Occurrence of Occult Neoplasia in Pterygium Specimens Among Hispanic and Non-Hispanic Patients.

PURPOSE: To determine the role of race and ethnicity in the prevalence of occult ocular surface squamous neoplasia in pterygium specimens. METHODS: This retrospective study reviewed pathology reports and medical records of 504 patients who underwent pterygium surgery in South Texas. Those with clinical signs of ocular surface squamous neoplasia were excluded. Clinical data including age, sex, and self-reported race and ethnicity were analyzed to determine risk factors for presence of occult ocular surface squamous neoplasia in pterygium specimens. RESULTS: There were 504 specimens; 95.8% were from patients identified as White, 1.8% from African Americans, and 2.4% from Asians. Ethnicity included Hispanic in 70.8% and non-Hispanic in 29.2%. Among all specimens, 18 (3.6%) were positive for occult ocular surface squamous neoplasia. The prevalence of occult ocular surface squamous neoplasia in pterygium specimens was higher in Hispanics compared to non-Hispanics (4.8% vs. 0.7%, respectively, p = .025). The prevalence of occult ocular surface squamous neoplasia in different races included 8.3% for Asians, 3.5% for Whites, and 0% for African Americans. However, the racial difference did not reach statistical significance (p = .57). There were also no statistically significant differences between those with or without occult ocular surface squamous neoplasia regarding age or sex. CONCLUSIONS: A significant but low rate of occult ocular surface squamous neoplasia was found in pterygium specimens. The percentage of those with ocular surface squamous neoplasia in pterygium specimens was significantly greater in Hispanics compared to non-Hispanics. As treatment and prognosis of pterygium and ocular surface squamous neoplasia differ, histopathologic evaluation of all pterygium specimens is warranted.

Numerical modeling of paintball impact ocular trauma: identification of progressive injury mechanisms.

PURPOSE: To create a computer-based numerical simulation model for comparison with empiric paintball-ocular ballistic study findings, allowing identification of the dynamic physical mechanisms (stress, strain, pressure) responsible for intraocular traumatic injury accompanying blunt ocular impact. Virtual experiments with numerical models could exploit mathematical "instrumentation" to facilitate internal observation impossible with physical experiments alone. METHODS: Models of human eye structures and orbit were implemented into the finite-volume Eulerian numerical hydrocode CTH. Numerical simulation results were compared with dynamic imaging and postimpact histopathology obtained during previous ballistic impact experiments on fresh porcine eyes impacted with paintballs. Forty numerical simulations and 59 impact experiments were conducted as part of the study. RESULTS: Time-lapse correlations showed the CTH models to be dynamically commensurate with orbital penetration and globe deformation measured from ballistic high-speed videos. CTH also predicted the types and levels of damage observed in detailed postimpact pathologic assessments of porcine specimens. High strain in the ciliary body and zonule corresponded with angle recession and lens displacement pathologically. Globe rupture was attained at the highest paintball impact velocities in both the porcine ballistic studies and CTH models, consistent with predicted dynamic intraocular pressures. The simulations also revealed that phenomena such as macular Berlin's edema, midperipheral retinoschisis, and choroidal and retinal detachment might be explained by focal dynamic pressure-wave reflection from the interior surface of the globe. CONCLUSIONS: Significant insight was gained regarding the physical mechanisms responsible for injury. CTH predictions corresponded closely with previous ballistic experimental results, adding intraocular detail otherwise unattainable.

Blunt eye trauma: empirical histopathologic paintball impact thresholds in fresh mounted porcine eyes.

PURPOSE: Ballistic studies were conducted using gelatin-embedded abattoir-fresh porcine eyes suspended within clear acrylic orbits to discern the energy required to produce specific ocular injuries. Paintball impact provides a robust ballistic model for isolating and quantifying the role of direct blunt force in ocular trauma. METHODS: Fifty-nine porcine orbital preparations received direct blows from 0.68 caliber (16-18 mm diameter/3.8 g) paintballs fired at impact velocities ranging from 26 to 97 meters per second (2-13.5 J). Five additional eyes not subjected to ballistic impact were also evaluated as controls. Impact energies were correlated with histopathologic damage. RESULTS: Minimum impact energies consistently producing damage in experimental eyes unobserved in control specimens were: 2 joules--posterior lens dislocation, zonulysis, capsular rupture, and choroidal detachment; 3.5 joules--moderate angle recession; 4 joules--anterior lens dislocation; 4.8 joules--peripapillary retinal detachment; 7 joules--severe angle recession, iridodialysis, and cyclodialysis; 7.5 joules--corneal stromal distraction; 9.3 joules--choroidal segmentation; and 10 joules--globe rupture. CONCLUSIONS: Impact thresholds correlating traumatic ocular pathology with impact energy followed a positive stepwise progression in severity with impact energies between 2 and 10 joules. Moderate angle recession commensurate with typical clinical traumatic glaucoma was not observed among control eyes, but occurred at relatively low impact energy of 3.5 joules among test eyes. Extensive disruption in and around the angle (iridodialysis/cyclodialysis) consistently occurred at energies >7 joules. Globe rupture required a minimum energy of 10 joules.

Plasminogen deficiency as a rare cause of conjunctivitis and lymphadenopathy.

Plasminogen deficiency is a rare disorder complicated by the subsequent formation of firm "woody" plaques in the eye (ligneous conjunctivitis) or other mucosal sites as the result of inflammation or trauma. The plaques are composed of fibrinogen, granulation tissue, and inflammatory cells. The findings may be considered nonspecific by the unsuspecting surgical pathologist and delay the appropriate diagnosis. We report the first case of lymph node involvement with characteristic eosinophilic hyaline deposits that are periodic acid Schiff positive, stain dark red with Masson trichrome, and contain fibrinogen as detected by immunofluorescence and describe the longitudinal evolution of this patient's disease over a 15-year period. The differential diagnosis of amorphous hyaline material in lymph node biopsies is discussed.

Use of bioglass for orbital volume augmentation in enophthalmos: a rabbit model (oryctolagus cuniculus).

PURPOSE: To investigate the clinical and histologic response of Novabone-C/M as an osteoproductive alloplastic implant for volume augmentation in the orbit in the treatment of enophthalmos and to compare its outcome alone versus its use in combination with autogenous bone or Medpor granules. METHODS: Novabone-C/M, a bioactive silicone glass material, was implanted in the subperiosteal space of the left orbit of 12 New Zealand White rabbits. The animals were divided into 3 groups, each with 4 animals, based on the material implanted in the orbit: group 1, Novabone alone; group 2, Novabone plus Medpor granules; and group 3, Novabone plus autogenous bone fragments. All rabbits were studied clinically, radiographically, and histologically at 1-, 3-, and 6-month intervals. Animals underwent preoperative and postoperative computed tomography (CT) with 3-dimensional reconstruction, proptosis measurements, and volumetric analysis. Orbit specimens were studied histologically with mineralized bone stain (MIBS) to look for bone formation, reactivity, infection, implant resorption, and migration. RESULTS: There were no signs of significant inflammation or infection. Subcutaneous migration of the implant was seen radiographically but not clinically in groups 1 and 3. Induced proptosis averaged 2.5 mm (at 1 month) and showed regression in all groups over a 6-month period but was not statistically significant. Implant volume was markedly reduced in all groups, averaging 69% in group 1, 37% in group 2, and 59% in group 3 at 6 months. New bone formation and bone remodeling was present in all 3 groups at 3 months and only in group 2 at 6 months. The rate and amount of implant remodeling and bone formation was greatest in the Novabone/Medpor group (group 2). CONCLUSIONS: Bioglass particulate is biocompatible, easy to use in the orbit, and stimulates bone growth. Bioglass is associated with volume loss and migration over 6 months and may not provide adequate volume augmentation in the orbit when used alone for the treatment of enophthalmos. The duration and amount of bone formation may be enhanced when Novabone is used in conjunction with Medpor.