Primary orbital neuroblastoma with intraocular extension.

Neuroblastoma is an undifferentiated malignancy of primitive neuroblasts. Neuroblastoma is among the most common solid tumors of childhood. Orbital neuroblastoma is typically a metastatic tumor. In this case report, we describe a 2-year-old child with a rapidly progressing orbital tumor. Computed tomography revealed an orbital mass lesion with extraocular and intraocular components. An incisional biopsy was done, and a histopathological examination showed features suggestive of neuroblastoma. Systemic workup including ultrasonography of the abdomen, chest roentgenogram, whole body computed tomography, and bone scintigraphy showed no evidence of systemic involvement. The diagnosis of primary orbital neuroblastoma was made, and the child was subjected to chemotherapy followed by rapid melting of the tumor. Neuroblastoma should be considered in the differential diagnosis of childhood orbital tumors.

A case to illustrate the role of ophthalmologist in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) affects the eye as part of the disease or due to the drugs used in therapy. Ocular involvement is seen in one third of the patients with SLE. SLE is rare in India and found less frequently in males and children. SLE retinopathy is usually bilateral. We report an unusual case of unilateral macular infarction in a boy caused by systemic lupus erythematosus. A fourteen year old boy was presented with skin rashes and loss of vision in left eye. Posterior segment examination showed hyperemic edematous disc, arteriolar attenuation, venous dilatation, multiple cotton wool spots around the disc and macula in the left eye. There was no improvement in vision with pulse steroids and cyclophosphamide. The clinical implication of SLE retinopathy is that the disease is severe and warrants systemic immunosuppressive therapy. SLE-induced macular infarction is rare and has poor visual prognosis. As serious ocular complications of SLE can be silent, routine ophthalmological evaluation is warranted in all patients.

Retinopathy in preeclampsia: association with birth weight and uric acid level.

PURPOSE: In a retrospective study of patients with preeclampsia and patients with pregnancy-induced hypertension (PIH) who delivered at term, the association of retinopathy with various clinical and laboratory manifestations and fetal birth weight was evaluated. METHODS: Medical records of patients with preeclampsia and patients with PIH who delivered at term between January 2003 and December 2004 were reviewed. Patients with preterm delivery, eclampsia, intrauterine fetal death, congenital defect in the fetus, and other systemic disorders were excluded. Parameters analyzed were retinopathy, systolic and diastolic blood pressure (BP), fetal birth weight, and various biochemical parameters. Multivariable linear regression was used for statistical analysis. P < or = 0.05 was considered significant. RESULTS: Forty patients were included in the preeclampsia group (study group) as well as in the PIH group (control group). Severity of retinopathy was found to be inversely related to fetal birth weight (P = 0.044) and positively related to serum uric acid level (P = 0.022) in the preeclampsia group. All other variables in the preeclampsia group including systolic BP (mean, 154.6 mmHg; P = 0.792) and diastolic BP (mean, 105.7 mmHg; P = 0.102) were found to have no significant association with retinopathy. In the PIH group, none of the parameters analyzed were significantly associated with ocular changes. CONCLUSIONS: The severity of retinopathy in preeclampsia is directly related to the level of placental insufficiency and intrauterine growth retardation. The severity of retinopathy might be independent of systemic BP.

Case reports of three patients showing optic nerve head melanocytoma and systemic hypertension.

PURPOSE: To report the association of optic disk melanocytoma with systemic hypertension. CASES: Ocular examination of 3 asymptomatic hypertensive patients revealed a pigmented lesion over the optic disk. After clinical examination and radiological evaluation a diagnosis of optic disk melanocytoma was made. One patient had a mild decrease in visual acuity associated with an increase in size of the lesion during the follow-up. Systemic evaluation revealed increased urinary vanillylmandelic acid in all the patients. MRI showed diffuse adrenal hyperplasia while a (131)I-MIBG scan showed increased uptake in 1 case. CONCLUSIONS: Optic disk melanocytoma is a benign tumor though the lesion may increase in size with the resultant decrease in visual acuity over few years. It may be associated with systemic hypertension secondary to increased levels of catecholamines in the body, which is related to the common neural crest origin of melanocytes, adrenal medullary cells and chromaffin cells.