Hereditary cataracts in the John Rapp inbred strain of Dahl salt-sensitive rat.

Cataracts were apparently fixed in the genome of a highly inbred strain of Dahl salt-sensitive (S/JR) rat during the course of the selection for hypertension. Cataracts were present in S/JR rats inbred for more than 40 generations, but were not present in any of the salt-resistant rats (R/JR) inbred and observed during the same time. Light and electron microscopic evaluation of 11 pairs of S/JR rat lenses revealed a large posterior capsular defect and marked degenerative changes in lens fibers in each case. While the reason for the posterior capsular break is unclear, the cataract is probably a manifestation of an abnormal recessive gene or a recent autosomal dominant mutation.

Primary malignancies of the thyroid: epidemiologic analysis of the Florida Cancer Data System registry.

PURPOSE: Descriptive epidemiology of thyroid cancer in Florida. METHODS: The Florida Cancer Data System (FCDS) registry was used to identify patients with the different histologic subtypes of thyroid cancer occurring in Florida from 1981 through 1993. RESULTS: The FCDS recorded 5746 primary malignancies of the thyroid. The average annual incidence of all types of thyroid cancer was 37.0 cases/1,000,000 population. One type of thyroid cancer (papillary carcinoma) accounted for the overall increase during the 13 years of this study. There was no difference in incidence based on Hispanic ethnicity, but the incidence in Blacks was half that of Whites, and Blacks showed less advanced disease at the time of diagnosis. CONCLUSIONS: The increase in incidence of only one histologic type of thyroid cancer suggests that the increasing rate is not an artifact related to the utilization of new diagnostic technologies. The lower incidence and tendency to have less advanced thyroid cancer in Blacks would indicate that racial differences in thyroid cancer are not likely explained by socioeconomic factors such as access to medical care. A substantial amount of the difference in incidence between Whites and Blacks is explained by differences in age distribution.

A pseudoepidemic of postoperative scleritis due to misdiagnosis.

OBJECTIVE: To describe a pseudoepidemic of infectious scleritis following eye surgery. METHODS: Retrospective cohort study with selected procedural and laboratory investigations. RESULTS: Twenty-one patients with postoperative scleritis were identified during a 2-month outbreak. Neither an infectious etiology nor a causative pre-, intra-, or postoperative exposure was found. The clinical findings, when carefully reviewed, were consistent with poor surgical-wound closure. CONCLUSIONS: The art of clinical diagnosis involves the subjective interpretation of clinical history, physical findings, and laboratory results. A repeated error in the interpretation of clinical findings can simulate an outbreak of disease. Clinicians may be reluctant to concede misdiagnosis.

Therapeutic ultrasound. Light and electron microscopic findings in an eye treated for glaucoma.

Focused high-intensity (FHI) ultrasound has recently been used to treat advanced glaucoma. This report describes the pathologic findings in the eye of a 30-year-old woman treated with FHI ultrasound for glaucoma. Major findings consisted of highly localized destruction of the pigmented and nonpigmented ciliary epithelium, profound atrophy of the ciliary muscle, and loss of scleral collagen. While the mechanism by which FHI ultrasound reduces intraocular pressure is not completely understood, the histologic effects of ultrasonic radiation are localized to the site of treatment.

Malignant melanoma of the choroid and ciliary body in black patients.

In a retrospective study of choroidal and ciliary body malignant melanomas in black patients, we found that the death rates due to metastatic melanoma after enucleation were equivalent for 39 blacks and 3,339 whites. When compared with a control group of whites, it was found that blacks were more likely to have secondary glaucoma and inflammation prior to enucleation. Of the histopathologic features analyzed, the presence of necrosis or mixed or epithelioid type cells within the tumor was associated with increased mortality in blacks. The histopathologic features of malignant melanomas in blacks and whites were similar, except that tumor necrosis and heavy pigmentation were found more frequently in tumors of blacks.

Mycobacterium chelonae conjunctivitis and scleritis following vitrectomy.

The atypical, or nontuberculous, mycobacteria are opportunistic pathogens that usually cause infection following accidental trauma or surgery. These organisms are ubiquitous in nature but have been found with increasing frequency in other environments that include medical offices and surgical suites. Management of atypical mycobacterial ocular infections can be difficult because in vitro antibiotic activity does not always correlate with in vivo efficacy and because normal immune defenses against mycobacteria may work too slowly to prevent irreversible damage to infected ocular tissues. This report describes a patient who developed a severe ocular infection due to Mycobacterium chelonae after vitrectomy. Despite eradication of the infection, the eye became blind and painful. Arch Ophthalmol. 2000;118:1125-1128

Bilateral central retinal vein occlusions in a patient with acquired immunodeficiency syndrome. Clinicopathologic correlation.

Four patients with human immunodeficiency virus (HIV) infection and central retinal vein occlusion have been previously described in the literature. The pathologic findings in a fifth patient with this association are reported. The histopathologic findings were similar to ischemic central retinal vein occlusion in persons without HIV infections. There was no evidence of HIV in vascular endothelial cells using electron microscopy and in situ hybridization techniques. The failure to identify any structural or direct infectious cause for central retina vein occlusion in this setting suggests that other hemorheologic factors related to HIV infection are probably responsible for the predisposition to vascular thrombosis.

Intraocular gentamicin toxicity.

The catastrophic effects of inadvertent intraocular injection of gentamicin can be difficult to distinguish from vascular occlusive disease, particularly ophthalmic artery obstruction. Diffuse vitreous haze and shallow retinal detachment were described by Brown et al in a study of the short-term and long-term effects of a 10-mg dose of intravitreal gentamicin in adult macaque monkeys. An earlier study by Peyman et al demonstrated a vitreal reaction in rabbits with high doses of intravitreal gentamicin. Vitreal haze and shallow retinal detachment appear to be important findings that distinguish gentamicin toxicity from ophthalmic artery occlusion, but, to our knowledge, they have not been described in humans.

Patterns of emergency department visits for disorders of the eye and ocular adnexa.

OBJECTIVE: To characterize the magnitude and patterns of visits to the emergency department (ED) for problems related to the eye and ocular adnexa. METHODS: The National Hospital Ambulatory Medical Care Survey was used to obtain information on ED visits in the United States for conditions of the eye and ocular adnexa in 1993. Patients were identified by International Classification of Diseases, Ninth Revision, Clinical Modification, codes. National projections were based on a staged probability design. RESULTS: There were 2.32 million projected ED visits for problems of the eye and ocular adnexa in 1993. Forty-nine percent of visits were for injuries, two thirds of which occurred in males. Thirty-five percent of injuries occurred in the home and 18% occurred in the workplace. Only 3% of patients required hospitalization. Most patients had private insurance, but substantial variations in coverage existed for patients who used the ED for injury- vs non-injury-related care. CONCLUSIONS: Emergency departments in the United States provide a large amount of eye care, much of which is for conditions other than trauma. Differences in insurance coverage for injury- and non-injury-related eye care indicate that factors other than medical urgency are involved in the decision to use ED services. Further studies are needed to determine the cost-effectiveness and quality of ocular-related ED visits.

Malignant tumors of the eyelid: a population-based study of non-basal cell and non-squamous cell malignant neoplasms.

OBJECTIVE: To determine the relative frequencies, average annual incidences, and patient characteristics of non-basal cell and non-squamous cell malignant neoplasms of the eyelid in a defined geographic population. DESIGN AND SETTING: A retrospective study using the Florida Cancer Data System to identify malignant tumors of the eyelid, except for basal cell and squamous cell carcinomas, from 1981 through 1994. Cases were limited to persons who resided within Florida. MAIN OUTCOME MEASURE: Incidence of histologically confirmed malignant eyelid tumors. RESULTS: Two hundred six primary malignant eyelid tumors were identified. The 3 most common, in order of frequency, were melanoma, sebaceous carcinoma, and lymphoma. The median age at diagnosis for all patients was 73 years. Only 3 of the 206 malignant neoplasms occurred in blacks. The annual incidence of eyelid melanoma and sebaceous carcinoma in whites older than 20 years was 0.6 and 0.5 per million, respectively. Kaposi sarcoma was the most common type of mesenchymal tumor. Eleven different histologic types of lymphoma were found in the eyelid. Only 2 of 27 lymphomas had T-cell lineage. CONCLUSIONS: Malignant tumors of the eyelid other than basal cell and squamous cell carcinoma are uncommon and usually occur in elderly white persons. Primary eyelid tumors of any type are rare in blacks. The risk of a non-basal cell and non-squamous cell malignant neoplasm of the eyelid in Florida is 6.4 times greater for whites than for blacks (95% confidence interval [CI], 2.1-20.2). A variety of B-cell lymphomas can be manifested as primary eyelid tumors.

Wound complications following cataract surgery. A case-control study.

OBJECTIVE: To determine whether selected preoperative medical, social, or behavioral factors predict the occurrence of cataract wound complications. PATIENTS AND METHODS: Patients who underwent cataract surgery at a Veterans Administration hospital were used in a case-control study. Cases were defined by the occurrence of any postoperative cataract wound gape with or without iris prolapse within 12 weeks of surgery and requiring repair in the operating room. Controls were patients who had no postoperative complications. Two controls were selected for each case patient and matched for surgeon. RESULTS: Thirty-one patients with postoperative wound complications occurred after 2041 cataract extractions (1.5%). Occurrence of wound complications was predicted by previous hematologic disorder (odds ratio, 2.9; 95% confidence interval, 1.1-8.1). Phacoemulsification surgery had a protective effect against wound complication (odds ratio, 0.2; 95% confidence interval, 0.09-0.64). There was no difference in final visual acuity and refractive indexes in patients with and without wound complications (P = .6 by Student t test). CONCLUSIONS: Most medical social and behavioral preoperative factors have limited discriminatory power in predicting who will have postoperative cataract wound complications. The association of previous hematologic disorders to predict the occurrence of wound complications varied with the level of alcohol use. Although this study was not primarily designed to assess the role of surgical technique, phacoemulsification cataract extraction had a statistically significant protective effect against wound complications. Visual outcome in patients with postoperative wound complications is generally very good.

Psammomatoid ossifying fibroma.

Fibro-osseous lesions represent a variety of bone proliferations each characterized by different morphologic patterns of osteoid production. Psammomatoid ossifying fibroma (POF) is characterized histologically by numerous small round ossicles resembling psammoma bodies and is a locally invasive lesion of facial and cranial bones. Two cases of POF arising in the ethmoid sinus and involving the orbit are presented to emphasize the importance of complete surgical removal of involved bones. Histologically, portions of POF may demonstrate other patterns of osteoid production, which resemble fibrous dysplasia and Paget's disease of bone. The variation in radiodensity in POF on computed tomography is a function of the density of psammomatoid ossicles and of the coexistence of other "minor" forms of bone proliferation.

Congenital optic tract syndrome.

We describe two patients with complete homonymous hemianopia who were unaware of their visual field defects. The clinical impression of an optic tract syndrome was confirmed by magnetic resonance imaging, which showed absence of the corresponding tract in each case. The pathogenesis of congenital absence of the optic tract is unclear but it could represent either a primary failure of development or secondary atrophy due to focal injury during the perinatal period.

Optic nerve aplasia.

Optic nerve aplasia is a rare congenital defect invariably associated with other ocular or systemic disorders. We examined a 3-year-old girl with monocular microphthalmos who had optic nerve aplasia on histopathologic examination of the eye after enucleation. Magnetic resonance imaging verified the presence of unilateral optic nerve aplasia, and demonstrated hemichiasmal hypoplasia on the affected side and bilateral optic tracts. The visually evoked cortical response revealed increased signals over the occipital cortex ipsilateral to the aplastic nerve, suggesting misdirection of axons from the temporal retina of the normal eye. The visual pathway in unilateral optic nerve aplasia may assume a primitive form of neuronal organization characterized by an increase in contralateral retinogeniculostriate projection.

Cystic epithelial downgrowth following clear-corneal cataract extraction.

Epithelial downgrowth is a serious complication of intraocular surgery. It is characterized by the diffuse or cystic proliferation of surface epithelium inside the eye. Advances in microsurgical technique that result in smaller surgical wounds and permit greater precision in wound closure should reduce the incidence of this complication. We report a case of epithelial downgrowth presenting 3 years after an uncomplicated clear-corneal cataract extraction with insertion of a posterior chamber silicone lens. The epithelial down-growth was amenable to surgical correction because the well-defined cyst could be excised en bloc.

Isolated inferior rectus muscle palsy from a solitary metastasis to the oculomotor nucleus.

A 55-year-old man with squamous cell carcinoma of the esophagus had vertical diplopia secondary to metastasis to the brain stem. The lesion was detected by magnetic resonance scanning but not by computed tomography. Clinically, the disturbance in ocular motility localized to the right inferior rectus muscle. At autopsy, a single metastasis was present in the brain stem, contiguous with the right oculomotor nucleus and involving a small portion of the nucleus. The findings in this case support the concept that, in humans, the oculomotor nucleus is organized into functional subnuclei.

Indeterminate melanocytic proliferations of the conjunctiva.

OBJECTIVE: To test the hypothesis that a subset of conjunctival melanocytic proliferations exists that cannot be reproducibly classified as benign, malignant, or indeterminate. METHODS: Three groups of excisional biopsy specimens of conjunctival melanocytic proliferations were evaluated by a panel of 5 ophthalmic pathologists. These groups included lesions that we considered to represent benign (group 1 [n = 5]), malignant (group 2 [n = 5]), and indeterminate melanocytic proliferations (group 3 [n = 5]). The panel classified the same sections in all 3 groups in a randomized, masked fashion, first without and then with a clinical history of patient age, sex, and race. The kappa statistic was used to quantify the degree of agreement among observers. RESULTS: There was strong concordance among the panel members for both group 1 (benign [kappa = 0.76]) and group 2 (malignant [kappa = 0.70]) melanocytic proliferations. There was no concordance of the panel for group 3 (indeterminate) lesions (kappa = -0.045). The concordance for groups 1 and 2 and lack of concordance for group 3 lesions were independent of knowledge of clinical history of age, sex, and race. CONCLUSION: A subset of melanocytic proliferations of the conjunctiva exists that cannot be reproducibly classified by pathologists as benign, malignant, or indeterminate.

Comparison of different biomaterials for glaucoma drainage devices: part 2.

BACKGROUND: Inflammation associated with biomaterials may contribute to the failure of glaucoma drainage devices. OBJECTIVE: To compare the inflammatory reaction associated with the insertion of Krupin silicone, Molteno polypropylene, and Acrosof end plates in the subconjunctival space of rabbits. METHODS: Similar-sized glaucoma end plates made of 3 different biomaterials were sutured to the sclera in the superotemporal quadrant of the rabbit eye. Thirty eyes of 15 albino New Zealand rabbits were randomly assigned to the 3 groups. Conjunctival vascular hyperemia was graded in a masked fashion among the 3 groups. At the end of 3 weeks, the enucleated eyes were examined histologically and by scanning electron microscopy. RESULTS: Molteno polypropylene was associated with more inflammation both in clinical observations and based on histological grading. Silicone and Acrosof were associated with less intense inflammation. One polypropylene end plate was extruded on day 21. CONCLUSIONS: Polypropylene appears to be more inflammatory than silicone. Flexible biomaterials appear to be less inflammatory than rigid ones. CLINICAL RELEVANCE: Bleb failure following glaucoma drainage device implantation could be related to the biomaterial-associated inflammation. Choosing a biomaterial with the least inflammatory potential might enhance the success rate of the glaucoma drainage device. Arch Ophthalmol. 2000;118:1081-1084

Experimental vitreous replacement with perfluorotri-n-propylamine.

OBJECTIVE: To evaluate perfluorotri-n-propylamine, a perfluorocarbon oil, as a temporary vitreous replacement in rabbits. METHODS: After undergoing gas compression vitrectomy, rabbits were injected with perfluorotri-n-propylamine for 24 hours or 2 weeks. The rabbits were evaluated clinically and with electroretinography. The globes were then enucleated and processed for histological evaluation. RESULTS: Clinical results showed droplet dispersion in the 2-week but not in the 24-hour group. Histological evaluation showed no changes in the retinal pigment epithelium or photoreceptor outer segments. Foam cells were seen in the 2-week but not in the 24-hour group. There was a marked dampening of the electroretinographic response that normalized after the removal of the oil. CONCLUSIONS: Perfluorotri-n-propylamine demonstrated no retinal toxic side effects in rabbits and is a promising liquid perfluorocarbon oil.

Retinochoroidal degeneration associated with progressive iris necrosis.

A 34-year-old man in good general health became bilaterally totally blind by an unusual retinochoroidal degenerative disease 3 years after the initial onset of visual symptoms. The advanced stages of the retinochoroidal disease were associated with bilateral progressive iris necrosis and severe ocular pain. The constellation of findings and course of this disease represent a clinical entity that has not been previously described in the literature.