Vascular basophilia in ocular and orbital tumors.

The occurrence of vascular basophilia in ocular tumors has been a selective histologic feature of retinoblastomas. We recently observed a metastatic oat-cell carcinoma to the choroid which also demonstrated such a vascular hematoxyphilia. Histologic review of a variety of ocular and orbital metastatic carcinomas failed to yield a similar basophilic pattern. Examination of 100 consecutive retinoblastomas for vascular basophilia revealed an incidence of 6.0%. Similar material was not seen in any of 125 melanomas, including 10 with areas of necrosis. Histochemical studies showed the basophilic material to be DNA, and electron microscopy revealed the nuclear debris of pyknotic tumor cells to be continuous with identical material surrounding the adjacent blood vessels. The pathogenesis of vascular deposition of DNA in these two ocular tumors remains unclear. This finding most likely represents a form of tumor activity requiring comparatively healthy blood vessels to adequately precipitate liberated nucleic acids being filtered from the necrotic and degenerating tumor tissue.

False-positive 32P uptake tests.

Three patients had suspected choroidal melanoma and positive results for radioactive phosphorus (32P) uptake tests, leading to enuclearion in two of the patients. No malignancy was present on histopathologic examination. This experience reemphasizes the need for the ophthalmologist to evaluate the total clinical picture and not to give inappropriate consideration to a "positive" 32P uptake test in deciding for or against enucleation in a suspected choroidal melanoma. The positive 32P uptake test, even with high values, cannot be equated with malignancy, and a variety of nonmalignant lesions may give false-positive results.

Cutaneous malignant melanoma metastatic to the vitreous.

A 38-year-old man previously had a cutaneous malignant melanoma excised from his right shoulder. He presented to our clinic with neovascular glaucoma, corneal edema, large pigmented keratic precipitates, anterior chamber reaction, and pigmented aggregates in the vitreous of his left eye. There were no other ocular findings. Subsequent enucleation was performed and the globe was studied histopathologically. Special stains and electron microscopy showed the presence of both macrophages and malignant melanin-producing cells within the vitreous. The diagnosis of cutaneous malignant melanoma metastatic to the vitreous was made based on these findings. This is a rarely reported clinical entity, for which a high index of suspicion should be maintained.

Treatment choice and quality of life in patients with choroidal melanoma.

OBJECTIVE: To determine if quality of life differs between patients with choroidal melanoma treated with enucleation and those treated with radiation therapy. MATERIALS AND METHODS: Patients treated for choroidal melanoma at 5 Midwest centers were asked to participate. There were 65 participants treated with enucleation and 82 treated with radiation therapy. Quality of life was assessed using the Medical Outcome Study Short Form 36 and the National Eye Institute Visual Function Questionnaire and by the Time-Tradeoff interview method. RESULTS: The average length of follow-up was 4.9 years for the group treated with radiation therapy and 6.3 years for the group treated with enucleation (P = .05). After adjusting for age, sex, years of follow-up, and the number of chronic conditions, there were few differences in any of the quality-of-life measures by treatment status. Participants in the group treated with radiation therapy were more likely to have higher (better) scores on the Vitality and Mental Component subscales of the Medical Outcome Study Short Form 36 than participants treated with enucleation. There were no differences on the National Eye Institute Visual Function Questionnaire or the Time-Tradeoff measures of quality of life. CONCLUSION: Choice of treatment for choroidal melanoma does not seem to be associated with large differences in quality of life in long-term follow-up.

The diagnosis of Adie's pupil using 0.0625% pilocarpine solution.

In five patients a 0.0625% concentration of pilocarpine provided the marked difference in miosis between Adie's and normal pupils. Other concentrations did not produce as much as a difference.

Central retinal vascular occlusion associated with oral contraceptives.

A 40-year-old woman took oral contraceptives for four years. She developed a vascular glaucoma and one year later the eye was enucleated. No other apparent cause for the occlusion was present. The vascular occlusion consisted of a combined central retinal artery and vein occlusion with severe intimal hyperplasia. An intravascular granulomatous reaction is attributed to chronic vascular injury.

Sympathetic ophthalmia.

A 29-year-old woman developed severe ocular manifestations of sympathetic ophthalmia on the day after enucleation of a blind, painful eye, and four weeks after a penetrating ocular injury. She was observed for one year with fundus photography, fluorescein angiography, and electrophysiologic tests. Nystagmus, a rare systemic manifestation of sympathetic ophthalmia, was noted early in the course of her disease and was accompanied by vertigo, truncal ataxia, and cerebrospinal fluid pleocytosis. Enucleation and intensive corticosteroid treatment resolved the process; however, she has experienced recurrences in the two-year follow-up period.

Ultrasonographic mapping of vitreoretinal abnormalities.

We conducted a prospective study of 50 consecutive eyes to determine the accuracy of ultrasonographic mapping of vitreoretinal abnormalities. The 50 eyes, all of which had opaque media, underwent A- and B-scan ultrasonography before undergoing vitrectomy. The location and differentiation of any abnormalities were mapped on a fundus drawing sheet. At the time of vitrectomy, the surgeon independently examined the fundus and recorded his findings on a second drawing sheet. When we compared the two sets of drawings, we found that ultrasonography correctly predicted the position of the retina in 45 of 50 eyes and the presence or absence of macular detachment in 48 of 50 eyes. These two findings are particularly important to the surgeon. Ultrasonography also correctly predicted the presence or absence of posterior vitreous detachment in all 50 eyes, correctly described the exact extents of the retinal detachments in 44 of 50 eyes, and located points of vitreoretinal adhesion in 39 of 50 eyes.

Spontaneously regressing retinoblastomas, retinoma, or retinoblastoma group 0.

A 5-year-old boy had a gray, translucent retinal mass containing calcified nodules and surrounded by retinal pigment clumping and atrophy. The eye was enucleated and the patient has remained well for seven years. Microscopic examination disclosed an intraretinal tumor composed of benign-appearing cells in a bed of well-vascularized ground substance with calcific foci. There was surrounding retinal pigment epithelial hyperplasia but no peripheral necrosis or signs of tumor regression. There were no mitoses, cellular pleomorphism, nuclear atypia, rosettes, or other characteristics of malignancy. Tumors with this typical fundus appearance have been termed spontaneously regressing retinoblastoma or retinoma. Although the tumor in this patient was histopathologically benign, it carries the same genetic risk as a retinoblastoma. A better term for this lesion, therefore, is retinoblastoma group 0.

Multiple recurrent serosanguineous retinal pigment epithelial detachments in black women.

Three middle-aged black women suffered recurrent, multiple, bilateral, asymmetric, serosanguineous retinal pigment epithelial detachments. These involved the posterior fundus with resolution and recurrences producing subretinal hemorrhages, vitreous hemorrhages, retinal pigment epithelial pigmentary mottling, and chorioretinal scars. Fluorescein angiography showed evidence of choroidal neovascular membranes, choroidal serosanguineous leaks, or both. Ocular inflammation was not evident. Systemic laboratory tests were noncontributory. The clinical pattern was not characteristic of any other entity producing serosanguineous retinal pigment epithelial detachments. The origin remains to be defined.

Hepatoma metastatic to the orbit.

A 69-year-old man with a history of cirrhosis of the liver had unilateral progressive proptosis without jaundice, abdominal pain, or gastrointestinal symptoms. Results of laboratory and radiographic studies were also normal. Orbital biopsy revealed hepatocellular carcinoma. Although hepatocellular carcinoma has often been shown to metastasize to the brain and often to the flat bones of the skull, to the best of our knowledge, this is the first histologically proven case of hepatoma metastatic to the orbit.

Vitrectomy in patients with decreased visual acuity secondary to asteroid hyalosis.

PURPOSE: To evaluate the role of vitrectomy in patients with decreased visual acuity solely attributable to asteroid hyalosis. METHOD: We retrospectively reviewed the records of patients with asteroid hyalosis and identified those who underwent vitrectomy for symptomatic asteroid hyalosis alone. RESULTS: After vitrectomy, nine of 10 eyes (10 patients) had at least 1 line of improvement in nonstandardized best-corrected visual acuity. In one eye, vision was unchanged postoperatively. The average gain was 3.44 lines. CONCLUSIONS: A small percentage of patients with asteroid hyalosis have decreased visual acuity caused solely or primarily by the asteroid hyalosis. Vitrectomy in these patients may alleviate symptoms and improve visual acuity.

Corneal donor material selection.

Histologic study of eyes used as donor material for corneal transplant revealed one instance of massive leukemic infiltration with leukemic keratic precipitates on the fellow eye. In another eye, microabscesses composed of acute and chronic inflammatory cells containing Crytococcus neoformans were present. In a third patient metastatic anaplastic cells were present in the choroid. We think donor eyes are absolutely unacceptable if death was caused by any chronic neurologic disorder, unless clearly secondary to trauma. Eyes from patients with septecimia, hepatitis, jaundice and any evidence of any active viral infection, syphilis, and positive serology are also unacceptable. Extreme caution should be used in selecting eyes of patients with ocular or systemic malignancy, long-term diseases, particularly if immunosuppressive agents were used, where a history of eye disease exists, including corneal disease or dystrophy, iritis, absolute glaucoma or acute glaucoma, and eyes with a history of previous intraocular surgery.

Increased incidence of choroidal malignant melanoma occurring in a single population of chemical workers.

In five patients with choroidal melanoma occurring among present or former workers of the duPont Belle, West Virginia, plant the involved eye was enucleated and histopathologic confirmation of the diagnosis was made. This represents a statistically significantly greater than expected occurrence of choroidal melanomas in the white male study population.

Chronic Propionibacterium endophthalmitis after extracapsular cataract extraction and intraocular lens implantation.

We studied six cases of chronic, indolent intraocular inflammation that occurred after extracapsular cataract extraction and posterior chamber intraocular lens implantation. The inflammation was characterized by a delayed onset, and in three cases had the clinical appearance of a granulomatous iridocyclitis. Cultures of intraocular specimens obtained from six eyes yielded Propionibacterium; five yielded P. acnes. Pleomorphic gram-positive bacilli consistent with Propionibacterium were identified in cytologic or histopathologic studies in four of the six culture-positive cases. After surgical and medical therapy, the inflammation resolved. Postoperative Propionibacterium endophthalmitis may masquerade as a chronic iridocyclitis.

Scleral and choroidal calcifications in a patient with pseudohypoparathyroidism.

This case report suggests that calcifications in the sclera and choroid may be a feature of pseudohypoparathyroidism and shows a calcium distribution more extensive and severe than that characteristically seen in other metabolic conditions associated with calcium deposits in the eye. Ocular ectopic calcification is a part of the more generalised ectopic soft tissue calcification seen with pseudohypoparathyroidism. Evaluation of the contribution of the terminal renal failure and uraemia to the ectopic ocular calcification would require sequential evaluation of eyes with pseudohypoparathyroidism, but without the added complication of uraemia.

Orbitofacial mucormycosis with unusual pathological features.

A 52-year-old man with mild diabetes and acute stem cell leukaemia developed an orbitofacial mucormycosis. Cultures showed the fungus to be Rhizopus oryzae. Vigorous treatment with amphotericin B and other bactericidal and bacteriostatic antibiotics for a concurrent sepsis failed to suppress the infections, and the patient died. On post-mortem examination characteristic haematoxylin-staining, broad, aseptate fungal hyphae were found in the right eye, orbit, and lung. A striking and unusual feature of this case is the presence of brightly birefringent crystals within the severely degenerated eye. These were found by histochemical staining and x-ray diffraction studies to be calcium salts of fatty acids, apparently liberated from necrotic adipose tissue of the orbit.

Combined malignant lymphoma of the eye and CNS (reticulum-cell sarcoma). Report of three cases.

Three cases of histopathologically proven combined ocular and central nervous system (CNS) malignant lymphoma (reticulum-cell sarcoma) are presented. A review of the literature revealed 33 cases described with this syndrome. Symptoms and signs of both CNS and ocular disease are discussed. The results of computerized tomography and angiography are also reviewed. The diagnosis has been made by craniotomy, cerebrospinal fluid cytological examination, and by pars plana vitrectomy. The latter two procedures should probably be attempted prior to considering craniotomy. Reticulum-cell sarcoma of the eye and CNS possibly has a multicentric origin.

Hibiclens keratopathy. A clinicopathologic case report.

A 39-year-old woman developed a painful, red eye immediately following oral surgery associated with preoperative preparation of her face with the antiseptic, Hibiclens. Epithelial and stromal edema was observed 2 weeks after surgery and progressed to diffuse bullous keratopathy. This led to penetrating keratoplasty 10 months later. Light and electron microscopic findings of the cornea included epithelial edema with bullous changes, marked loss of keratocytes, a thickened Descemet's membrane, and an attenuated, disrupted endothelial cell layer. These findings demonstrate the corneal damage that may occur following ocular exposure to Hibiclens.

Bacterial contamination of anaerobic vitreous cultures: using techniques employed for endophthalmitis.

PURPOSE: To investigate the occurrence of contaminated cultures of vitreous specimens from non-infected eyes obtained using anaerobic techniques employed for endophthalmitis. METHODS: Vitreous specimens were obtained using meticulous sterile techniques employed for endophthalmitis from seventeen patients undergoing pars plana vitrectomy for non-infective indications: vitreous hemorrhage (12 eyes), retinal detachment (3), Coat's disease (1), and congenital dislocated lens(1). Vitreous specimens were inoculated in the operating room onto an anaerobic blood agar plate and into thioglycolate broth. Bacterial growth occurring before 10 days was considered positive. RESULTS: Three organisms were isolated from three separate eyes. One colony of Staphylococcus species was isolated on an anaerobic blood agar plate on day 3. A single colony of Propionibacterium acnes grew on an anaerobic blood agar plate on day 6. Alpha-hemolytic streptococci grew from thioglycolate broth on day 10. CONCLUSIONS: Growth as detected in this study might represent contaminating rather than an infecting organism in an eye suspected of having endophthalmitis.