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PHOTO ESSAY |
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Year : 2020 | Volume
: 68
| Issue : 6 | Page : 1175-1176 |
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Intraocular osseous metaplasia
Md. Shahid Alam, Rajeev Priyadarshi
Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
Date of Submission | 13-Oct-2019 |
Date of Acceptance | 30-Dec-2019 |
Date of Web Publication | 25-May-2020 |
Correspondence Address: Dr. Md. Shahid Alam Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Mukundapur, Kolkata, West Bengal India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/ijo.IJO_1829_19
Keywords: Intraocular, long standing retinal detachment, osseous metaplasia, phthisis bulbi
How to cite this article: Alam MS, Priyadarshi R. Intraocular osseous metaplasia. Indian J Ophthalmol 2020;68:1175-6 |
A 35-year-old male patient presented to us with complaints of pain in the right eye for the past 3 months. He had suffered blunt trauma to the right eye 17 years back, following which there was complete loss of vision; however there was no history of undergoing any surgery. The vision in the right eye was no perception of light while it was 20/20; N6 in the left. The right eye was phthisical with leucomatous corneal opacity.
B scan ultrasonography was advised for the right eye. It showed disorganized globe structure with reduced axial length, and a well-defined area of intraocular calcification [Figure 1]a. Suspecting an underlying intraocular mass, the patient underwent enucleation with ball implant in the right eye. Gross histopathological examination revealed a grayish white mass of approximately 1.4 cm × 1 cm in size which was bony hard in consistency [Figure 1]b. Microscopic examination showed extensive osseous metaplasia and bone formation by the retinal pigment epithelial (RPE) cells [Figure 1]c. No tumor cells were identified and a diagnosis of intraocular osseous metaplasia in a long standing blind eye was made. | Figure 1: (a) Ultrasound B scan showing an area of well-defined intraocular calcification (arrow) with back scattering. (b) Cylindrical grayish white mass covered by pigmented uveal and retinal tissue. (c) Hematoxylin and Eosin stained microphotograph showing areas of bone formation (asterisk) surrounded by retinal pigment epithelial cells (arrow)
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Ossification of or within the ocular coat is a rare variety of metaplasia. The retinal pigment epithelium (RPE) cells are considered to be pluripotent and have the capacity to differentiate in to mesenchymal phenotype, including fibroblasts and osteoblasts.[1] Chronic inflammation, trauma, or long-standing retinal detachment can cause RPE to differentiate into mesenchymal cells resulting in intraocular bone formation.[2],[3] It usually requires 10 years or longer for ossification to appear. The pro-osteogenesis factors, bone morphogenic protein-7, and growth differentiation factor-5 play a significant role in RPE osseous transformation.[4]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | | |
1. | Pecorella I, Vingolo E, Ciardi A, Grenga P. Scleral ossification in phthisical eyes. Orbit 2006;25:35-8. |
2. | Vemuganti GK, Honavar SG, Jalali S. Intraocular osseous metaplasia. A clinico-pathological study. Indian J Ophthalmol 2002;50:183-8. [ PUBMED] [Full text] |
3. | Manusow JS, Brownstein S, Jordan DR. Osseous metaplasia with formation of hematopoietic bone marrow in a blind painful eye. Ophthal Plast Reconstr Surg 2011;27:e81-3. |
4. | Toyran S, Lin AY, Edward DP. Expression of growth differentiation factor-5 and bone morphogenic protein-7 in intraocular osseous metaplasia. Br J Ophthalmol 2005;89:885-90. |
[Figure 1]
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