Objective: To explore the use of red and green lasers in studying retinoblastoma seeds in pathological samples. Methods: This study was a retrospective, laboratory-based experimental study, conducted at a tertiary care eye center of northeast India. Medical records were retrospectively analyzed in a 7-year period from 2016 to 2023 to identify enucleated retinoblastoma (RB) eyeballs having tumor seedings. All pathological specimens that were studied using red and green laser pointers (Class III Laser product) were included. Lasers of wavelength 532 nm (green) and 630 nm (red) were used under the objective of compound microscopes to study different RB seeds. The activities of seeds were studied by the use of lasers. The seeds were documented under the objective of the compound microscope. For statistical analysis, IBM SPSS 26 was utilized. The descriptive statistics of the quantitative variables was reported through the metric mean. The categorical variables were described using count and percentages. Independence of categorical variable was carried out using Chi-square test and P values. Results: Thirty-eight specimens with RB seedings at different locations were included in the study. RB seeds in anterior segment (n = 2 cases), over ciliary process (n = 2 cases), vitreous seeds (n = 18 cases), retinal seeds (n = 2 cases), retinal pigment epithelium seeds (n = 3 cases), subretinal seeds (n = 5 cases), combined vitreous and subretinal seeds (n = 6 cases), and calcified seeds (n = 2 cases) were noted. With red and green lasers, varied changes were observed in the RB seeds, particularly the presence and absence of electron dense clouding within the seeds. Active seeds could be differentiated from inactive seeds using the laser technique. Conclusion: Use of laser in the present study was first of its kind, carried out to visualize RB seeds at different sites in raw or wet specimens of the enucleated eyeballs. By this technique, active seeds could be differentiated from the inactive seeds based on electron dense clouds within the seeds’ configurations.

ABSTRACT Almost all retinal pigment epithelial (RPE) adenocarcinomas are clinically diagnosed as choroidal melanomas. Retinal adenoma and adenocarcinoma appear black in color. A 63-year-old woman presented with progressive visual loss in her right eye with intermittent throbbing pain. A brownish pigmented choroidal mass was identified occupying the entire intraocular cavity with hemorrhagic foci. Histopathology revealed an infiltrative epithelial neoplasm with ill-defined glandular differentiation and moderate cytological atypia. Immunohistochemical staining with epithelial membrane antigen, cytokeratin 7, HMB-45, and S-100 favored a RPE origin of the lesion. RPE adenocarcinoma is exceedingly uncommon, but should be included in the differential diagnosis of pigmented intraocular tumors. Histopathology, combined with immunohistochemistry, is essential for accurate diagnosis.

IgG4-related disease (IgG4-RD) is a chronic autoimmune condition characterized by fibrosis and inflammation affecting multiple organs. The association between IgG4-RD and an increased risk of lymphoma remains debated. A 68-year-old man presented with painless, gradually enlarging swelling in the left orbit over the past 7 months. His thyroid function tests were normal. The serum IgG4 level was found to be very high (874 mg/dL). Histopathological and immunohistochemical analysis of the left orbital tissue suggested IgG4-positive orbital B-cell non-Hodgkin lymphoma. Immunohistochemistry showed positive staining for CD20, CD3, and Ki-67, along with lambda light chain restriction. More than 50% of the plasma cells stained positive for IgG4. Patients with IgG4-RD have a higher risk of developing lymphoma compared to the general population, highlighting the importance of screening for non-Hodgkin lymphoma during diagnosis and treatment of IgG4-RD.

INTRODUCTION:Phthisis bulbi is an end stage ocular disease caused by injury, long term eye disease and infection. The adipocytic metaplasia within the ocular coat is a rare variety of metaplasia. CASE:An 18 year-old female presented with complaints of severe dimness of vision in the right eye for last 11 years. OBSERVATION:Slit lamp examination showed total cataract, shallow anterior chamber and enophthalmos in the right eye. As the right eye was blind, enucleation with silicon ball implant was advised. Histopathological examination of the eyeball showed evidence of phthisical eye, exudative retinal detachment with extensive osseous and adipocytic metaplasia. CONCLUSION:Adipocytic metaplasia of retinal pigment epithelium is a very rare feature observed in intraocular pathology.

A 70-year-old man reported a gradual decline in vision in his left eye over the past four months. Upon slit-lamp examination, the left eye showed a sluggish pupillary response to light, a posterior subcapsular cataract, and a pigmented choroidal mass. Due to the presence of the choroidal mass, enucleation with placement of a silicone ball implant was recommended. Histopathological analysis of the eye revealed a choroidal malignant melanoma of the mixed cell type, extending into the ciliary body. It is important to distinguish melanomas from benign pigmented lesions such as choroidal nevi, congenital hypertrophy of the retinal pigment epithelium, and choroidal hemorrhages. Some choroidal nevi can closely resemble small melanomas, making diagnosis challenging. When ocular melanoma metastasizes, the five-year survival rate drops to around 15%. The somatic mutations and prognosis associated with intraocular melanoma differ significantly from those of cutaneous melanoma. The presence of choroidal melanoma alongside a lump in the nape of the neck is an extremely rare finding in ophthalmic pathology.

Leukemia patients may experience a broad range of eye-related symptoms, some of which can cause significant vision loss. These ocular manifestations may arise either from the direct invasion of leukemic cells or as secondary effects due to blood-related abnormalities. In this report, we describe three known cases of B-cell acute lymphoblastic leukemia identified in a tertiary care center in North-Eastern India during 2024. The patients presented with various eye findings, including chemosis, hypopyon, papilledema, retinochoroidal thickening, optic disc hemorrhages, and Roth’s spots. Clinical and blood test data from all patients were collected prospectively. Tests included peripheral blood smear analysis and live-cell cytology with fluorescent staining to monitor the behavior and activity of leukemic blast cells in real time. Routine eye examinations should be considered essential for all leukemia patients, as ocular signs may be detected even in those without any eye-related symptoms.

Circumscribed choroidal hemangioma can mimic other conditions affecting the posterior segment of the eye, such as choroidal melanoma, melanocytoma, Coats’ disease, choroidal metastasis, central serous chorioretinopathy, or nonspecific retinal detachment. A 43-year-old woman reported experiencing significant vision loss in her right eye over the past three years. Upon slit-lamp examination, the right eye exhibited a total cataract, a shallow anterior chamber, and endophthalmos. Since the eye was no longer functional, enucleation followed by the placement of a silicone ball implant was recommended. Histopathological analysis of the removed eye revealed features consistent with phthisis bulbi and a localized overgrowth of numerous blood vessels in the choroid, indicative of a choroidal hemangioma. The presence of a choroidal capillary hemangioma in a phthisical eye is an extremely rare finding. It may lead to significant vision impairment due to secondary complications such as exudative retinal detachment, neovascular glaucoma, cataract formation, and optic nerve atrophy.

Objective Histopathological analysis of the retinal pigment epithelial (RPE) changes in retinoblastoma (RB) cases who received pre-surgical chemotherapy. Design Laboratory-based observational study. Methods Five-year analysis was performed to identify Retinoblastoma cases who underwent enucleation after receiving systemic chemotherapy. Grossly, RPE cells were observed in flat preparation in small calottes by staining with fluorescein stain in the raw specimens. They were documented under the objective of compound microscope and compared with hematoxylin and eosin-stained slides in the permanent tissue sections. Results Out of 51 cases of RB, post-chemotherapy enucleation was performed in 17 cases. Mean age of enucleation was 3.2 years. Endophytic RB (11 cases, 64.71%) was more common than the exophytic variety. Choroidal involvement was noted in 8 cases (47.06%), and optic nerve involvement was seen in 5 cases (29.4%). Focal and diffuse RPE changes were seen in one case each (5.88%). Central RPE cell changes near the cell nucleus were seen in all 17 cases (100%), which were documented by both fluorescein and Hematoxylin and eosin stain (100%). Drusens were observed in 8 cases (47.06%), and RPE proliferations were seen in 3 cases (17.65%). Conclusion The study highlights the characteristic histopathological RPE changes after systemic chemotherapy in RB cases. These changes may be attributable to cell nucleus damage after chemotherapy.

Background: To prepare ocular emulsions containing bipartitioned oil droplets to entrap cyclosporin A (0.05% w/w) and etodolac (0.2% w/w) by using castor, olive and silicon oils. Methods: The physicochemical characterizations of prepared emulsions were performed. The drug's biodistribution profiles and pharmacokinetic parameters from emulsions were checked using the ultraperformance liquid chromatography-tandem mass spectrometry method in the ocular tissues of the healthy rabbit eye model. Results: The emulsions displayed 365.13 +/- 7.21 nm size and 26.45 +/- 2.09 mV zeta potential. The ferrying of two drugs after releasing from emulsions occurred across corneal/conjunctival tissues to enter the vitreous and sclera following a single drop administration into the rabbit's eyes. Conclusion: The dual drug-loaded emulsions were more likely to produce synergistic anti-inflammatory activity for managing moderate-to-severe dry eye disease.

AIMTo study parasitic eye diseases in a tertiary institute of North-east India by live examination of parasites, rapid staining, and scanning electron microscopy (SEM).METHODSA 12-year retrospective analysis was performed and all patients diagnosed with ocular parasitic diseases were identified. Examination under a compound microscope, fluorescein staining, and scanning electron microscopy were done.RESULTSA total of 160 ocular parasitosis cases were identified.     The cases for which rapid staining and SEM studies were done included Cysticercosis (n = 18, 11.25%), Hydatidosis (n = 5, 3.13%), Dirofilariasis (n = 5, 3.13%), Thelaziasis (n = 3, 1.87%), and Gnathostomiasis (n = 2, 1.25%). Live examination was performed in 11 cases (6.63%) and 8 cases (4.82%) underwent scanning electron microscopy. .CONCLUSIONFluorescein staining for identification of parasites and SEM study helped in detailing microscopic and ultrastructural findings.

Filariasis, a predominantly lymphatic disease can rarely have ocular involvement in endemic as well as a few non-endemic zones of the Indian subcontinent. It has also been reported from countries of South East Asia. In India, Wuchereria bancrofti and Brugia malayi are the nematodes causing filariais. Ocular involvement can happen in a wide spectrum, involving lacrimal glands, conjunctiva and fornices, cornea, anterior chamber, and vitreous cavity. We report a case of adult filarial worm (B. malayi) inside a conjunctival granuloma in a lady hailing from a rural, non-endemic part of the country. The lady presented with a short history of ocular irritation and redness. Clinical examination revealed a small granuloma-like lesion with surrounding inflammation over the conjunctiva. The rest of the anterior segment as well as the posterior segment was fairly within normal limits. The history as well as clinical examination was not supportive of a parasitic infestation, leading the doctors to treat the lesion as an allergic disease. However, the lesion remained unresolved, and surgical excision was undertaken. On surgical intervention, a live worm was spotted inside the lesion. Parasitological evaluation of the worm was confirmatory of adult filaria (B. malayi). The patient responded to a combination therapy of oral diethylcarbamazine and albendazole.

Intraocular cysticercosis with central nervous system involvement is not that rare. We report a male child with a right-sided painful blind eye who had intraocular cysticercosis and granuloma in the left frontal lobe of the brain. There was an incidental finding of chronic inflammation in the choroid of that eye supported by histopathology. Immunohistochemistry for T-cells marker and B-cells marker was variable. The patient was treated with antiparasitic, anti-epileptic medications, and oral steroids subsequently.

Cyclosporin A (CsA, 0.05% w/w)–loaded positively charged emulsions were prepared based on castor oil, chitosan, poloxamer 188, glycerin and double-distilled water. To augment the shelf/storage-stability of original emulsions, the solid-dry powder for reconstitution was made by spray drying technique. The screening (Taguchi OA) and optimization (face-centered central composite) designs produced the optimized conditions for spray drying: 40 Nm3/h aspirator flow rate, 15 ml/min feed rate, 115 °C inlet temperature, 10% mannitol and 1.25% trehalose. The % drug entrapment efficiency values of original and reconstituted emulsions ranged from 73.20 ± 0.13 to 71.55 ± 1.25%. At 20 min post-dissolution, two times higher CsA release was seen from reconstituted emulsions than the original emulsions (85.78 ± 1.14 vs. 42.25 ± 1.84%) in simulated tear fluid. Using MTT assay, the reconstituted emulsions with or without CsA produced 94.512 ± 2.12 to 99.941 ± 1.89% cell viability values in HCE-2 cells. No appreciable change in capillary integrity was visualized in HET CAM following reconstituted emulsions treatment. At equivalent 15 µg drug, the in vitro protein denaturation assay showed augmented inhibition value (~ 85%) for tested CsA emulsions compared to diclofenac reference (68.30 ± 2.05) indicating enhanced anti-inflammatory activity. The CsA concentrations in multiple ocular matrices of rabbit eyes determined by the UPLC-MS/MS method attained the therapeutic drug level of 50–300 ng/ml even at 90 min post-topical instillation of both emulsions. Overall, the CsA emulsion eyedrops can be supplied as a spray dried storable intermediate product for reconstitution.

Pigment dispersion syndrome (PDS) can have varied manifestations. Anterior and posterior segment involvement by dispersed pigments was documented in gross pathology and by staining under microscopy. Pigmentary changes in the sclera, cornea, anterior chamber, iris, trabecular meshwork, lens, and retinal pigment epithelium and optic nerve findings were consistent with PDS. External scleral and vitreous pigmentation has never been reported before in the scientific literature. Retinal pigment degeneration and granule dispersion were seen throughout the retina which could be a contributing factor in the etiology of PDS.

A 66-year-old North-East Indian male presented with bilateral eyelid swelling, ptosis, and bilateral submandibular gland enlargement. Dry skin on both arms was another peculiar complaint. Contrast enhanced CT scans revealed homogenously enhancing, diffusely enlarged lacrimal glands and blood investigations showed raised serum IgG4 levels. Histopathology from lacrimal gland biopsy showed lymphoplasmacytic infiltrates in storiform pattern. Immunohistochemistry showed 35% plasma cells positive for IgG4. A diagnosis of IgG4-related disease was made, due to supportive histopathology, immunohistochemistry, and serum IgG4 levels. The patient showed excellent response to systemic immunomodulators. Abbreviations: IgG4-RD = IgG4-related disease, CECT = Contrast-enhanced computed tomography, ACE = Angiotensin converting enzyme, IHC = Immunohistochemistry, HPF = high power field, IgG4-ROD = IgG4-related ophthalmic disease, ACR/ EULAR = American College of Rheumatology/ European League Against Rheumatism.

Sympathetic ophthalmia is a dreaded ocular condition resulting in bilateral panuveitis following penetrating injury in one eye or associated with surgeries and laser procedures. We describe a case of a 13-year-old girl who presented with blurring of vision in the right eye for the past 2 years following penetrating trauma in the left eye 9 years back. Histopathology of left enucleated phthisical eye showed diffuse stromal choroiditis with B-cell proliferation on immunohistochemistry, thus confirming chronicity of the disease.

A 41-year-old male presented with phthisical, painful blind left eye (OS) following sympathetic ophthalmia (SO) for last six years. Vision was perception of light negative in OS and 20/20, N6 in the right eye. Intraocular pressure by applanation tonometry was 32 mmHg in OS. Clinically, morgagnian globules (MGs) were noted on the anterior surface of the complicated cataractous lens in the OS [Fig. 1a] with panuveitis. MGs were seen in an enucleated eyeball of raw specimen by fluorescein stain [Fig. 1b], and later by hematoxylin and eosin (H&E) stain [Fig. 1c].[12] Morgagnian cataract is seen due to osmotic change in degenerated lens fibers.[123] Other histopathological findings were consistent with SO.Figure 1: (a) Slit-lamp photograph of left eye showing morgagnian globules on the anterior surface of the lens with posterior synechiae. (b) Morgagnian globules with fluorescein stain (× 40X). (c) Liquefied lens cortex with morgagnian globules filled clefts in H&E-stained slide (× 10X)Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal their identity. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.