Massive Silicone-Induced Orbital Granuloma.

We report a large subconjunctival-orbital granuloma in a 51-year-old male presenting with a blind painful right eye and marked chemosis 15 months after undergoing vitrectomy and silicone oil retinal tamponade for retinal detachment with no reported intraoperative complications. Gross and histopathologic examination of the enucleated eye and episcleral tumor revealed a bosselated mass measuring 17 × 10 × 5 mm containing prominent vacuoles with surrounding epithelioid histiocytes and foreign body multinucleated giant cells. Such a large silicone-induced orbital granuloma following uncomplicated retinal surgery in a grossly intact eye has not been previously reported to the authors' knowledge. High intraocular pressure and emulsification of oil may facilitate silicone extravasation through scleral wounds after retinal surgery.

Vitreomacular Attachment Ultrastructure and Histopathological Correlation.

PURPOSE: The ultrastructural anatomy of the vitreomacular interface in young human donor eyes and animal eyes is explored using scanning electron microscopy (SEM) to determine its relationship with the formation of the perimacular ridge from abusive head trauma, as well as macular hole formation, vitreomacular traction syndrome, and preretinal hemorrhage. MATERIALS AND METHODS: SEM is used to image the posterior poles of 23 human donor eyes, as well as several cow, dog, monkey, pig, and rabbit eyes for vitreomacular interface anatomy. We examined autopsy eyes from abusive head trauma histopathologically. RESULTS: Two rings of thick, circumferential, vitreous attachment at the area centralis are found. An inner ring at the fovea, R1, and an outer ring at the perifoveal region, R2, are both observed in eyes from donors < 30 years of age; comparatively, in eyes from donors > 30 years, only R2 is present (p<0.001). R2 is found with unique elliptical shape in Cynomolgus monkey. Macula, R1, and R2 are not detected in cow, dog, pig, or rabbit eyes. CONCLUSIONS: The vitreomacular ring attachments found in donor eyes correspond anatomically with the perimacular ridge found histopathologically in abusive head trauma, and likely correlates with the macular hole, vitreomacular traction syndrome, and preretinal hemorrhage. Vitreomacular interface anatomy in the monkey, but not the cow, dog, pig, or rabbit, demonstrates some anatomical similarity to that of the human, consistent with species differences regarding the area centralis.

Features of Cutaneous Malignant Melanoma Metastatic to the Retina and Vitreous.

BACKGROUND/AIMS: To report a case of cutaneous malignant melanoma with cerebral metastasis found to have vitreoretinal metastasis upon referral for neovascular glaucoma. METHODS: The clinical history and ocular examination findings, including histologic, cytologic, genetic, and immunohistochemical features of the vitreoretinal metastatic tumor, were reviewed. Additionally, the histologic and immunohistochemical features of the primary skin tumor and brain metastasis were also assessed. RESULTS: A 62-year-old woman with cutaneous malignant melanoma metastatic to the right frontal lobe (BRAF V600E negative) was evaluated for blurred vision in the right eye. Neovascular glaucoma, iritis, and posterior synechiae with no view of the retina or vitreous were evident on examination. Vitreoretinal biopsy and enucleation specimen both showed widespread neoplastic involvement of the retina and residual vitreous strands after vitrectomy. Choroid, trabeculum, and other intraocular structures were devoid of tumor burden. Diagnosis of cutaneous malignant melanoma metastatic to the retina and vitreous was confirmed, and the patient expired shortly thereafter. CONCLUSION: Cutaneous malignant melanoma metastatic to the eye has a relatively greater preference for the retina and frequently presents with uveitis and glaucoma. Neovascular glaucoma in these cases may likely be attributable to unusually increased vascular endothelial growth factor production by the intraocular melanoma tumor cells.

Clinicopathological findings in abusive head trauma: analysis of 110 infant autopsy eyes.

PURPOSE: To investigate the histopathology in a large series of autopsy eyes from children with abusive head trauma. DESIGN: Retrospective case-control series. METHODS: One hundred and ten eyes from 55 autopsies examined at an academic tertiary referral center over 21 years were tabulated for histopathology: subdural hemorrhage in the optic nerve sheath, intrascleral hemorrhage, any retinal hemorrhage, ora-extended hemorrhage, cherry hemorrhage, perimacular ridge, and internal limiting membrane tear. Select tissues with cherry hemorrhage were further examined by transmission electron microscopy. RESULTS: Sixty eyes were identified as "abusive head trauma" (cases), 46 as "alternative cause" (controls), and 4 as "abusive head trauma survivor". Cases were legally verified or confirmed by confession in all except 1 case. All ocular histopathologic observations from cases were similar or more frequent in infants younger than 16 months of age. When present, a cherry hemorrhage and perimacular ridge were most often found together, and only with a torn internal limiting membrane. Both abusive head trauma survivor cases demonstrated severe optic nerve atrophy and macular ganglion cell loss. CONCLUSIONS: Younger infants may be even more susceptible to damage from vitreomacular traction by rotational and/or acceleration-deceleration forces. Identifying cherry hemorrhages may aid abusive head trauma diagnosis. Survivor abusive head trauma pathology demonstrates unique, irreversible macular and optic nerve damage.

Analysis of Schwalbe's Line (Limbal Smooth Zone) by Scanning Electron Microscopy and Optical Coherence Tomography in Human Eye Bank Eyes.

PURPOSE: Implantation of intraocular devices may become critical as they decrease in size in the future. Therefore, it is desirable to evaluate the relationship between radial location and Schwalbe's line (smooth zone) by examining its width with scanning electron microscopy (SEM) and to correlate this with observations by optical coherence tomography (OCT). METHODS: Full corneoscleral rings were obtained from twenty-six formalin-fixed human phakic donor eyes. SEM of each eye yielded a complete montage of the smooth zone, from which the area was measured, and width was determined in each quadrant. In three different eyes, time domain anterior segment OCT (Visante, Carl Zeiss Meditec Inc., Dublin, CA, USA) and spectral domain OCT (Cirrus 4.0, Carl Zeiss Meditec Inc., Dublin, CA, USA) were used to further characterize Schwalbe's line. RESULTS: The overall smooth zone width was 79±22 µm, (n=15) ranging from 43 to 115 µm. The superior quadrant (103±8 µm, n=19), demonstrated significantly wider smooth zone than both the nasal (71±5 µm, n=19, P<0.001), and inferior (64±5 µm, n=18, P<0.0001) quadrants but not the temporal quadrant (81±7 µm, n=17, P>0.05). SEM findings of the smooth zone were correlated with visualization of Schwalbe's line by Cirrus and Visante OCT imaging. CONCLUSION: The smooth zone appears widest superiorly and thinnest inferonasally, suggesting that as glaucoma surgical devices become smaller, their placement could be argeted clinically by using OCT with preference to the superior quadrant, to minimize damage to the corneal endothelium.