Unusual Ocular Pathologies.

This special thematic issue of the Saudi Journal of Ophthalmology, dedicated to Unusual Ocular Pathologies is a valuable treasure, highlighting the continued impact of ocular pathology across all ophthalmic subspecialties. As eruditely discussed by Grossniklaus in his 2015 editorial “Ophthalmic Pathology: History, Accomplishments, Challenges, and Goals”, ophthalmic pathology adds steadfast value to ophthalmology by virtue of dedicated individuals advancing the field, through research and clinicopathologic correlation, and utilizing a confluence of technology, i.e. a synthesis of specialized diagnostic methods, including imaging modalities, digital technologies, and molecular biology. The body of work assembled in this issue by leading international authors in various branches of ophthalmology confirms that this statement holds true.

Clinicopathologic correlation continues to be the cornerstone of ocular pathology and this is further evident in this issue of the Saudi Journal of Ophthalmology. With an understanding of ocular embryology, Williams et al reviewed the published literature on torpedo maculopathy and speculate that this lesion develops from a congenital nerve fiber layer-driven mechanism. Similarly, meticulous synthesis of the clinical and pathologic features of corneal opacification in acquired corneal subepithelial hypertrophy by Al-Rajhi et al. , of the various etiologies of tarsal cysts by Al Rubaian et al. , and of challenging inflammatory juvenile conjunctival melanocytic nevi by Nebot et al. will expand our understanding of these diseases.

Ancillary specialized diagnostic techniques have become an integral part of ophthalmology practice across the specialties, including ocular oncology and ocular pathology. Ancillary imaging studies, such as fundus autofluorescnece imaging, B scan ultrasonography, fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), and OCT angiography have contributed to the detailed characterization of various intraocular diseases and, in some instances, have been likened to an “in vivo biopsy”. Similarly, anterior segment imaging correlation with histopathology has contributed significantly to clinical diagnostic accuracy and to improved management of ocular surface neoplasms and non-neoplastic disease processes. Some of these imaging modalities are illustrated herein in large cohort analyses by Dalvin et al. in their characterization of choroidal hemangioma and by Welch et al. in their evaluation of uveal metastasis. Analogously, in their study on acquired corneal subepithelial hypertrophy Al-Rajhi and colleagues correlate corneal topography findings with clinical presentation and histopathology .

Immunohistochemical and molecular biologic methods have largely replaced ultrastructural studies in our approach to the pathologic diagnosis of challenging lesions. This trend is exemplified by several publications in this issue of the journal, which document advances in our understanding of underlying molecular genetic mechanisms of ocular adnexal and intraocular diseases, and how these advances translate into improved diagnostics, management, and prognostication. In addition to their increasing importance in the diagnosis of heritable diseases and neoplasia, the continually evolving molecular biology-based diagnostic methods are successfully employed to rapidly and accurately detect and identify the pathogenic organism in ocular infections. These advances are summarized in the review by Alkatan and Al-Essa on the available diagnostic methods for microbial keratitis.

The cross-sectional studies in ocular pathology and ocular oncology allow us to characterize the epidemiology of disease and to derive prognostically and therapeutically-relevant data. The eagle’s eye overview of enucleation trends over the past 2 decades at a single institution by Thaung offers an insight into the continually changing landscape of ocular disease and its management. The analysis of 100 consecutive older patients with retinoblastoma diagnosed at age 4 years or older over 6 decades by Masoomian and colleagues offers an invaluable perspective on the clinical characteristics and histopathologic findings of this uncommon, “older-age” presentation of retinoblastoma, and additionally highlights the evolution of therapies through the years. Similarly, evaluation of timing of uveal metastasis based on primary cancer type and the related overall survival of over 1000 patients by Welch et al. provides a valuable resource on cancer screening and surveillance.

This special issue on Unusual Ocular Pathologies offers a small glimpse into the incredibly diverse spectrum ophthalmic disease, ranging from developmental anomalies, to corneal opacification and infection, to eyelid and orbit inflammatory and neoplastic disorders, and to the vast assortment of intraocular tumors. This synthesis of histopathology with clinical data and ancillary diagnostic methods by the worlds experts in various ophthalmic subspecialties has led to a wide array of insightful and thought-provoking treasures.