RESUMO
PURPOSE: To describe the clinical features, management, and long-term outcome of Infectious crystalline keratopathy (ICK). METHODS: The medical records of clinically diagnosed and microbiologically proven cases of ICK were reviewed from January 2011 to December 2022. Clinical characteristics include the presence of whitish needle-like projections with branching, limited to anterior-mid stroma. Keratoplasty being the most common risk factor, graft-related microbial keratitis during the same period was also studied. The demography, clinical profile, microbiology, treatment, and outcome were analyzed, and compared with secondary graft infiltrate(GI). RESULTS: Medical records of 24 cases with ICK were reviewed. The mean age was 49.3 ± 20.1 years, with 15(62.5%) males. Prior keratoplasty was done in 18 (75%) cases, with a mean graft size of 10.1 ± 1.5 mm, and mean interval between the last graft and presentation was 9.7 ± 6.2 (3-90) months. In comparison to GI (n = 24), ICK patients (n = 18,75%) were less symptomatic, presented late (7.3 ± 6.5 days vs 16.3 ± 19.4, p = 0.003), using frequent topical steroids (> 3 times/day, p = 0.006), smaller infiltrate size < 4 mm (p = 0.008), central (p = 0.02), less associated with epithelial defect (p = 0.0001), hypopyon (p = of 0.0002), corneal perforation (p = 0.0006), and surgical management (p = 0.03). On microbiology, 22 (91.6%) ICK cases were culture positive, 14 (63.6%) gram-positive, 3 (13.6%) gram-negative, 2 (9%) mixed bacteria, and 3 (13.6%) fungus, comparable with GI. CONCLUSION: ICK affects poor ocular surfaces usually following keratoplasty with larger graft size, the use of steroids being the most common association, and it responds to medical management as compared to GI.
Assuntos
Infecções Oculares Bacterianas , Acuidade Visual , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Bacterianas/terapia , Estudos Retrospectivos , Adulto , Idoso , Bactérias/isolamento & purificação , Antibacterianos/uso terapêutico , Córnea/microbiologia , Córnea/patologia , Seguimentos , Ceratite/microbiologia , Ceratite/diagnóstico , Doenças da Córnea/diagnóstico , Doenças da Córnea/microbiologia , Doenças da Córnea/cirurgia , Doenças da Córnea/terapia , Idoso de 80 Anos ou mais , Adulto Jovem , Transplante de Córnea/métodos , Fungos/isolamento & purificaçãoRESUMO
We describe the outcomes of oral mucous membrane grafting as a surgical technique for unilateral lid margin keratinization following radiotherapy. A 47-year- old woman presented with an 8-month history of a white spot in her right eye. She had a history of adenoid cystic carcinoma of the right spheno-ethmoid sinus, for which she underwent radiotherapy. Slit-lamp evaluation revealed lid margin keratinization of the right upper and lower eyelids and a keratin plaque on the corneal surface. We performed excision of the keratin plaque and lid margin keratinization, followed by oral mucous membrane grafting of the upper and lower eyelid margins. Histopathological evaluation of the excised lid margin revealed keratinized stratified squamous epithelium, consistent with lid margin keratinization. The corneal surface and lid margins showed no recurrent keratin deposition at the final follow-up, 11 months postoperatively.
Assuntos
Pálpebras , Mucosa Bucal , Feminino , Humanos , Pessoa de Meia-Idade , Pálpebras/cirurgia , Pálpebras/patologia , Mucosa Bucal/transplante , QueratinasRESUMO
PURPOSE: To report the spectrum of keratitis treated within 3 months of acute COVID-19 infection. METHODS: Retrospective, descriptive case series study of 19 eyes of 16 patients who presented at tertiary eye care centre in Southern India. RESULTS: Median age of the patients was 43(IQR 35-55.5) years. Majority (15/16, 93.75%) were males. Unilateral affliction was predominant (13/16, 81.25% patients). Nine had a history of hospitalization, five had received oxygen supplementation and five had been treated with steroids during COVID-19 illness. The median duration between COVID-19 diagnosis and the ocular symptoms in the eye was 29 (IQR 22-57) days. Microbiological diagnosis consisted of microsporidia in nine eyes of seven patients, fungus in six patients, Pythium in one patient, and herpes zoster ophthalmicus in one patient. One patient had neurotrophic keratitis. Therapeutic penetrating keratoplasty was performed in five patients, glue application in two patients and three were managed with tarsorrhaphy with/without amniotic membrane grafting or tenonplasty. There was medical and surgical cure in all patients. CONCLUSIONS: Microsporidia was the commonest cause of keratitis, followed by fungal infection. Majority of the microsporidia infections were keratoconjunctivitis. The fungal isolates identified were Aspergillus and Mucor species. All patients responded to conventional management guidelines with favourable outcomes.
Assuntos
COVID-19 , Infecções Oculares Fúngicas , Ceratite , Adulto , COVID-19/terapia , Teste para COVID-19 , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/epidemiologia , Infecções Oculares Fúngicas/terapia , Feminino , Humanos , Ceratite/diagnóstico , Ceratite/epidemiologia , Ceratite/terapia , Ceratoplastia Penetrante , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Atenção Terciária à SaúdeRESUMO
Management of urolithiasis in an ectopic pelvic kidney is challenging and laparoscopic pyelolithotomy and laparoscopy-guided percutaneous nephrolithotomy (PCNL) are commonly favored options. We report a case of ultrasound-guided supine mini-PCNL in ectopic pelvic kidney in an adolescent female. Complete stone clearance was achieved with an uneventful postoperative period. Ultrasound-guided supine mini-PCNL is safe and effective treatment option for the management of calculus in the ectopic pelvic kidney. The risk of injury to surrounding structures associated with ultrasound modality of access can be avoided with proper case selection and careful technique.
RESUMO
PURPOSE: To investigate the histopathological and ultrastructural changes in the lacrimal glands (LGs) of rabbits following either botulinum toxin (BTX) injection or simple glandular needling. METHODS: Twenty-four LGs of 24 eyes of 12 healthy New Zealand white rabbits were included in the study. Of these, 4 LGs of 4 eyes of 2 rabbits were used as controls. In the intervention group, all the right LG received 5 U in 0.1 ml of BTX-A (Botox, Allergan, Dublin, Ireland) and the left LG received simple glandular needling under general anesthesia. The BTX-A was injected directly into the LG via the transconjunctival route under direct visualization. For simple needling, 5 LG passes were made through a single-entry point using a 29-gauge needle mounted on an empty tuberculin syringe. The rabbits did not receive any postoperative medications other than lubricants. The rabbits were sacrificed at 8 weeks and the 20 treated and 4 control LG's were retrieved for histopathological and transmission electron microscopic (TEM) analysis as per standard protocols. RESULTS: In comparison to the control LG samples, both the treated groups showed pathological changes, which were more pronounced in the simple needling group. The BTX-A-treated LGs showed mild to moderate acinar atrophy, few degenerating acini and patchy chronic inflammatory infiltrates with thick hyalinized collagen within the glandular stroma. TEM analysis showed the cytosol of few acinar cells to contain vacuoles and autophagosomes with marginal chromatin condensation of the nucleus and an eccentric nucleolus. The LGs treated with simple needling showed marked pathological changes which include moderate to severe, focal, and diffuse acinar atrophy, dense stromal fibrosis, inflammatory infiltrates, and peri-vasculitis. TEM analysis showed focal disorganized acinar morphology, loss of intra-acinar and ductal architecture, and needle track zones with surrounding fibrotic areas. CONCLUSIONS: Histopathological and ultrastructural changes were noted in the LGs treated with BTX-A and simple glandular needling. Simple needling of the LG has the prospect to be an effective and cheaper alternative to BTX-A.
Assuntos
Toxinas Botulínicas Tipo A , Aparelho Lacrimal , Animais , Elétrons , CoelhosRESUMO
Primary adenocarcinoma of the lacrimal drainage system is a rare malignancy. Poorly differentiated subtypes of this tumor demonstrate aggressive behaviors, and metastasis is not uncommon. We present a patient with poorly differentiated adenocarcinoma of the lacrimal sac and nasolacrimal duct with an orbital extension. The case was managed by a combined external and endoscopic approach excision followed by adjuvant radiotherapy.
Assuntos
Adenocarcinoma/patologia , Neoplasias Oculares/patologia , Doenças do Aparelho Lacrimal/patologia , Ducto Nasolacrimal/patologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Idoso , Terapia Combinada , Endoscopia , Neoplasias Oculares/diagnóstico por imagem , Neoplasias Oculares/terapia , Humanos , Doenças do Aparelho Lacrimal/diagnóstico por imagem , Doenças do Aparelho Lacrimal/terapia , Masculino , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Radioterapia Adjuvante , Tomografia Computadorizada por Raios XRESUMO
Limbal stem cell deficiency (LSCD) is one of the serious cause of visual impairment and blindness with loss of corneal clarity and vascularization. Factors such as ocular burns (acids, lime, thermal), genetic disorders or infections results in the loss of limbal stem cells leading to LSCD. Reliable animal models of LSCD are useful for understanding the pathophysiology and developing novel therapeutic approaches. The purpose of the present study was to validate small and large animal models of LSCD by immunohistochemcal, clinical and histopathological comparison with human. The animal models of LSCD were created by topical administration of sodium hydroxide on the ocular surface of C57BL/6 mice (m, nâ¯=â¯12) and New Zealand white rabbits (r, nâ¯=â¯12) as per the standard existing protocol. Human corneal specimens (h, nâ¯=â¯12) were obtained from tissue bank who had chemical burn-induced LSCD. All samples were either paraffin embedded or frozen in cryogenic medium and the sections were processed for Hematoxylin-Eosin and Periodic Acid-Schiff staining to analyse the morphology and histopathological features of the corneal surface such as vascularization, inflammation, presence of goblet cells, epithelial hyperplasia and keratinization. Immunofluorescence was performed to distinguish between corneal (CK3+), conjunctival (CK19+) and epidermal (CK10+) epithelial phenotype. Histological analysis of corneal specimens from the three groups showed the presence of goblet cells (h:83%, m:50%, r:50%, p = 0.014), epithelial hypertrophy (h:92%, m:50%, r:66.6%, p = 0.04), epithelial hyperplasia (h:50%, m:17%, r:17%, p = 0.18), intra epithelial edema (h:42%, m:33%, r:100%, p = 0.02), stromal inflammation (h:100%, m:67%, r:67%, p = 0.01) and stromal vascularization (h:100%, m:50%, r:67%), in varying proportions. Immunostaining showed presence of total LSCD (CK19 + and/or CK10+, CK3-) in 92% of human and 50% of animal specimens. While partial LSCD (CK19 + and/or CK10+, CK3+) was seen in 8% of human and 50% of animal specimens. Our study shows the significant differences in the extent of vascularization, inflammation, epithelial thickness and goblet cell formation in mice and rabbit models of LSCD when compared to post-chemical burn LSCD in human corneas. In both mice and rabbit models complete LSCD developed in only 50% of cases and this important fact needs to be considered when working with animal models of LSCD.
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Queimaduras Químicas/patologia , Neovascularização da Córnea/patologia , Modelos Animais de Doenças , Queimaduras Oculares/induzido quimicamente , Células Caliciformes/patologia , Ceratite/patologia , Limbo da Córnea/patologia , Animais , Queimaduras Químicas/metabolismo , Doenças da Córnea/metabolismo , Doenças da Córnea/patologia , Neovascularização da Córnea/metabolismo , Células Epiteliais/metabolismo , Epitélio Corneano , Queimaduras Oculares/metabolismo , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Células Caliciformes/metabolismo , Humanos , Imunofenotipagem , Inflamação/metabolismo , Inflamação/patologia , Queratina-19/metabolismo , Queratina-3/metabolismo , Ceratite/metabolismo , Limbo da Córnea/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Mucinas/metabolismo , Coelhos , Hidróxido de Sódio/toxicidadeRESUMO
Urbach-Weithe syndrome is an exceedingly rare multisystem disorder characterized by pathognomonic clinical findings of multiple beaded papules along the eyelid margins and peri-ocular areas and hoarseness of voice secondary to intercellular deposition of periodic acid Schiff (PAS)-positive hyaline material. Lacrimal drainage anomalies are not well defined in this syndrome; however, punctal involvement and acquired nasolacrimal duct obstructions have been reported. We present a patient of Urbach-Weithe syndrome with bilateral punctal and peri-punctal involvement.
Assuntos
Doenças Palpebrais/diagnóstico , Doenças do Aparelho Lacrimal/diagnóstico , Proteinose Lipoide de Urbach e Wiethe/diagnóstico , Endoscopia , Doenças Palpebrais/cirurgia , Feminino , Humanos , Doenças do Aparelho Lacrimal/cirurgia , Proteinose Lipoide de Urbach e Wiethe/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Stents , Adulto JovemRESUMO
Purpose: The aim of this study was to perform a histopathological assessment of the efficacy of sclerosing agents in dacryocystosclerotherapy (DCST) and to evaluate its role as an alternative to dacryocystectomy (DCT) in a specific group of patients. Methods: Thirteen lacrimal drainage systems of 10 patients with primary acquired nasolacrimal duct obstruction (PANDO) were studied. All patients were awaiting a DCT, indications being repeated attacks of dacryocystitis with severe systemic or ocular co-morbidities and/or refusal for a dacryocystorhinostomy. Fluorescent labelled sodium tetradecyl sulphate (SDS) or bleomycin were used as sclerosing agents for a DCST taking specific precautions. All patients underwent a DCT after 4 weeks and histopathological evaluation was performed to assess the changes and extent of DCST. Results: There were nine females and one male, and all patients were above the age of 60 years. Of the 13 lacrimal systems studied, the mean duration of PANDO was 1.3 years. All the patients had associated systemic and/or ocular co-morbidities. SDS and bleomycin were used in 6 and 7 lacrimal systems, respectively. The mean doses used for SDS and bleomycin were 0.26 and 0.31 cc, respectively. The post-injection phase was uneventful except for one patient who had a moderate inflammation, which resolved with low dose oral steroids. Histopathological features were more marked in the SDS group and included loss of epithelium, luminal closure, gross fibrosis across the lacrimal sac wall, congestion and hyalinization of blood vessels, and multiple areas of haemorrhages in the sac wall. Conclusions: DCST is a safe and effective alternative to DCT in very carefully selected patients. Histopathology demonstrates SDS to be more effective as compared to bleomycin.
Assuntos
Obstrução dos Ductos Lacrimais/terapia , Ducto Nasolacrimal/patologia , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Idoso , Idoso de 80 Anos ou mais , Bleomicina/efeitos adversos , Bleomicina/uso terapêutico , Dacriocistorinostomia , Feminino , Fluoresceína/efeitos adversos , Fluoresceína/uso terapêutico , Humanos , Obstrução dos Ductos Lacrimais/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Soluções Esclerosantes/efeitos adversos , Tetradecilsulfato de Sódio/efeitos adversos , Tetradecilsulfato de Sódio/uso terapêutico , Resultado do TratamentoRESUMO
Eccrine hidrocystoma is a benign cystic tumor. Such benign cystic lesions may be a cosmetic concern, or when large, can cause eyelid malpositions. We report a patient with a peri-punctal hidrocystoma of the eyelid.
Assuntos
Neoplasias Palpebrais/cirurgia , Hidrocistoma/cirurgia , Neoplasias das Glândulas Sudoríparas/cirurgia , Adulto , Glândulas Écrinas , Neoplasias Palpebrais/patologia , Hidrocistoma/patologia , Humanos , Aparelho Lacrimal , Masculino , Neoplasias das Glândulas Sudoríparas/patologiaRESUMO
PURPOSE: To characterise the corneal deposits of macular corneal dystrophy and correlate with high-resolution optical coherence tomography (OCT). METHODS: A total of 23 eyes of 15 patients were evaluated for clinical features on slit lamp biomicroscopy, and high-resolution OCT was performed to correlate the clinical findings. The deposits were characterised based upon their location and level in the corneal layers. RESULTS: Mean age was 31.5 (Range 20-67) years. The stromal deposits were restricted to central 8 mm in 9 eyes; in the rest of the 14 eyes, the deposits were seen in both central and peripheral cornea. In one patient, no such distinction could be made due to diffuse nature of the deposits throughout the cornea with sparing of 1-2 mm of the cornea internal to the limbus. The central deposits were in the anterior stromal layers, while the peripheral deposits were in the deep stromal corneal layers and non-contiguous with the anterior stromal deposits. In one patient aged 67 years, the peripheral deposits in deep corneal layers were more prominent than the central anterior stromal deposits and were associated with a significant thickening of Descemet membrane. CONCLUSIONS: MCD exhibits a clinically diverse presentation as revealed on the clinical and optical coherence tomography study. Immunophenotype and genotype-phenotype correlation may further help in understanding various clinical presentations of MCD.
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Córnea/patologia , Distrofias Hereditárias da Córnea/patologia , Macula Lutea/patologia , Adulto , Idoso , Substância Própria/patologia , Lâmina Limitante Posterior/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica/métodos , Adulto JovemRESUMO
Linear scleroderma is a localized variety of scleroderma characterized by fibrotic areas of the dermis involving head region without systemic features. Ocular involvement has been sparsely reported in the form of episcleritis, dry eye, and uveitis. We describe a 42-year-old man with linear scleroderma, en coup de sabre type with associated nasolacrimal duct obstruction and prolonged dacryocystitis.
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Doenças do Aparelho Lacrimal/diagnóstico , Esclerodermia Localizada/diagnóstico , Adulto , Biópsia , Humanos , Doenças do Aparelho Lacrimal/etiologia , Masculino , Esclerodermia Localizada/complicações , Tomografia Computadorizada por Raios XRESUMO
Postoperative blindness after orbital surgery is an extremely rare and a disastrous complication. Ophthalmic artery occlusion as a cause of such unexpected vision loss has not been documented in literature. The authors report a case of a middle aged man who developed sudden vision loss due to ophthalmic artery occlusion following transconjunctival excision of orbital schwanomma. The possible mechanisms contributing to the loss of vision are discussed and preventive strategies are suggested to reduce the incidence of this complication.
Assuntos
Arteriopatias Oclusivas/etiologia , Túnica Conjuntiva/cirurgia , Artéria Oftálmica , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Órbita/cirurgia , Neoplasias Orbitárias/cirurgia , Complicações Pós-Operatórias , Adulto , Arteriopatias Oclusivas/diagnóstico , Humanos , Masculino , Procedimentos Cirúrgicos Oftalmológicos/métodos , Neoplasias Orbitárias/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Percutaneous nephrolithotomy (PCNL) has undergone significant changes in recent years in the quest for improving efficacy and reducing morbidity. Newer minimally-invasive modalities of PCNL such as mini-PCNL, ultra-mini PCNL, and micro-PCNL have evolved with advancement in optics and technology. However, with these newer advancements, migration of small fragments produced with laser lithotripsy remains a concern, which may result in incomplete stone clearance. We describe a new technique of PCNL termed "Superperc", that utilizes suction to remove all the fragments and maintain one-way flow. METHODS: This was a prospective observational study involving 52 consecutive patients who underwent PCNL with the Superperc technique from April 2014 to June 2015. Surgery was performed using a pediatric ureteroscope used as a nephroscope and a specially designed sheath with a suction attachment. The Superperc uses a 10/12 F tract size, specially designed Superperc sheath (Shah Sheath) with suction mechanism and a pediatric ureteroscope (4.5/6 Fr, Richard Wolf) as nephroscope. RESULTS: The mean age of the group was 41.8 years (range 6-84) with 33 males and 19 females. Mean stone size was 19.11 mm (range 10-37 mm) and mean operative time was 40.9 min (range 26-92 min). Twenty-seven renal units had upper calyceal puncture, whereas 12 had middle, 8 lower calyceal and 5 had two punctures. DJ stent was placed in 20 patients, whereas 32 patients were totally tubeless. Only three patients required a nephrostomy tube. The mean hemoglobin drop was 0.32 g with no blood transfusion. Postoperatively, three patients had a mild fever and one had transient hematuria. The stone clearance rate in our study was 96.15% and the mean hospital stay was 31.5 h (range 22-76 h). CONCLUSION: Superperc is a new technique of minimally-invasive PCNL and can be successfully done with minimal modification in armamentarium, with the potential advantage of good stone clearance.
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Doenças da Túnica Conjuntiva/complicações , Síndromes do Olho Seco/etiologia , Doenças do Aparelho Lacrimal/etiologia , Síndrome de Stevens-Johnson/complicações , Actinas/metabolismo , Adulto , Antígenos CD20/metabolismo , Biomarcadores/metabolismo , Síndromes do Olho Seco/metabolismo , Síndromes do Olho Seco/patologia , Humanos , Doenças do Aparelho Lacrimal/metabolismo , Doenças do Aparelho Lacrimal/patologia , Lactoferrina/metabolismo , Muramidase/metabolismo , Estudos Prospectivos , Proteínas S100/metabolismoRESUMO
PURPOSE: To report the histopathological and immuno histochemical features of congenital lacrimal fistulae. METHODS: Retrospective chart review of all patients who underwent a fistulectomy for congenital lacrimal fistulae, over a 3-year period from a single surgeon's (M.J.A.) database, were included in the study. A detailed lacrimal system evaluation was performed, and intraoperative findings were documented. The excised fistulae were studied using hematoxylin and eosin and periodic acid-Schiff staining. Immunophenotyping was performed using CD3, CD5, CD10, and CD20. RESULTS: Twelve excised fistulae of 12 patients were studied. The mean age at presentations was 5.3 years (range, 3-11 years). The deeper parts of the fistulae were lined with hypertrophied stratified squamous epithelium similar to canalicular tissue in 83.3% (10/12), reflecting its origin from the canalicular tissue, and 16.7% (2/12) originated from the lacrimal sac and were lined with columnar epithelium with areas of squamous metaplasia. The subepithelial areas showed presence of fibrosis and chronic inflammatory infiltrate. The infiltrates were lymphoplasmacytic and were positive for CD3, CD5, and CD20 and negative for CD10 immunostaining. CONCLUSION: Hypertrophied stratified squamous lining was the commonest finding. Immunophenotyping revealed features of chronic inflammatory infiltrate composed of a mixture of both T and B lymphocytes. Histopathological analysis of fistulae may be of adjunctive value in determining the origin of the anlage.
Assuntos
Fístula/patologia , Doenças do Aparelho Lacrimal/patologia , Antígenos CD/imunologia , Linfócitos B/patologia , Criança , Pré-Escolar , Células Epiteliais/patologia , Feminino , Fibrose , Fístula/congênito , Fístula/imunologia , Humanos , Hipertrofia , Imunofenotipagem , Doenças do Aparelho Lacrimal/congênito , Doenças do Aparelho Lacrimal/imunologia , Masculino , Reação do Ácido Periódico de Schiff , Estudos Retrospectivos , Linfócitos T/patologiaRESUMO
PURPOSE: The aim of this study is to report the histopathological, Immunohistochemical, and ultrastructural features of a dacryocystorhinostomy ostium cicatrix. METHODS: A prospective histopathological study was performed in a tertiary eye care setting. Scarred nasal mucosal tissues obtained during endoscopic revisions of 10 previously failed dacryocystorhinostomies secondary to complete cicatricial closure of the ostia were studied. The tissue specimens were analyzed using hematoxylin and eosin, periodic acid-Schiff staining. Special stains used include Masson's trichrome and Alizarin red. Immunohistochemistry was performed using vimentin, smooth muscle actin, CD3, CD5, and CD20. Specimens were processed for ultrastructural analysis as per standard protocols for transmission electron microscopy. RESULTS: The respiratory epithelial regeneration was noted to be complete. Irregular laying of deeply eosinophilic and hyalinized collagen with intervening fibroblasts was noted. Focal areas of new bone formation were seen within the cicatricial tissue with osteocytes and ongoing osteoblastic rimming. The infiltrates were mixture of both T and B lymphocytes and were positive for CD3, CD5, and CD20 immunostaining. Electron microscopy showed disorganized collagen fibrils with numerous fibroblasts and mononuclear inflammatory infiltrate. Amorphous bony osteoid within a fibrillar background with metabolically active osteoblasts showed a vesicular cytoplasm, hyperplastic proliferating mitochondria, large Golgi apparatus, and dense endoplasmic reticulum. CONCLUSION: There is new bone formation within the dense connective tissues of a dacryocystorhinostomy cicatrix. This study may provide useful inputs for further basic science studies aimed at better understanding of wound healing in failed dacryocystorhinostomy.
Assuntos
Biomarcadores/análise , Cicatriz/diagnóstico , Dacriocistorinostomia/efeitos adversos , Imuno-Histoquímica/métodos , Microscopia Eletrônica de Transmissão/métodos , Mucosa Nasal/ultraestrutura , Ducto Nasolacrimal/ultraestrutura , Actinas/análise , Cicatriz/etiologia , Cicatriz/metabolismo , Seguimentos , Humanos , Mucosa Nasal/metabolismo , Ducto Nasolacrimal/metabolismo , Ducto Nasolacrimal/cirurgia , Complicações Pós-Operatórias , Estudos Prospectivos , Vimentina/análiseRESUMO
PURPOSE: To study the histologic, immunohistochemical, and electron microscopic features of puncta and proximal vertical canaliculi to understand the etiopathogenesis of punctal stenosis. METHODS: Prospective study of 26 stenosed punctae that were collected following a punctoplasty. Sixteen were from lower eyelid and 10 from upper eyelid. Histopathological examination was performed on 20 punctae using hematoxylin-eosin, periodic acid-Schiff, and Masson trichrome staining. Immunohistochemical patterns were analyzed after staining with leukocyte common antigen or CD45, CD3, CD5, CD10, CD20, CD138, and smooth muscle actin. Six punctae (3 upper, 3 lower) were separately processed for electron microscopic studies as per standard protocols. RESULTS: All punctae showed evidence of subepithelial and subconjunctival fibrosis. Thirty percent (6/20) showed extensive fibrosis. Inflammation was noted in 80% (16/20) of the samples; however, 20% (4/20) showed severe inflammation. Strong immunoreactivity was noted, with CD45 and CD3 in 80% (16/20) with predominance in the subepithelial areas. Focal immunoreactivity was noted for CD10, CD20, and CD138. Immunoreactivity was negative for CD5. Electron microscopic features include blunted epithelial microvilli, numerous fibroblasts, extensive and irregularly arranged collagen bundles, mononuclear infiltration in the vicinity of fibroblasts or in between collagen bundles, and inter- and intracellular edema in areas of inflammation. CONCLUSIONS: Chronic inflammation and subsequent fibrosis appear to be the basic ultrastructural response to various noxious stimuli. Mononuclear inflammatory infiltration in the vicinity of fibroblasts could possibly reflect a close cellular interaction between these 2 cells.
Assuntos
Pálpebras/ultraestrutura , Obstrução dos Ductos Lacrimais/etiologia , Obstrução dos Ductos Lacrimais/patologia , Actinas/metabolismo , Idoso , Antígenos CD/metabolismo , Biomarcadores/metabolismo , Túnica Conjuntiva/patologia , Fibrose , Humanos , Obstrução dos Ductos Lacrimais/metabolismo , Microscopia Eletrônica de Transmissão , Estudos Prospectivos , Linfócitos T/patologiaRESUMO
Objective: The aim is to report a very rare case of a fibroblastic tumour in the medial rectus muscle of the right eye in a young adult. Methods: A 28-year-old patient presented to the strabismus clinic with large-angle exotropia in the right eye. The patient had previously undergone strabismus surgery in both eyes, and the old photos showed increasing exotropia from childhood to adulthood. On examination, the patient had a best corrected visual acuity of 20/20, 85 PD of exotropia with a -4 limitation of adduction, and retinal evaluation was unremarkable. In view of the chronicity of the deviation, increasing exotropia over time, and limitation of the ocular motility in adduction, a magnetic resonance imaging was performed. Results: Orbital magnetic resonance imaging (MRI) undertaken to identify the extraocular muscle position revealed a bulky and thickened right medial rectus muscle with post-contrast enhancement and without fat stranding and orbital extension. A muscle biopsy was performed, and a series of histopathological stains revealed that the tumour cells were positive for CD34 and vimentin. Immuno histochemistry and histopathology suggested a benign fibroblastic tumour (superficial CD34+ fibroblastic tumour) with low malignant potential. Conclusion: This report describes a fibroblastic tumour of the eye muscle identified on neuroimaging and confirmed on histopathology. Such a presentation is very rare and to the best of our knowledge has not been previously reported in ophthalmic literature.