Eosinophilic granuloma: Presenting as a draining fistula.

A case report of an orbital eosinophilic granuloma presenting as a fistula in a 15-year-old boy is presented. The patient had a history of a painful right upper eyelid swelling which required drainage and was considered as an abscess. An increase in swelling occurred and a small fistula appeared in the area subsequently. Computed tomography scan revealed a large soft tissue lesion in right superolateral orbit having intracranial extradural extension with destruction of bony orbital margin. Fine needle aspiration biopsy of the lesion revealed eosinophilic granuloma. A complete excision of the lesion was performed by a brow incision and histopathological examination of the excised specimen confirmed diagnosis. Although upper eyelid area eosinophilic granuloma is known to occur, its presentation as a fistula is not known.

Oxidative stress profile in graves' ophthalmopathy in Indian patients.

PURPOSE: To report the oxidative stress profile in patient of Graves' ophthalmopathy and to study the effect of hormone level normalization on oxidative stress profile. METHODS: All first time reporting patients with Graves' ophthalmopathy to Department of ophthalmology CSM Medical University (erstwhile King George's Medical University) Lucknow during the period January 2006 to December 2008 formed the cohort. Before initiating treatment a proforma directed detailed history, complete ophthalmological examination and investigations were done. Blood sample for pro/antioxidant enzyme were withdrawn for study after taking an informed consent. Patients were treated with antithyroid drugs alone to achieve a stable euthyroid status for at least 6 months following which a blood sample was again withdrawn to study the pro/anti oxidant enzyme status following treatment. RESULTS: On normalization of thyroid status the values of reactive oxygen species decreased significantly (p<0.05) and levels of antioxidants also got corrected significantly (p<0.05). However both these values remained significantly (p<0.05) altered as compared to normal persons. CONCLUSION: We demonstrated that even after normalization of thyroid hormone level, the oxidative stress levels remain elevated. Moreover, activity of Superoxide Dismutase (SOD), Catalase (CAT), Glutathione reductase (GSHR), Glutathione peroxidise (GPx) showed decrease which could be attributed to altered metabolism and already prevalent deficiency of essential micronutrients like zinc, copper, mercury, and selenium in the Indian population. Hence, this gives way to the thought that the supplementation of these nutrients may have a role as an adjuvant to hormonal therapy in patients with Graves' ophthalmopathy.

Topical bevacizumab for corneal neovascularization after penetrating keratoplasty.

PURPOSE: To evaluate the efficacy of topical bevacizumab for corneal neovascularization in graft rejection. METHODS: A 55-year-old man presented with corneal neovascularization and graft rejection 6 months following penetrating keratoplasty (triple procedure) in the left eye. His best-corrected visual acuity (BCVA) was counting fingers at 1 meter. He was administered topical bevacizumab (4 mg/4 mL) in a dose of one drop twice a day for 15 days. No adjunct therapy was given during bevacizumab administration. RESULTS: After 1 month, his BCVA improved to 20/120. Corneal vascularization and stromal haze regressed. After 6 months, his BCVA improved to 20/60 with further regression in corneal vascularization and stromal haze. At 9-month follow-up, he maintained BCVA of 20/60. CONCLUSIONS: Short-term topical bevacizumab therapy may potentially offer a safer and more effective alternative in treating graft rejection after penetrating keratoplasty.