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Intracorneal rhinosporidiosis managed with deep anterior lamellar keratoplasty.

Mukhopadhyay S, Datta H, Sen D - Middle East Afr J Ophthalmol (2014 Oct-Dec)

Bottom Line: Anterior segment optical coherence tomography (OCT) confirmed that an intracorneal mass sparing deep stroma and Descemet's membrane.The patient achieved 20/60 BCVA with -1.25 Χ× 120° 1 year postoperatively without any evidence of recurrence at the graft-host interface.This unique presentation (as an 'intracorneal mass') of ocular rhinosporidiosis emphasizes that clinicians from our region of the world must consider rhinosporidiosis in the differential diagnosis especially with a history of penetrating injury while swimming in pond or river water.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Cornea Services, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.

ABSTRACT
A healthy 22-year-old male presented to Institutional Cornea Clinic with an intracorneal mass overlying the pupil with lobulated edges having many tiny greyish white dots. The patient had a history of trauma while swimming in a pond with subsequent removal of intracorneal foreign body in the left eye approximately a year prior to presentation. Anterior segment optical coherence tomography (OCT) confirmed that an intracorneal mass sparing deep stroma and Descemet's membrane. A deep anterior lamellar keratoplasty (DALK) was performed in left eye and the mass was sent for histology examination. Histology evaluation was suggestive of rhinosporidiosis. The patient achieved 20/60 BCVA with -1.25 Χ× 120° 1 year postoperatively without any evidence of recurrence at the graft-host interface. This unique presentation (as an 'intracorneal mass') of ocular rhinosporidiosis emphasizes that clinicians from our region of the world must consider rhinosporidiosis in the differential diagnosis especially with a history of penetrating injury while swimming in pond or river water.

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Anterior segment optical coherence tomography image showing an intracorneal lesion
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Figure 2: Anterior segment optical coherence tomography image showing an intracorneal lesion

Mentions: A healthy 22 year-old male patient reported to the Cornea Clinic of our Institute with a history of gradual dimness of vision in the left eye over the previous 6 months. He had a history of ocular trauma in left eye inflicted while swimming in a pond. Subsequently he was examined by a local ophthalmologist who removed a vegetative foreign body partially embedded in the superficial stroma near the limbus at the 9 o'clock position of left cornea at the slit lamp under topical anesthesia. Presenting vision in left eye was counting fingers close to face and 20/20 in fellow eye. Slit lamp examination of involved eye revealed a large intracorneal mass with lobulated edges. The mass was obstructing the pupil. Many small greyish white dots were noted along the edges of the lesion [Figure 1]. Posterior segment evaluation of the left eye (by B-scan ultrasonography) and the right eye (by slit lamp biomicroscopy) was normal. Intraocular pressure (measured by non-contact method) was normal OU. Anterior segment ocular coherence tomography (Visante™ OCT, software version 3.0.0.139; Carl Zeiss Meditech, Jena, Germany) scan in left eye confirmed the intracorneal nature of the mass (vertical length 0.68 mm and horizontal length 6.52 mm) sparing the deeper part corneal stroma and Descemet's membrane [Figure 2]. We elected for surgical removal of the mass after discussion with the patient. Deep anterior lamellar keratoplasty was performed under peribulbar anesthesia with sedation, layer-by-layer dissection of the stromal layers was performed until exposure of Descemet's membrane. A 9.0-mm donor lenticule whose DM-endothelial layers had been stripped off was sutured to the recipient bed with 16 interrupted 10:0 monofilament nylon sutures. He was discharged with standard postoperative regimen of topical moxifloxacin (0.5%) four times a day and prednisolole acetate (1%) six times a day with gradual tapering. The patient was seen the following day and the graft was clear with good graft-host apposition.


Intracorneal rhinosporidiosis managed with deep anterior lamellar keratoplasty.

Mukhopadhyay S, Datta H, Sen D - Middle East Afr J Ophthalmol (2014 Oct-Dec)

Anterior segment optical coherence tomography image showing an intracorneal lesion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219233&req=5

Figure 2: Anterior segment optical coherence tomography image showing an intracorneal lesion
Mentions: A healthy 22 year-old male patient reported to the Cornea Clinic of our Institute with a history of gradual dimness of vision in the left eye over the previous 6 months. He had a history of ocular trauma in left eye inflicted while swimming in a pond. Subsequently he was examined by a local ophthalmologist who removed a vegetative foreign body partially embedded in the superficial stroma near the limbus at the 9 o'clock position of left cornea at the slit lamp under topical anesthesia. Presenting vision in left eye was counting fingers close to face and 20/20 in fellow eye. Slit lamp examination of involved eye revealed a large intracorneal mass with lobulated edges. The mass was obstructing the pupil. Many small greyish white dots were noted along the edges of the lesion [Figure 1]. Posterior segment evaluation of the left eye (by B-scan ultrasonography) and the right eye (by slit lamp biomicroscopy) was normal. Intraocular pressure (measured by non-contact method) was normal OU. Anterior segment ocular coherence tomography (Visante™ OCT, software version 3.0.0.139; Carl Zeiss Meditech, Jena, Germany) scan in left eye confirmed the intracorneal nature of the mass (vertical length 0.68 mm and horizontal length 6.52 mm) sparing the deeper part corneal stroma and Descemet's membrane [Figure 2]. We elected for surgical removal of the mass after discussion with the patient. Deep anterior lamellar keratoplasty was performed under peribulbar anesthesia with sedation, layer-by-layer dissection of the stromal layers was performed until exposure of Descemet's membrane. A 9.0-mm donor lenticule whose DM-endothelial layers had been stripped off was sutured to the recipient bed with 16 interrupted 10:0 monofilament nylon sutures. He was discharged with standard postoperative regimen of topical moxifloxacin (0.5%) four times a day and prednisolole acetate (1%) six times a day with gradual tapering. The patient was seen the following day and the graft was clear with good graft-host apposition.

Bottom Line: Anterior segment optical coherence tomography (OCT) confirmed that an intracorneal mass sparing deep stroma and Descemet's membrane.The patient achieved 20/60 BCVA with -1.25 Χ× 120° 1 year postoperatively without any evidence of recurrence at the graft-host interface.This unique presentation (as an 'intracorneal mass') of ocular rhinosporidiosis emphasizes that clinicians from our region of the world must consider rhinosporidiosis in the differential diagnosis especially with a history of penetrating injury while swimming in pond or river water.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Cornea Services, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.

ABSTRACT
A healthy 22-year-old male presented to Institutional Cornea Clinic with an intracorneal mass overlying the pupil with lobulated edges having many tiny greyish white dots. The patient had a history of trauma while swimming in a pond with subsequent removal of intracorneal foreign body in the left eye approximately a year prior to presentation. Anterior segment optical coherence tomography (OCT) confirmed that an intracorneal mass sparing deep stroma and Descemet's membrane. A deep anterior lamellar keratoplasty (DALK) was performed in left eye and the mass was sent for histology examination. Histology evaluation was suggestive of rhinosporidiosis. The patient achieved 20/60 BCVA with -1.25 Χ× 120° 1 year postoperatively without any evidence of recurrence at the graft-host interface. This unique presentation (as an 'intracorneal mass') of ocular rhinosporidiosis emphasizes that clinicians from our region of the world must consider rhinosporidiosis in the differential diagnosis especially with a history of penetrating injury while swimming in pond or river water.

Show MeSH
Related in: MedlinePlus