Vasoproliferative tumours of the retina.

This paper describes three cases of vasoproliferative tumours of the retina including histopathology in one. The clinical presentation, differential diagnosis and treatment modalities are discussed with a brief review of the literature.

Ultrasound biomicroscopic imaging of the anterior aspect of peripheral choroidal melanomas.

PURPOSE: To correlate ultrasound biomicroscopic features of the anterior aspect of peripheral choroidal melanoma with respect to histopathology. METHODS: We examined 17 eyes of 17 patients who had clinically diagnosed peripheral choroidal melanomas that approached the ora serrata or extended into the ciliary body and who had been assessed with ultrasound biomicroscopy before enucleation. Comparisons were made between anterior tumor margins imaged by ultrasound biomicroscopy and histopathologic specimens. Anatomic features noted on ultrasound biomicroscopy before enucleation were correlated with enucleation specimens, including supraciliary effusion, rotation of the ciliary body, angle involvement, and internal reflectivity patterns. Anterior tumor margin position was determined with reference to the scleral spur. RESULTS: Mean distances from the anterior tumor margin to the scleral spur were 1.47 mm on ultrasound biomicroscopy and 1.65 mm on pathologic examination. This difference was not statistically significant (P = .325). Tumor features evident on ultrasound biomicroscopy were also seen on pathologic examination: supraciliary choroidal effusions in seven of seven, ciliary body rotation in seven of eight, and angle involvement in seven of eight. All tumors were mixed-cell melanomas, and 12 of 17 (70%) demonstrated homogeneous ultrasound biomicroscopic internal reflectivity. Irregular internal reflectivity was seen in five of 17 tumors (29%) and was related to prominent internal vascularity on pathology in three of five. CONCLUSIONS: Ultrasound biomicroscopy is an accurate imaging technique for the in vivo assessment of anterior tumor margins of peripheral choroidal melanomas and can provide detailed imaging of the tumor's interface with the ciliary body.

Ocular masquerade syndrome in lymphoid blast crisis of chronic myeloid leukemia.

A 56-year-old woman presented with CML in lymphoid blast crisis. Complete remission with no suggestion of CML was achieved with chemotherapy. Twenty-six months later, an isolated ocular anterior chamber relapse of acute leukemia presenting as uveitis (ocular masquerade syndrome) was diagnosed and treated with radiotherapy. Ten months later, a second ocular relapse in the same location was diagnosed and treated with radiotherapy. Two months later, a systemic relapse into second chronic phase was diagnosed and is currently being treated with alpha interferon. Only one previous case of leukemic hypopyon in CML has been reported. This is also the first case of isolated ocular blast crisis relapse in CML to be described.

Ultrasound biomicroscopy of anterior segment tumors.

BACKGROUND: Ultrasound biomicroscopy is a new method of imaging the anterior segment of the eye at microscopic resolution using high frequency ultrasound. METHODS: A prospective study was performed to evaluate the use of ultrasound biomicroscopy in imaging anterior segment tumors. Forty-five patients underwent clinical examination followed by slit-lamp photography, anterior segment B-scan ultrasonography, and ultrasound biomicroscopy according to an established protocol. RESULTS: All lesions were clearly imaged by ultrasound biomicroscopy, while only 17 were detectable by conventional B-scan ultrasound. Ultrasound biomicroscopy allowed precise measurement and visualization of subsurface features in small tumors. Differentiation between solid and cystic lesions was easily achieved. The margins of ciliary body tumors could be more accurately defined. Histopathologic correlation was possible in four cases managed surgically. Ultrasound biomicroscopy images compared favorably with low-power microscopy. No complications were encountered. CONCLUSION: Ultrasound biomicroscopy proved a valuable new noninvasive technique in the evaluation of anterior segment tumors.

Adenoma of the nonpigmented epithelium of the ciliary body.

A 56-year-old man presented with a left ciliary body mass, anterior vitreous hemorrhage and a subluxed, cataractous lens. The clinical course included rapid enlargement of the mass, anterior uveitis, cataract progression and secondary glaucoma. Investigation included fluorescein angiography, ultrasonography and computed tomography. The eye was enucleated because of progressive enlargement with poor vision and uncontrolled secondary glaucoma. Histopathological examination showed an adenoma of the nonpigmented ciliary epithelium with cystic areas of hyaluronidase-sensitive acid mucopolysaccharide. The mass distorted the iris, occluded the angle structures and produced a complete cataract. The basement membrane of the adjacent ciliary processes was extensively thickened. The authors discuss the clinical association with vitreous hemorrhage and the local damage caused by this benign tumour.

Ultrasound determination of the relationship of radioactive plaques to the base of choroidal melanomas.

There is an assumption that radioactive plaques placed at surgery are, and will remain, in proper relationship to the base of the tumor. The plaque dose is calculated based on this assumption. In fact, factors such as loose sutures, improper diameter estimations, pressure from adjacent rectus muscles, and intervening tissue (oblique muscles) can compromise this relationship. Ultrasound provides a practical method of imaging the tumor and plaque simultaneously. The authors have used postoperative ultrasound to monitor the accuracy of iodine-125 plaque placement in nine cases. Detection of eccentrically placed and malpositioned plaques provides valuable insight which can be used to refine surgical technique. Detection of plaque tilting by oblique muscles can serve as a basis for recalculating dosage. The relationship of plaque margins to vital ocular structures such as the optic nerve can also be determined by ultrasound.

Orbitotonography, the dynamic assessment of orbital tension: 2. Results in patients with orbital disease.

Dynamic orbitotonography was done in 17 patients with Graves' disease, 25 patients with orbital tumours and 15 healthy subjects. The mean orbital pressure for both patient groups was significantly different from that for the healthy subjects at each time interval (p less than 0.001). Healthy patients may be differentiated from those with orbital disease with a good degree of reliability with this technique. As well, the technique may provide information about the location of disease within the orbit.

Orbitotonography, the dynamic assessment of orbital tension: 1. Results in subjects without known orbital disease.

This paper describes a new orbitotonometer and method of dynamically assessing the orbital tissue resistance ("orbital tension"). In 20 healthy volunteers without known orbital disease the inexpensive instrument proved to be safe and accurate, providing useful, reproducible clinical information. The full diagnostic work-up of patients with orbital disease should include the accurate measurement of orbital tension, as this may provide the ophthalmologist with earlier objective evidence of the disease process as well as a method of following its course.