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Iris Granuloma

Iris Granuloma. Dr Mamta Agarwal Dr J Biswas. History. 44yr / M C/O mild redness, decreased vision & mass in the right eye x 3-4 months No h/o any surgery, trauma. No systemic illness. Clinical findings. BCVA OD - 6/9 OS – 6/6 SLE OD

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Iris Granuloma

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  1. Iris Granuloma Dr Mamta Agarwal Dr J Biswas

  2. History • 44yr / M • C/O mild redness, decreased vision & mass in the right eye x 3-4 months • No h/o any surgery, trauma. • No systemic illness

  3. Clinical findings • BCVA OD - 6/9 OS – 6/6 • SLE OD • Aqueous cells & flare 1+ • Mutton fat keratic precipitates • Lobulated, pinkish – white mass with irregular surface extending from 7 – 9 clock hours in the inferotemporal quadrant

  4. Mass in the anterior chamber Mutton Fat KPs Slit lamp photograph OD

  5. Gonioscopy OD

  6. Ultrasound biomicroscopy • Mass lesion involving ciliary body and iris, extending three clock hours in inferotemporal quadrant

  7. Investigations • Laboratory tests • Complete blood count - normal • ESR – 43 mm Ist hr • Serum ACE – 92.2U/L (12-68) • Mantoux test – Negative

  8. Investigations • Chest X ray • Hilar lymphadenopathy & parenchymal lesions suggestive of ‘Sarcoidosis’ • Cervical lymphadenopathy

  9. 242 bp Aqueous tap Agarose gel photograph showing the amplified products of Mycobacterium tuberculosis Lane 1 & 2 : Negative Control M. tuberculosis Lane 3: AC tap Positive for M. tuberculosis Lane 4: M. tuberculosis( H37Rv) Positive control DNA

  10. Differential diagnosis • Tuberculosis • Sarcoidosis

  11. Sarcoidosis • CXR Hilar lymphadenopathy • S. ACE High • ESR Raised • Mantoux test negative • Cutaneous anergy

  12. Tuberculosis • Mantoux test Negative • S.ACE High (granulomatous reaction) • ESR Raised • AC Tap PCR Mycobacterium tuberculosis - positive

  13. Treatment • Anti Tubercular therapy • Systemic & topical steroids

  14. After 5 months OD Complete resolution of the granuloma

  15. Other options of treatment…… • ? Treated with ATT alone • ? Treated as Sarcoid only • ? Biopsy from the lesion itself • ? Excision biopsy

  16. Conclusion • TB & sarcoidosis can present as granuloma of the iris. • Polymerase chain reaction of the intraocular fluids can help in the diagnosis.

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