Sarcoidosis manifesting as uveitis and menometrorrhagia.

PURPOSE: To report a rare systemic manifestation of sarcoidosis identified in a 47-year-old white woman while she was undergoing evaluation for bilateral recurrent uveitis. METHODS: The patient underwent clinical and laboratory evaluation for bilateral recurrent uveitis including serologic and radiologic testing, a gallium scan, and an endometrial biopsy. RESULTS: Although the serologic tests and chest x-ray were normal, the gallium scan was consistent with sarcoidosis, and the endometrial biopsy provided a tissue diagnosis. CONCLUSION: Sarcoidosis involving the female reproductive tract is rare. A thorough review of systems is crucial in the evaluation of any patient with recurrent uveitis.

Deep venous thrombosis following immobilization after retinal detachment surgery.

Although deep venous thrombosis (DVT) and pulmonary embolism are potentially fatal complications of numerous surgical procedures, DVT associated with ophthalmic surgery has rarely been reported in the current literature. We report the development of a DVT in a patient following complicated vitreoretinal surgery.

Heterotransplantation of human uveal melanoma.

Cell lines established from the biopsy specimen of a patient with a spindle B choroidal melanoma were transplanted into the posterior choroid of 30 immunosuppressed, pigmented New Zealand rabbits. Growth of the tumor xenografts could be seen 7 to 10 days after transplantation. Tumor xenografts were reproducible and reached an average size of 5 mm in height and 8 mm in their basal dimension by 4 weeks. Histopathology of the original tumor revealed primarily spindle B cells, while the tumor xenografts contained epithelioid, spindle B, and clear cell melanoma cells. Of particular interest was the presence of an extensive and intact vasculature and the absence of a capsule surrounding the lesions in situ. The use of human uveal melanoma cells, the ease of transplantation, and the posterior location of the tumor may make this animal model of use in studies on new diagnostic and therapeutic modalities.

Combined localized current field hyperthermia and irradiation for intraocular tumors.

Ten patients with large melanomas and one patient with recurrent retinoblastoma were treated with combined localized current field (LCF) hyperthermia and iodine 125 irradiation delivered by episcleral plaque. Tumors were heated to 43 degrees to 45 degrees C for 28 to 45 minutes. Localized current field hyperthermia when combined with irradiation appeared to induce rapid tumor necrosis. One eye enucleated 17 hours after treatment showed only focal necrosis of the melanoma, while another eye demonstrated extensive necrosis 60 hours after treatment. In all remaining eyes, tumor regression occurred within the first month of treatment. Complications included cataract formation in six eyes, hemorrhagic retinal detachment in five eyes, and phthisis in two eyes. Complications from combined therapy of large intraocular tumors in this series appeared to result from the rapid necrosis of the tumor and secondary intraocular inflammation. Intraocular temperature dosimetry measurements demonstrated a temperature gradient of not more than -0.23 degrees C/mm-1 per axial millimeter from the episcleral plaque surface to the apex of the tumor. The authors believe that LCF hyperthermia could be a suitable means of application of hyperthermia in patients with intraocular tumors if further modifications were performed to reduce ocular complications.

Echographic characteristics of ocular toxocariasis.

Ocular toxocariasis most commonly presents as one of three distinct clinical syndromes: endophthalmitis, localized posterior granuloma, or peripheral granuloma. Using standardized echography, the authors studied 11 toxocariasis patients presenting with one of these syndromes. Common echographic findings were noted in ten of these patients, and included: (1) a solid, high-reflective peripheral mass, (2) a vitreous band or membranes extending between the posterior pole and the mass, and (3) a traction retinal detachment or fold from the posterior pole to the mass. These findings were present in patients presenting with leukocoria or endophthalmitis, as well as in patients in whom the peripheral nematode lesion could be visualized clinically. In combination with the history, clinical examination, and enzyme-linked immunosorbent assay (ELISA), standardized echography may be useful in establishing the diagnosis of ocular toxocariasis in cases of leukocoria in which nematode endophthalmitis is suspected.

Localized current field hyperthermia: effect on normal ocular tissue.

Using a 500 kHz radiofrequency electromagnetic heating system, the effects of localized current field hyperthermia in normal rabbit eyes were examined. A specially designed scleral plaque placed on normal rabbit eyes was heated to temperatures of 43 degrees C, 45 degrees C, and 47 degrees C for a period of 45 min. The effects of hyperthermia were monitored by clinical examination, fluorescein angiography, electroretinography and histopathology. A graded effect with increasing temperature was found at the lower temperature, and it was confined to the treatment field. At 47 degrees C the electroretinogram was extinguished due to diffuse photoreceptor damage outside the treatment field, as demonstrated by histopathology and electron microscopy. This study indicates that hyperthermia at 45 degrees C for 45 min is the maximum allowable temperature without causing diffuse retinal damage in the normal rabbit eye.