singh, Natasha Dogra, Divya Shelly, Amit Kumar Das, Manoj Pant","doi":"10.4103/hjo.hjo_8_24","DOIUrl":"https://doi.org/10.4103/hjo.hjo_8_24","url":null,"abstract":"\u0000 \u0000 \u0000 Eccrine hidrocystomas are a rare, benign cystic lesion of the skin primarily found in the head and neck region, with a predilection for the periorbital area in adult females. These cysts typically present as small, tense, thin-walled structures ranging from 1 to 6 mm in size, occurring either as solitary entities or in multiples. Despite their benign nature, eccrine hidrocystomas pose diagnostic challenges due to their resemblance to malignant lesions both clinically and in imaging studies. This study aims to explore the varied clinical presentations of eccrine hidrocystoma and discuss the complexities associated with its diagnosis.\u0000 \u0000 \u0000 \u0000 Five cases were included in the study along with a comprehensive review of the existing literature. We emphasize the importance of accurate and early diagnosis for appropriate management. The clinical manifestations of eccrine hidrocystoma often overlap with features suggestive of malignancy, underscoring the necessity for meticulous histopathological examination to definitively differentiate between these entities. This differentiation is crucial as it impacts treatment decisions and patient outcomes.\u0000 \u0000 \u0000 \u0000 In conclusion, our study underscores the diagnostic dilemmas posed by eccrine hidrocystoma, highlights its potential mimicry of malignancy, and emphasizes the significance of histopathological evaluation in achieving accurate diagnosis and guiding management strategies.\u0000","PeriodicalId":370883,"journal":{"name":"Himalayan Journal of Ophthalmology","volume":"172 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present a challenging case of a 60-year-old female who underwent cataract surgery in the right eye (RE) 10 years back. On presentation, visual acuity in RE with aphakic correction was 6/18, and the patient had a superior corneal scar with iris incarceration. Fundus examination revealed an attached retina and healthy optic nerve head with two dislocated rigid intraocular lenses (IOLs). The patient underwent vitrectomy with temporal scleral tunnel for explanting the IOLs. The same tunnel was used for scleral fixation of IOL whose haptics were buried into two opposite-facing scleral partial thickness scleral tunnels made at 12 and 6 o’clock. Thus, we describe a newer technique of sutureless scleral fixated IOL where scleral pockets are used for fixating three-piece IOL without the use of any suture, glue, or specialized IOL.
{"title":"Triple tunnel and triple intraocular lenses (IOL): Modified scleral fixated IOL in a case of double dislocated IOL","authors":"G. Sood, Sandeep Mahajan","doi":"10.4103/hjo.hjo_10_24","DOIUrl":"https://doi.org/10.4103/hjo.hjo_10_24","url":null,"abstract":"\u0000 We present a challenging case of a 60-year-old female who underwent cataract surgery in the right eye (RE) 10 years back. On presentation, visual acuity in RE with aphakic correction was 6/18, and the patient had a superior corneal scar with iris incarceration. Fundus examination revealed an attached retina and healthy optic nerve head with two dislocated rigid intraocular lenses (IOLs). The patient underwent vitrectomy with temporal scleral tunnel for explanting the IOLs. The same tunnel was used for scleral fixation of IOL whose haptics were buried into two opposite-facing scleral partial thickness scleral tunnels made at 12 and 6 o’clock. Thus, we describe a newer technique of sutureless scleral fixated IOL where scleral pockets are used for fixating three-piece IOL without the use of any suture, glue, or specialized IOL.","PeriodicalId":370883,"journal":{"name":"Himalayan Journal of Ophthalmology","volume":"84 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shrinkhal, Pragati Garg, Ruchi Shukla, S. Singh, Nilakshi Banerjee
A 34-year-old male presented with a sudden, painless decrease in vision in both eyes in the past 7 days. He had a history of an episode of fever 7 days before ocular symptoms and had been treated with three doses of injection cefixime (1.5 g) and antipyretics based on a positive Widal test. On detailed fundus examination, both eyes showed creamy white superficial lesions with ill-defined margins, suggestive of retinitis, with a few hemorrhages along the inferior arcade. The diagnosis of both eyes’ post-typhoid fever retinitis was made, and he was investigated for complete blood count, peripheral smear, erythrocyte sedimentation rate, and human immunodeficiency virus Tridot test, which were normal. He was treated with oral cefixime (400 mg) twice daily and oral prednisolone 1 mg/kg body weight for 7 days. The patient showed significant improvement after the treatment.
{"title":"Post-typhoid fever retinitis","authors":"Shrinkhal, Pragati Garg, Ruchi Shukla, S. Singh, Nilakshi Banerjee","doi":"10.4103/hjo.hjo_13_24","DOIUrl":"https://doi.org/10.4103/hjo.hjo_13_24","url":null,"abstract":"\u0000 A 34-year-old male presented with a sudden, painless decrease in vision in both eyes in the past 7 days. He had a history of an episode of fever 7 days before ocular symptoms and had been treated with three doses of injection cefixime (1.5 g) and antipyretics based on a positive Widal test. On detailed fundus examination, both eyes showed creamy white superficial lesions with ill-defined margins, suggestive of retinitis, with a few hemorrhages along the inferior arcade. The diagnosis of both eyes’ post-typhoid fever retinitis was made, and he was investigated for complete blood count, peripheral smear, erythrocyte sedimentation rate, and human immunodeficiency virus Tridot test, which were normal. He was treated with oral cefixime (400 mg) twice daily and oral prednisolone 1 mg/kg body weight for 7 days. The patient showed significant improvement after the treatment.","PeriodicalId":370883,"journal":{"name":"Himalayan Journal of Ophthalmology","volume":"303 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Cutaneous involvement primarily affects the central face, with findings, such as persistent centrofacial redness, papulopustules, flushing, telangiectasia, and phymatous skin changes (e.g., rhinophyma). Ocular involvement may manifest with lid margin telangiectases, conjunctival injection, ocular irritation, or other signs and symptoms. In this review, we focus on the ophthalmological manifestations of rosacea and its management.
{"title":"Ophthalmological involvement in rosacea: Ocular rosacea","authors":"N. Kansal, Anupam Singh, Barun Kumar","doi":"10.4103/hjo.hjo_16_24","DOIUrl":"https://doi.org/10.4103/hjo.hjo_16_24","url":null,"abstract":"\u0000 Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Cutaneous involvement primarily affects the central face, with findings, such as persistent centrofacial redness, papulopustules, flushing, telangiectasia, and phymatous skin changes (e.g., rhinophyma). Ocular involvement may manifest with lid margin telangiectases, conjunctival injection, ocular irritation, or other signs and symptoms. In this review, we focus on the ophthalmological manifestations of rosacea and its management.","PeriodicalId":370883,"journal":{"name":"Himalayan Journal of Ophthalmology","volume":"15 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Strabismus surgery in a scleral buckle patient is a challenging task that requires precise planning and meticulous surgical skills to accomplish a successful outcome. We report a case of a 32-year-old male who presented with complaints of diminution of vision in the right eye (RE) for 23 years and outward deviation of RE for 5 years after blunt trauma with a ball. The patient was diagnosed with RE total retinal detachment (RD) with traumatic retinal dialysis. He underwent scleral buckling as RD surgery in 2004 followed by silicon oil removal 6 months later elsewhere. On ocular examination of the RE, the best corrected visual acuity was perception of light with accurate projection of rays in all four quadrants, there was grade III relative afferent pupillary defect with an exotropia of 20° on Hirschberg test. The prism bar reflex test revealed an exotropia of 50 prism diopters (PD) [Figure 1]. An anterior segment examination revealed posterior subcapsular and cortical cataracts. After taking a retina clinic opinion, the patient underwent uneventful RE cataract surgery with in-bag implantation of a foldable implant cataract surgery first, followed by strabismus surgery under a guarded visual prognosis. Clinically significant adhesion and the presence of the scleral buckle posed a magnificent challenge during the strabismus surgery. The plan was improvised to 8 mm lateral rectus recession with 4 mm hang loose recession irrespective of a large deviation under local anesthesia. To our surprise, a satisfactory primary position alignment within 10 PD (orthophoria) was achieved, which was maintained on subsequent follow-up visits. We report an interesting and challenging case of restrictive strabismus due to scleral buckle which emphasizes that surgical procedures and their outcomes may not always align with expectations. Therefore, it is necessary to adopt a flexible and customized approach to effectively manage such instances.
巩膜扣带患者的斜视手术是一项具有挑战性的任务，需要精确的计划和细致的手术技巧才能取得成功。我们报告了一例 32 岁男性患者的病例，他主诉右眼（RE）视力减退 23 年，球类钝性外伤后 RE 向外偏斜 5 年。患者被诊断为右眼全视网膜脱离（RD）并伴有外伤性视网膜透析。2004 年，他接受了作为 RD 手术的巩膜扣带术，6 个月后在其他地方接受了硅油摘除术。经眼部检查，RE 的最佳矫正视力为感光，光线在四个象限均能准确投射，瞳孔相对传入缺损为 III 级，赫氏试验显示外斜 20°。棱镜条反射测试显示外斜 50 个棱镜屈光度（PD）[图 1]。眼前节检查发现后囊下白内障和皮质白内障。在听取了视网膜诊所的意见后，患者接受了顺利的 RE 白内障手术，首先进行了袋内植入可折叠人工晶体的白内障手术，随后在视力预后良好的情况下进行了斜视手术。临床上明显的粘连和巩膜扣的存在给斜视手术带来了巨大挑战。在局部麻醉的情况下，考虑到偏差较大，我们临时将计划改为外侧直肌后退 8 毫米，悬吊松弛后退 4 毫米。出乎我们意料的是，在 10 PD（正位）范围内实现了令人满意的原位对齐，并在随后的随访中保持不变。我们报告了一例有趣而具有挑战性的巩膜扣带引起的限制性斜视病例，强调了手术过程及其结果并不总是与预期一致。因此，有必要采取灵活和个性化的方法来有效处理此类情况。
{"title":"A challenging case of scleral buckle-related restricted strabismus with unexpected good postoperative outcomes: A case report","authors":"Shreya Angrish, Kiran Bala Malik, Shreya Mishra, Anam Ansari, Anupam Singh","doi":"10.4103/hjo.hjo_12_24","DOIUrl":"https://doi.org/10.4103/hjo.hjo_12_24","url":null,"abstract":"\u0000 Strabismus surgery in a scleral buckle patient is a challenging task that requires precise planning and meticulous surgical skills to accomplish a successful outcome. We report a case of a 32-year-old male who presented with complaints of diminution of vision in the right eye (RE) for 23 years and outward deviation of RE for 5 years after blunt trauma with a ball. The patient was diagnosed with RE total retinal detachment (RD) with traumatic retinal dialysis. He underwent scleral buckling as RD surgery in 2004 followed by silicon oil removal 6 months later elsewhere. On ocular examination of the RE, the best corrected visual acuity was perception of light with accurate projection of rays in all four quadrants, there was grade III relative afferent pupillary defect with an exotropia of 20° on Hirschberg test. The prism bar reflex test revealed an exotropia of 50 prism diopters (PD) [Figure 1]. An anterior segment examination revealed posterior subcapsular and cortical cataracts. After taking a retina clinic opinion, the patient underwent uneventful RE cataract surgery with in-bag implantation of a foldable implant cataract surgery first, followed by strabismus surgery under a guarded visual prognosis. Clinically significant adhesion and the presence of the scleral buckle posed a magnificent challenge during the strabismus surgery. The plan was improvised to 8 mm lateral rectus recession with 4 mm hang loose recession irrespective of a large deviation under local anesthesia. To our surprise, a satisfactory primary position alignment within 10 PD (orthophoria) was achieved, which was maintained on subsequent follow-up visits. We report an interesting and challenging case of restrictive strabismus due to scleral buckle which emphasizes that surgical procedures and their outcomes may not always align with expectations. Therefore, it is necessary to adopt a flexible and customized approach to effectively manage such instances.","PeriodicalId":370883,"journal":{"name":"Himalayan Journal of Ophthalmology","volume":"2013 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mittali Khurana, Omna Chawla, Anupam Singh, P. Panda, I. Sharawat, S. Mittal, Barun Kumar
The purpose of this study is to explore any association between body mass index (BMI) and anthropometric parameters and amblyopia in children and adolescents. A total of 82 participants, aged 4–18 years, were included in this cross-sectional, observational study. The anthropometric parameters, which included height, weight, and BMI Z score, were assessed in a subset of amblyopic children and adolescents. We compared these parameters with the healthy age and gender-matched control group. The results revealed that out of all 82 participants, the mean age of 55 amblyopes was 9.11 ± 4.06 years (range, 4–18 years), and that of controls was 8.44 ± 3.69 years (range, 4–17 years). The mean ± standard deviation (SD) of height (cm) and weight (kg) in amblyopia was 129.69 ± 19.01 cm and 29.27 ± 12.01 kg, respectively, and in controls, it was 124.43 ± 13.83 cm (P = 0.159) and 27.01 ± 9.89 kg (P = 0.399). The median (25th–75th percentile) of the BMI Z score in the amblyopia group was -0.27 (-1.365 to 0.885), and in controls was 0.00.01 (-0.85885; P = 0.399). We did not find any clinically or statistically significant difference in the above parameters between cases and controls. This study concludes that amblyopes do not have deranged BMI and anthropometric parameters in the early years of life. Ophthalmologists are the primary healthcare professionals who have a crucial role in prompt identification and intervention to prevent long-term vision impairments in patients with amblyopia. Enhancements in visual acuity are expected to improve their overall quality of life and social well-being, which may reduce the other negative consequences in the form of deranged BMI and other related morbidities in their adulthood.
{"title":"Association of amblyopia and body mass index in children and adolescents","authors":"Mittali Khurana, Omna Chawla, Anupam Singh, P. Panda, I. Sharawat, S. Mittal, Barun Kumar","doi":"10.4103/hjo.hjo_11_24","DOIUrl":"https://doi.org/10.4103/hjo.hjo_11_24","url":null,"abstract":"\u0000 \u0000 \u0000 The purpose of this study is to explore any association between body mass index (BMI) and anthropometric parameters and amblyopia in children and adolescents.\u0000 \u0000 \u0000 \u0000 A total of 82 participants, aged 4–18 years, were included in this cross-sectional, observational study. The anthropometric parameters, which included height, weight, and BMI Z score, were assessed in a subset of amblyopic children and adolescents. We compared these parameters with the healthy age and gender-matched control group.\u0000 \u0000 \u0000 \u0000 The results revealed that out of all 82 participants, the mean age of 55 amblyopes was 9.11 ± 4.06 years (range, 4–18 years), and that of controls was 8.44 ± 3.69 years (range, 4–17 years). The mean ± standard deviation (SD) of height (cm) and weight (kg) in amblyopia was 129.69 ± 19.01 cm and 29.27 ± 12.01 kg, respectively, and in controls, it was 124.43 ± 13.83 cm (P = 0.159) and 27.01 ± 9.89 kg (P = 0.399). The median (25th–75th percentile) of the BMI Z score in the amblyopia group was -0.27 (-1.365 to 0.885), and in controls was 0.00.01 (-0.85885; P = 0.399). We did not find any clinically or statistically significant difference in the above parameters between cases and controls.\u0000 \u0000 \u0000 \u0000 This study concludes that amblyopes do not have deranged BMI and anthropometric parameters in the early years of life. Ophthalmologists are the primary healthcare professionals who have a crucial role in prompt identification and intervention to prevent long-term vision impairments in patients with amblyopia. Enhancements in visual acuity are expected to improve their overall quality of life and social well-being, which may reduce the other negative consequences in the form of deranged BMI and other related morbidities in their adulthood.\u0000","PeriodicalId":370883,"journal":{"name":"Himalayan Journal of Ophthalmology","volume":"117 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Artificial intelligence applications for pediatric ophthalmology; a long way to go","authors":"Anupama Singh","doi":"10.4103/hjo.hjo_14_23","DOIUrl":"https://doi.org/10.4103/hjo.hjo_14_23","url":null,"abstract":"","PeriodicalId":370883,"journal":{"name":"Himalayan Journal of Ophthalmology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123895225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a case of 46-year-old male who had progressive visual loss in right eye for 1 month, preceded by pain. He had visual acuity of hand movement at presentation and examination revealed a choroidal mass lesion in the superior quadrant with exudative retinal detachment. Systemic workup was inconclusive. Fluorescein angiography revealed speckled fluorescence contrary to hypo fluorescence of choroiditis, and the presence of T sign on B-scan led us to the diagnosis of nodular posterior scleritis (NPS). The patient was treated with oral steroids and visual acuity recovered to 6/6. NPS can present as a choroidal mass resembling granuloma; careful workup and investigations can diagnose the entity and result in good treatment outcome.
{"title":"Solitary choroidal mass: A diagnostic dilemma","authors":"G. Sood, S. Mahajan, S. Sood","doi":"10.4103/hjo.hjo_9_23","DOIUrl":"https://doi.org/10.4103/hjo.hjo_9_23","url":null,"abstract":"We report a case of 46-year-old male who had progressive visual loss in right eye for 1 month, preceded by pain. He had visual acuity of hand movement at presentation and examination revealed a choroidal mass lesion in the superior quadrant with exudative retinal detachment. Systemic workup was inconclusive. Fluorescein angiography revealed speckled fluorescence contrary to hypo fluorescence of choroiditis, and the presence of T sign on B-scan led us to the diagnosis of nodular posterior scleritis (NPS). The patient was treated with oral steroids and visual acuity recovered to 6/6. NPS can present as a choroidal mass resembling granuloma; careful workup and investigations can diagnose the entity and result in good treatment outcome.","PeriodicalId":370883,"journal":{"name":"Himalayan Journal of Ophthalmology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133509143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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