Primary Ciliary Body Marginal Zone Lymphoma Presenting as Hemorrhagic Hypopyon.

PURPOSE: Our purpose is to report a patient with primary unilateral ciliary body marginal zone lymphoma who initially presented with hemorrhagic hypopyon. METHODS: Retrospective review of the clinical, imaging, and immunohistopathological features of the case was performed. RESULTS: A 59-year-old man was referred with right anterior uveitis of unknown etiology which was unresponsive to systemic treatment. Slit-lamp biomicroscopy showed normotensive hemorrhagic hypopyon in that eye. Anterior segment ultrasound biomicroscopy revealed an iridociliary mass lesion. Because an anterior chamber paracentesis was noncontributory, a diagnostic cyclectomy was performed. Histopathological evaluation showed that the neoplastic cells were positive for CD20, lambda light chain, and BCL 2. BCL 6, CD10, CD5, SOX11, kappa, and Cyclin D1 stains were negative. The final diagnosis was extranodal marginal zone lymphoma of the ciliary body. CONCLUSIONS: Although rare, ciliary lymphoma may be a cause of intractable anterior uveitis. Repeat biopsies could be carried out when there is a high level of clinical suspicion.

[The specific features of penetration of the antioxidant histochrome across the blood-ocular barrier: an experimental study].

Analysis of intraocular fluid and the vitreous body in 7 rabbits (14 eyes) by high performance liquid chromatography reveals histochrom metabolic products and, possibly, histrochrom itself during intravenous and subconjunctival injections and retrobulbar administration of histochrom through the irrigation system on models of experimental rabbit hyphema and hemophthalmia, which suggests that histochrom is able to penetrate across the blood-ocular barrier.

Fluorescence of blood-stained cornea.

Corneal blood staining represents deposition of hemoglobin and its breakdown products within the cornea. Pathologic examination of these corneas typically reveals degenerating endothelial cells and keratocytes. These degenerative changes have typically been attributed to the blunt trauma itself or to toxicity of the erythrocytic debris (a "localized hemosiderosis"). Another possible mechanism for this injury, however, is porphyrin-induced photosensitivity. Examination of frozen sections of an acutely blood-stained human cornea demonstrated fluorescence within all layers of the cornea, similar to that seen with hematoporphyrin derivative. The production of cytotoxic oxygen species within the blood-stained cornea exposed to light may contribute to endothelial and keratocyte degeneration. Limiting light exposure of blood-stained corneas or eyes with hyphemas might theoretically reduce light-induced and porphyrin-mediated toxicity.

Protoporphyrin IX photosensitization of corneal endothelium.

Protoporphyrin IX, a naturally occurring precursor of hemoglobin found in serum and erythrocytes, is a photoactive compound that we have detected in aqueous aspirates of three patients with hyphemas (0.13, 0.33, and 0.67 microgram/dL). To determine whether corneal endothelial photosensitization could occur, rabbit corneas were exposed to physiologic concentrations of protoporphyrin and light (200 microEinsteins [microE]/m2 per second). Experimental corneas demonstrated endothelial swelling with loss of intercellular contact by scanning electron microscopy. Flux chamber experiments demonstrated an increase in the net endothelial inflow, indicating a loss of the endothelial barrier function. Control corneas had normal ultrastructural architecture and flux study results. These studies suggest that patients with long-standing hyphemas who may be exposed to long periods of light are possibly at risk for developing endothelial dysfunction and corneal blood staining. Patching of these patients' affected eyes may be prudent.

Clearance from the anterior chamber of RBCs from human diabetics.

Erythrocytes from diabetic patients manifest decreased deformability and increased adherence. These abnormal membrane properties may diminish the ability of erythrocytes (RBCs) from diabetics to undergo deformation in passage through the trabecular meshwork. Using sodium chromate Cr 51-labeled RBCs from type I diabetic patients with proliferative retinopathy and normal control subjects, we studied RBC clearance from the rabbit anterior chamber. The mean time for 50% clearance (T50) of RBCs from diabetics (76 hours) was significantly longer than that for RBCs from normal subjects (19.5 hours). In this model, RBCs from diabetics have a slower clearance from the anterior chamber than do RBCs from normal subjects.

Experimental hyphema clearance in rabbits. Drug trials with 1% atropine and 2% and 4% pilocarpine.

The effect of topical 1% atropine sulfate, 2% pilocarpine hydrochloride, and 4% pilocarpine hydrochloride on the clearance rate of RBCs labeled with chromium 51 (51Cr) that were injected into the anterior chamber of rabbits was determined by monitoring sequential radioactivity counts. Counts were made directly over the anterior chamber. One eye of each animal was treated with either 1% atropine, 2% pilocarpine, or 4% pilocarpine, and the other eye served as a control. None of these drugs significantly altered the clearance rate of 51Cr-labeled RBCs injected into the anterior chamber.