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BRIEF COMMUNICATION
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 75-77

Ocular crystals in chronic uveitic eye


1 Department of Ocular Pathology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
2 Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Date of Submission08-Apr-2020
Date of Decision23-Jul-2020
Date of Acceptance27-Jul-2020
Date of Web Publication31-Jul-2021

Correspondence Address:
Dipankar Das
Department of Ocular Pathology, Uveitis and Neuro-Ophthalmology Services, Sri Sankaradeva Nethralaya, 96 Basistha Road, Beltola, Guwahati, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_37_20

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  Abstract 


Intraocular crystals are seen in chronic uveitis. We present a case of a young man with clinical presentation of refractile crystals in the anterior chamber (AC) with right painful blind eye secondary to uveitic glaucoma, which had earlier retinal detachment surgery. AC tap revealed the crystals in cytology, and further, enucleation of the eyeball showed those crystals in the anterior and posterior segments of the eye. Intraocular crystals at multiple sites were rare occurrence.

Keywords: Crystals, enucleation, retinal detachment, uve


How to cite this article:
Das D, Kuri GC, Soibam R, Bhattacharjee H, Tayab S, Deka H, Das BC, Das Mohapatra SS, Gupta T, Deka A. Ocular crystals in chronic uveitic eye. J Clin Ophthalmol Res 2021;9:75-7

How to cite this URL:
Das D, Kuri GC, Soibam R, Bhattacharjee H, Tayab S, Deka H, Das BC, Das Mohapatra SS, Gupta T, Deka A. Ocular crystals in chronic uveitic eye. J Clin Ophthalmol Res [serial online] 2021 [cited 2022 Jul 2];9:75-7. Available from: https://www.jcor.in/text.asp?2021/9/2/75/322792



Uveitic glaucoma can be secondary to long-standing uveitis or from any other complications such as retinal detachment surgery.[1],[2],[3] Keratic precipitates, anterior chamber (AC) reactions, neovascularization of iris, and 360° posterior synechiae along with AC crystals can be seen in varied causes of uveitis.[1],[2],[3] Mostly, those crystals were seen in the AC of the eye and often associated with Fuch's uveitis.[4],[5] We had observed those refractile crystals clinically, in cytology and in enucleated eyeball of a young man who had previous history of retinal detachment surgery in that eye.


  Case Report Top


A 28-year-old man came to a tertiary eye care center of Northeast India with chief complaint of diminution of vision in the right eye (OD) for the last 2 weeks. The patient had a history of myopia in both eyes (OU) with retinal detachment surgery in OD. There was no history of cough, shortness of breath, joint pain, and other history of recent infections in the patient. On examination, vision in OD was perception of light and projection of rays was inaccurate and left eye (OS) had a vision of 20/80 and pinhole improved to 20/63. On slit-lamp examination, OD showed circumciliary congestion, numerous polychromatic refractile crystals in the AC [Figure 1], cells and flare ++ with 360° posterior synechiae, rubeosis irides, and small twigs of blood vessels seen on the cataractous lens. There was no buckle effect observed on scleral examination. OS showed AC quiet with cataract and festooned pupil. Intraocular pressure (IOP) by applanation tonometry was noted 18 mmHg in OD and 14 mmHg in OS, respectively. Fundus was not seen in OD, and B-scan ultrasound of OD showed multiple hyperreflective echoes in the vitreous cavity with funnel-shaped recurrent retinal detachment [Figure 2]. There was suspected small mass with no choroidal excavation seen. Retinochoroidal thickness was normal in OU. Further, magnetic resonance imaging scan of the brain and orbit did not reveal any mass lesion. Fundus examination was normal in OS. The patient came after 1 month with severe pain in the OD and IOP was 32 mmHg. Vision and IOP were stable in OS. On gonioscopy, OD showed closed angles in all quadrants and opened in OS. AC tap was done in OD which showed the crystals, and all other infectious causes were ruled out in polymerase chain reaction tests. Other systemic investigations for uveitis including sarcoidosis were negative. IOP in OD did not come down even after maximum medical antiglaucoma treatment. Because of painful blind eye, the patient was advised enucleation after proper surgical consent.
Figure 1: Clinical picture of anterior segment of the right eye showing multiple refractile crystals in the anterior chamber. Please note 360° posterior synechiae was observed

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Figure 2: B-Scan ultrasound of OD with a funnel-shaped retinal detachment

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The enucleated eyeball (OD) measured normally in all required dimension and was sectioned vertically [Figure 3]. Cut end of the optic nerve was submitted separately. Grossly, glistening crystals were seen under polarizer and were observed in the AC [Figure 4], limbus, ciliary body, and vitreous cavity [Figure 5] and on the surface of the retina. Grossly, deep cupping of the optic nerve was noted.
Figure 3: Enucleated eyeball cut section of the patient showing intraocular content and retinal detachment

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Figure 4: Gross photograph showing refractile crystal under polarizer in the anterior chamber

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Figure 5: Photograph showing multiple crystals along with pigmented cells in the vitreous cavity

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Microscopic examination showed normal cornea with episcleral congestion, inflammation in episclera, and limbal sclera. Iris showed neovascularization. Ciliary bodies were blunted at one end, and the retinal tissue showed inflammation by chronic inflammatory cells and calcifications were noted. Few crystals were seen in the AC under the polarizer. There was retinal detachment noted without any foam cells or telangiectatic vessels in the exudation. Optic nerve and choroid were normal.


  Discussion Top


Intraocular crystals in the anterior uveitis had been reported previously.[1] Those dichroic bodies had been seen in the AC of eye and reported to be the part of Russell's bodies in histopathology.[1],[2],[3] We had seen those bodies clinically in the AC of OD in our patient with panuveitis which was later diagnosed as painful blind eye. AC tap showed those crystals in that eye. Enucleated gross eyeball showed birefringent shining crystals under polarizer in the AC, vitreous, and ciliary body and on retinal surface. Intraocular crystals in uveitis and other ocular conditions may be due to chronicity of the case.[4],[5] Intraocular crystallization can be due to number of factors. In uveitis, it had been seen in chronic Fuch's uveitis cases, in some of intravitreal injection-like ganciclovir or in some chronic uveitis with or without a cause. In chronic uveitis, there is a possibility of biochemical change inside the eye. Change in pH can lead to the formation of crystals in the AC and posterior chamber of eye. Extraocular matrix proteins interact with biological tissues or fluids and lead to crystallization. Another thought about the formation of intraocular crystals is its association with Russell's bodies.[4],[5],[6] Immunoglobin can aggregate in nonfunctional organ-like phthisical eye and forms crystals consisting of probably amyloid fibrils.[4],[5],[6] In our case, we did not see the plasma cells infiltration or the Russell's bodies in the histopathology (HPE). Moreover, we did not perform the chemical analysis of the crystals. Cholesterolosis was sometimes seen in long-standing exudative retinal detachment such as in Coat's disease, but we did not observe the foam cells, cholesterol clefts, or any telangiectatic vessels in HPE. In our case, festooned pupil was seen in the OS also which could indicate a bilateral involvement; however, all the local and systemic investigations were negative in the patient.

In conclusion, multiple crystals in AC and posterior chamber were characteristics in our case, and there were no such histopathological reports previously of such extensive crystallization of intraocular structures.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has/have given his consent for his 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.

Acknowledgments

We would like to acknowledge Kanchi Sankara Health and Educational Foundation, Guwahati, Assam, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Murray PI. Iris crystals and uveitis. Br J Ophthalmol 1993;77:466.  Back to cited text no. 1
    
2.
Zamir E, Margalit E, Chowers I. Iris crystals in Fuchs' heterochromic iridocyclitis. Arch Ophthalmol 1998;116:1394.  Back to cited text no. 2
    
3.
Iwamoto T, Witmer R. Light and electron microscopy on plasma cells and Russell bodies in the iris of a chronic uveitis patient. Invest Ophthalmol 1969;8:563-82.  Back to cited text no. 3
    
4.
Jones NP. Fuchs' heterochromic uveitis: An update. Surv Ophthalmol 1993;37:253-72.  Back to cited text no. 4
    
5.
Zamir E, Margalit E, Chowers I. Iris crystals in Fuchs' heterochromic iridocyclitis. Arch Ophthalmol 1998;116:1394.  Back to cited text no. 5
    
6.
Tandon M, Malhotra PP, Gupta V, Gupta A, Sharma A. Spectrum of Fuchs uveitic syndrome in a North Indian population. Ocul Immunol Inflamm 2012;20:429-33.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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