Prognosis in uveal melanoma with extrascleral extension.

Two thirds of 60 patients followed up after enucleation for uveal melanoma with extrascleral extension eventually died of metastatic disease. Large intraocular tumor size, more malignant cell types, optic nerve invasion, and surgical transection or nonencapsulation of the extraocular tumor margin were found to be significantly correlated with development of metastases. Advanced age at enucleation and large intraocular tumor size were significantly associated with early metastatic death. Recurrence of tumor in the orbit was identified in 10% of the patients and was significantly correlated with large intraocular tumor size and optic nerve invasion. Early exenteration, performed in seven cases, did not improve prognosis. Application of Bayesian methods produced a multifactorial model for prediction of metastatic disease within 13 years after enucleation.

Microbial endophthalmitis resulting from ocular trauma.

Twenty-seven cases of culture-positive endophthalmitis that developed after ocular trauma were reviewed. The intraocular culture specimens showed a virulent microbiologic spectrum with Bacillus sp as the most common isolate (8 eyes). The visual prognosis was poor, with only 22% of patients retaining 20/400 or better vision. This level of vision was achieved in 2 of 22 (9%) bacterial cases and in four of five (80%) fungal cases. Retinal detachment (5 cases) or retinal breaks (2 cases) at the time of the initial injury had a uniformly poor visual prognosis. Postoperative retinal detachment not associated with phthisis bulbi occurred in five eyes, three of which had successful retinal reattachment surgery. Delayed onset retinal detachment after successful initial management of traumatic endophthalmitis had a greater frequency of successful retinal reattachment surgery.