Rachna Meel

All India Institute of Medical Sciences | AIIMS · Dr. R.P. Centre for Ophthalmic Sciences

Due to the increased longevity of patients and advances in diagnostic modalities, an increase in the prevalence of patients with orbital metastasis is being observed. Here, we report a lady in her 40s who presented with complaints of painless protrusion of the left eyeball with restricted motility and reduced vision. She gave history of surgery for...

Retinoblastoma (RB) is the most common intraocular malignancy of childhood. Advanced stage presentation of RB is common in low middle-income countries (LMICs) due to lack of awareness, social taboos associated with enucleation, seeking alternative conservative treatment options, and poor accessibility to health care. Over the last few decades, ther...

Retinoblastoma (RB) is the most common childhood intraocular malignancy. Delayed presentation due to a lack of awareness and advanced intraocular tumors are a common scenario in low-middle income countries (LMICs). Remarkable treatment advances have been made in the past few decades allowing globe salvage in advanced intraocular RB (IORB) including...

Introduction Eyelid sebaceous gland carcinoma (SGC) is an aggressive malignancy. Surgical excision is the standard treatment for non-metastatic eyelid SGC. This study aimed to evaluate treatment outcomes with use of neoadjuvant chemotherapy (NACT) and any change in ease/difficulty of surgical treatment in such cases. Methods This was a prospective...

Retinoblastoma (RB) is the most common intraocular tumor in childhood. It is mainly caused by mutations in both alleles of the RB1 tumor suppressor gene that is found on chromosome 13 and regulates the cell cycle. Approximately 8000 children are diagnosed with RB globally each year, with an estimated 1500 cases occurring in India. The survival rate...

Purpose This study aimed to determine the clinical indications for orbital exenteration, demographic profile of these patients, and clinicopathologic correlations in the current times and to compare these results with previous published data. Methods It was a retrospective study. All exenterations performed at a tertiary eye care center over a per...

Purpose Retinoblastoma (RB) is the most common intraocular tumor in pediatric age group. The role of genetics has been explored in predicting survival prognosis, but its role in predicting globe salvage remains largely unexplored. We hereby aim to isolate cell-free DNA (cfDNA) from aqueous humor (AH) in RB eyes and validate its use for genetic stud...

To explore the magnitude of sex bias and determinants of treatment abandonment (TA) in childhood cancer in India. Individual data of children (0–19 y) registered between January 1, 2017 and July 31, 2022, was compiled. TA was defined as defaulting curative intent treatment ≥4 wk. Defaulting treatment irrespective of intent ≥4 wk was defined as Trea...

Receptor tyrosine kinases (RTKs) serve as molecular targets for the development of novel personalized therapies in many malignancies. In the present study, expression pattern of receptor tyrosine kinases and its clinical significance in orbital RMS has been explored. Eighteen patients with histopathologically confirmed orbital RMS formed part of th...

Background Tumor-Associated Macrophages (TAMs) are associated with an unfavorable outcome in uveal melanoma (UM). Literature showed the correlation between UM with monosomy 3 and an inflammatory phenotype including the presence of TAMs.¹ TAMs in UM with monosomy 3 are predominantly pro-angiogenic M2 polarized macrophages which are characterized by...

Background Pigmentation could be a relevant prognostic factor in uveal melanoma (UM) development. Microphthalmia-associated transcription factor (MITF) regulates melanin synthesis by activating tyrosinase-related protein 2 (TYRP2) and silver protein (SILV) that induce the melanogenesis pathway. Although their oncogenic potential has been observed i...

Purpose: To describe a staging system for optic nerve invasion using magnetic resonance imaging (MRI) and report any correlation with survival outcome. Methods: This was a ambispective study. Twenty-one patients with retinoblastoma who had optic nerve involvement on MRI were staged at baseline based on contrast enhancement and/or thickening and...

Introduction: Optic nerve (ON) enhancement alone without ON thickening on contrast-enhanced magnetic resonance imaging (CE-MRI) can be associated with post-laminar optic nerve invasion (PLONI) in eyes with group E retinoblastoma. A few case reports and retrospective studies in the literature show a poor correlation between ON enhancement on MRI an...

Purpose: To excise external angular dermoid cyst (EADC) by transconjunctival approach and compare the surgical outcomes with the standard transcutaneous approach. Design: This was a prospective, pilot, interventional, comparative study. Methods: Patients with EADC with no or minimal fixity to the underlying bone on palpation and limited to eye...

Unlabelled: Background Response rate of PD-1/PD-L1 immunotherapeutic blockade agents in uveal melanoma (UM) is poor. Lymphocyte activation gene 3 (LAG3) and cytotoxic T-lymphocyte-associated protein 4 (CTLA4) are the two promising immune checkpoint targets. Therefore, our aim was to explore at how these proteins were expressed in tumour tissue and...

Objective: End-stage ocular diseases usually end up with atrophic bulbi or phthisis bulbi leading to orbital volume loss which needs to be addressed. We studied the use of autologous fat for volume augmentation of the orbit because it is minimally invasive and allows early rehabilitation with the use of an artificial eye. Design: It was a prospe...

Aspergillus infection is relatively rare disease, and we present a case of orbital aspergillus infection who presented with right orbital pain and swelling. Right orbital lesion was identified on CT, MRI, and PET-CT imaging followed by confirmation of aspergillus on histopathological examination. We demonstrate that Tc-99 m ubiquicidin scan can yie...

Purpose To explore the burden, clinical features and associations of trichiasis due to trachomatous and non-trachomatous aetiologies. Methods Consenting patients presenting with trichiasis of either eyelid (of one or both eyes) attending the outpatient department, cornea and oculoplasty clinics of a tertiary eye care hospital in New Delhi between...

Existing clinical indicators for metastatic risk classification and patient treatment of uveal melanoma (UM) in the Asian population are limited. Preferentially expressed antigen in melanoma (PRAME) has gained attention in the prognosis of cancers and considered as a potential biomarker in many tumors including UM. Therefore, this study investigate...

Background Cicatricial ectropion can be corrected by invasive surgical modalities such as full-thickness skin graft, lateral tarsal strip procedure, etc., which are associated with donor site morbidity and additional scars. Use of autologous fat graft (AFG) in treatment of burn scars has previously shown encouraging clinical results as to skin colo...

Background The aim of the study was to evaluate the outcomes of voriconazole in terms of functional recovery and response on imaging in the management of invasive aspergillosis of orbit. Methods This was a prospective non-comparative interventional study. Diagnosed cases of invasive orbital aspergillosis were studied in a tertiary care hospital. I...

Clinical relevance: Patients undergoing exenteration have significant anxiety and depression, and lower quality of life that worsens after surgery. Therefore, counselling by an eye health-care provider along with the team of psychologist and psychiatrist could be provided pre-operatively to assess baseline psychosocial status and be continued post...

Background This study aimed to determine the clinical indications for orbital exenteration, demographic profile of these patients and clinicopathological correlations in current times, and to compare these results with previous published data. Methods A retrospective analysis was conducted of exenterations performed at a tertiary eye care centre o...

Objectives: To study the thickness of levator palpebra superioris-Muller's muscle complex (LMC) on ultrasound biomicroscopy (UBM) and to correlate with the clinical response to botulinum toxin A (BTA) injection in patients with inactive-stage of thyroid-related upper eyelid retraction (UER). We also studied the correlation of clinical parameters,...

Full-thickness deficiency of eyelid tissues can result in coloboma or retraction or both. Here we report our initial experience on the use of auricular skin-cartilage sandwich graft technique for full-thickness eyelid deformities. Five patients (4-32 years) underwent the procedure. Patients with full-thickness eyelid deformity were included. Three...

Background To highlight the clinical presentations and management outcomes of rhino-orbital mucormycosis during first wave of COVID-19 pandemic in North India. Methods A retrospective observational study. 15 patients with mucormycosis (orbital disease) who presented during short span of 3 months (October–December 2020) in a tertiary-care referral...

Purpose: The purpose of the study is to evaluate the safety and efficacy of adjunctive use of mitomycin-C (MMC) using two different concentrations 0.2 mg/ml and 0.4 mg/ml for lacrimal duct probing to treat the nasolacrimal duct obstruction (NLDO) in adults. Subjects and methods: Prospective, an interventional comparative randomized pilot study o...

Heminasal agenesis is an exceedingly rare congenital anomaly which is frequently associated with disorders of eye, lacrimal drainage system and face. At times, a proboscis may also be noted with this condition. Herein, we present a case of a 13-year-old boy who presented to us with heminasal agenesis with concomitant microphthalmos, leucomatous cor...

Purpose VEGF and HIF-1α are important regulators of angiogenesis, overexpressed in various tumors. Lacrimal gland Adenoid cystic carcinoma (ACC) is a malignant tumor whose angiogenic properties remain unexplored. This study was designed to evaluate the expression of HIF-1α and VEGF in lacrimal gland ACC. Methods VEGF and HIF-1α immunoexpression wa...

There are sparse data on neoadjuvant systemic chemotherapy (NACT) in eyelid sebaceous gland carcinoma (SGC). The aim of this study was to evaluate efficacy and outcomes with NACT in eyelid SGC. We retrospectively analyzed 8 patients who received platinum-based NACT. The median number of cycles per patient was 4 (range, 3–5). The mean percentage red...

Background To understand how to improve the effect of immune checkpoint inhibitors in uveal melanoma (UM), we need a better understanding of the expression of PD-1 and PD-L1, their relation with the presence of tumor-infiltrating lymphocytes (TILs), and their prognostic relevance in UM patients. Materials and methods Expression of PD-1 and PD-L1 w...

Background/objectives The conventional modality for management of advanced invasive ocular surface squamous neoplasia (OSSN) (AJCC grade T4 and T3 with fornicial involvement) is surgical excision which is not only challenging in terms of ability to achieve tumor free margins and tissue reconstruction but also has high morbidity. We describe the use...

PurposeMolecular mechanisms of uveal melanoma development in association with high pigmentation are unclear. Tyrosinase Related Protein (TYRP1) is not only one of the important melanogenesis marker that contributes to melanin synthesis, but can also prevents the melanocyte death. The induction of melanogenesis leads to induction of HIF-1α which can...

Purpose Adenoid Cystic Carcinoma (ACC) is an aggressive malignant lacrimal gland tumour associated with poor prognosis. Aberrant Notch signalling has been investigated in various tumours. However, very few studies on Notch signalling in lacrimal gland ACC are reported. The aim of the present study was to evaluate the status of Notch1 receptor and a...

BACKGROUND: To evaluate the role of interferon alpha 2b (IFNα2b) in the management of primary/recurrent cases of ocular surface squamous neoplasia (OSSN). METHODOLOGY: Medical records of 27 OSSN cases managed with IFNα2b (topical drops and/or perilesional injection) in 1 year were retrospectively reviewed. RESULTS: The median age of presentation wa...

Objective: The aim of this work was to study the clinical and histopathology features and treatment outcome in retinoblastoma cases presenting at an older age (>6 years). Design: This was a retrospective study. We recruited 48 retinoblastoma patients who were treated at our institute over 7 consecutive years and were older than 6 years at presen...

Objective: To evaluate the adjunctive role of conjunctival autofluorescence in the management of ocular surface squamous neoplasia (OSSN). Materials and methods: Seventeen patients with clinically diagnosed OSSN were included. Morphological characteristics, type of OSSN, and autofluorescence photographs of the lesion were captured. Presence and...

Background and Aims: Orbital Rhabdomyosarcoma(RMS) is a favourable prognostic tumour with cure rates of more than 90% when treated with combination chemotherapy and local radiotherapy in trial setting. Methods: The treatment plan for patients diagnosed with orbital RMS was induction chemotherapy (VAC regimen-Vincristine, Actinomycin D, Cyclophospha...

Ocular oncology is a rapidly evolving field with new information coming to light about the clinical and pathologic features of tumors every few years. This has a significant bearing in terms of the prognosis and treatment of these cancers. As a result, cancer staging systems are updated frequently to reflect these developments. Our article provides...

The chapter discusses different types of ocular surface tumours in brief.

Description of presentation, diagnosis and management of common and uncommon eyelid tumors.

IGG4 orbitopathy has gained a lot of importance in the last decade. The authors here report a case of IGG4 orbitopathy which showed a good response to oral steroids.

Biological understanding of pigmentation and its association with clinicopathological implications in uveal melanoma (UM) risk is still unexplored. HECT and RLD Domain Containing E3 Ubiquitin Protein Ligase 2 (HERC2) and Pink-eyed dilution protein (P-protein) are the important markers that regulate pigmentation in eye. Therefore, our aim of the stu...

Purpose To determine the significance of both massive choroidal invasion and optic nerve invasion (retrolaminar [(RL]+cut end [CE]) as a criterion for classifying high metastatic potential retinoblastoma and their relationship with other known histopathological high‐risk features. Methods A retrospective review of 650 eyes diagnosed as retinoblast...

Frydman Cohen Karmon Syndrome is an extremely rare syndrome associated with blepharophimosis. The authors here report the first case from the Indian subcontinent.

Post traumatic subperiosteal hematomas can be sight threatening. The authors here reports a video documentation of a vision threatenening subperiosteal hematoma drainage in a young male.

PurposeThe goal of this study is to identify the pathological findings and expression of immune checkpoint marker (PD-1, PD-L1, and CTLA-4) in the tumor microenvironment of both primary and chemoreduced retinoblastoma and correlate them with clinicopathological parameters and patient outcome.Methods Total of 262 prospective cases was included prosp...

Hemolacria is a rare condition. The author here reports a case of hemolacria in a young female.

Herein, the authors report a case of relapsing polychondritis (RP) presenting as isolated bilateral nodular episcleritis. A 23-year-old male presented to us with bilateral large ocular surface masses for which he had received antitubercular medications. A workup was performed to rule out infective, neoplastic, and immune etiologies, after which the...

The authors report a case of extremely uncommon malignancy of lacrimal gland epithelial-myoepithelial carcinoma. This carcinoma is more commonly encountered in salivary glands and comprises 1% of all salivary gland tumors. Its occurrence in the orbit is very rare with only 6 cases reported in the literature, most of which arose in a pleomorphic ade...

Abstract PURPOSE: Barrett Universal II (BU-II) is considered as one of the most accurate intraocular lens (IOL) power calculation formulas; however, there is no literature studying the same in Indian population. THE AIM OF THIS STUDY WAS TO: evaluate the accuracy of BU-II formula in prediction of IOL power for cataract surgery in Asian Indian popu...

Purpose Non-canonical NFκB (NC-NFκB) pathway plays an influential role in metastasis, which promotes cancer proliferation and progression. The aim of the study was to examine the expression of NC-NFκB proteins and their correlation with clinicopathological factors associated with metastatic cases of uveal melanoma (UM) and with the patient outcome....

Purpose Uveal melanoma (UM) is the most common intraocular cancer with a high mortality rate that requires new research in the field of prevention and treatment. c-REL is a member of the nuclear factor κB (NF-κB) transcription factor family and an emerging regulator of tumorigenesis. Therefore, the objective of the study is to evaluate the constitu...

Objective: To report one of the largest case series on periorbital and orbital dermoid/epidermoid cyst and to highlight some important and unusual findings. Methods: Retrospective analysis of 280 cases with orbital or periorbital dermoid/epidermoid cyst that presented over a period of 14 years. Results: Periorbital cyst was more than twice as...

Immunoglobulin G4 (IgG4)–related diseases are a spectrum of systemic inflammatory conditions of unknown etiology, which are characterized by infiltration of tissues by IgG4 plasma cells and sclerosing inflammation (Cheuk and Chan Adv Anat Pathol 17:303–32, 2010). Although this condition was initially described in relation to autoimmune pancreatitis...

Graves' ophthalmopathy (GO) involves autoimmune activation of fibroblasts, resulting in chronic inflammatory reaction. Somatostatin receptors are expressed in the cells associated with chronic inflammation. We hereby present patients with active GO, with delayed response to the standard treatment regimen, in whom 68Ga-DOTANOC positron emission tomo...

Background Uveal melanoma is the most common primary intraocular malignancy in adults. Almost half of patients with uveal melanoma may die from metastatic disease and the most frequent site of metastases is the liver. It is considered as an inflammatory phenotype. NFκB plays a connecting link between the inflammation and cancer. c-Rel and p50 are t...

Purpose: To report a case of Laryngeal Onycho Cutaneous Syndrome in a 10 year old child presenting with an ocular surface mass. Methods: A 10 year old boy presented in the out-patient department with a painless mass in left eye. There was history of airway obstruction requiring tracheotomy in early childhood and recurrent skin ulcerations. Aslit...

Purpose: To analyze the activation of NFκB1/p50 in the inflammatory and non-inflammatory environment of uveal melanoma and its association with clinicopathological factors and patient outcome. Methods: Activation of NFκB1/p50 was evaluated in 75 cases of uveal melanoma by immunohistochemistry. mRNA expression in 58 fresh UM specimen was measured...

Purpose: To study microscopic and ultrastructural changes of levator palpebrae superioris (LPS) muscle in congenital ptosis. Methods: In this prospective observational study, LPS muscle was studied in 77 eyelids with congenital ptosis; 35-simple congenital ptosis (SCP), 12-Marcus Gunn jaw winking phenomenon (MGJWP), and 30-blepharophimosis epica...

Inflammation in uveal melanoma (UM) is linked to a bad prognosis. It is rare type of cancer, of which the metastases are usually fatal within a year. Infiltration with an inflammatory infiltrate increases with disease progression but does not seem to inhibit metastasis. The Canonical NFκB (C-NFκB) pathway is known to play a crucial role in tumor in...

Objective: To evaluate the use of labial mucosa as a spacer for levator-Muller's recession in correction of severe eyelid retraction. Design: Retrospective interventional study. Participants: We retrospectively reviewed records of 4 patients with severe upper eyelid retraction not associated with cicatricial diseases of the conjunctiva. Metho...

The authors report a rare case of globe luxation following an injury with a cow horn.

A case of a 6-year-old boy presenting with epiphora, medial canthal swelling, and lymphadenopathy is reported. Biopsy revealed a poorly differentiated squamous cell carcinoma. The child underwent neoadjuvant chemotherapy and showed tumor progression after a remarkable initial response. This case highlights the atypical age of presentation of potent...

A 19-year-old woman presented to the outpatient department with occasional ocular pain and redness and a perilimbal mass, which she noticed 5 months ago in her left eye. She had no systemic complaints. Ultrasound biomicroscopy of the mass showed a hypoechoic lesion with uniform reflectivity. The patient underwent an excision biopsy and a histopatho...

Clinical evaluation of an early-onset left esotropia in an adolescent revealed a large macular lesion with extensive posterior pole retinochoroidal atrophy from superior arcade to inferior arcade. The lesion also showed pigmentary changes over the base, edges and beyond, along with a popcorn-like calcification just above the inferior arcade. Swept-...

Orbital cellulitis is the most common subset of orbital inflammatory disease. We describe a patient with necrotic choroidal melanoma who presented with orbital cellulitis. MRI revealed a mass lesion suggesting intraocular melanoma with no extrascleral extension. There was no metastasis on positron emission tomography-CT scan. Enucleation with orbi...

A 19-year-old male patient presented to the ocular emergency services with sudden onset of proptosis, pain, and bloody discharge. Further evaluation revealed bilateral visual acuity of finger counting close to face vision with an accurate projection of rays. Computed tomography scan of the head and orbit revealed diffuse orbital hemorrhage (mainly...

Giant Congenital Melanocytic Nevus (GCMNs) is mostly reported in area of trunk followed by limbs and head. Their incidence is

Purpose: To study the clinical profile, ultrasound biomicroscopy (UBM) findings, and treatment outcome of ocular surface squamous neoplasia with intraocular extension (OSSN-IO). Methods: It was a retrospective case series of 7 eyes of OSSN-IO treated at our center from March 2015 till December 2016. Results: Mean age of presentation was 53 yea...

The spectrum of pediatric orbital tumors differs from that of adults and further varies according to age. Tumors seen in teenage are similar to those seen in adults, while congenital space-occupying lesions such as colobomatous cyst and teratoma form an entity unique to infancy and early childhood. There is a vast difference in the management of or...

Purpose Uveal melanoma, although a rare form of cancer, is the most common primary malignancy of the eye in adults. Nuclear factor-κB (NF-κB) is a transcription factor that transactivates genes involved in the regulation of cell growth, apoptosis, angiogenesis, and metastasis, but the molecular mechanisms that negatively regulate NF-κB activation a...

Purpose: To study the features of upper eyelid in healthy individual and different types of congenital ptosis in the Indian population using ultrasound biomicroscopy (UBM). Methods: This was a prospective observational study at a tertiary care center. Eyelid structure of healthy individuals with no eyelid abnormalities (n = 19); simple congenita...

Purpose The aim is to study the clinicodemographic profile and treatment outcome of ocular surface squamous neoplasia (OSSN). Methods This was a retrospective observational study of 57 eyes (56 cases) with clinically diagnosed OSSN, presenting in our center over the past year. Results The median age of presentation was 55 years with male:female r...

Purpose: To report a rare case of isolated severe microblepharon in a neonate. Methods: A 27 days old male child was brought by parents with redness, photophobia and discharge for two weeks. Thorough ophthalmological and systemic examination was performed. Results: The diagnosis of isolated severe microblepharon with infectious keratitis was m...