Subcutaneous sarcoidosis associated with sarcoid tenosynovitis.

Subcutaneous sarcoidosis and sarcoid tenosynovitis are unusual manifestations of systemic sarcoidosis. We report two Japanese women with disseminated sarcoidosis presenting with subcutaneous and tenosynovial involvement demonstrated by computed tomography and magnetic resonance imaging. Sarcoidosis must be considered in the differential diagnosis of unexplained subcutaneous nodulosis or tenosynovitis in patients with or without a previous diagnosis of sarcoidosis.

Screening for ocular toxicity in asymptomatic patients treated with tamoxifen.

Tamoxifen is an antiestrogen drug used in the treatment of patients with breast cancer that is being studied for use in patients at high risk for developing breast cancer. Case reports have documented ocular toxicity caused by tamoxifen in patients with visual symptoms. We attempted to determine the prevalence of ocular toxicity in visually asymptomatic tamoxifen-treated patients. We performed extensive ocular examinations on 135 visually asymptomatic tamoxifen-treated patients. Two patients (1.5%) had intraretinal refractile crystals consistent with tamoxifen retinopathy. Both patients were without visual symptoms or visual loss. Corneal crystals, macular edema, and optic nerve changes were absent. The cumulative tamoxifen doses of these two patients were 10.9 and 21.9 g, respectively. For the 135 patients studied, the mean cumulative dose was 17.2 g, with a standard deviation of 13.0. We do not believe the relatively uncommon finding of tamoxifen-related ocular toxicity merits special screening for such disease.

Rhegmatogenous retinal detachment after Molteno glaucoma implant surgery.

BACKGROUND: The Molteno implant is a device used for surgical treatment of complicated glaucoma. Rhegmatogenous retinal detachment (RD) is a relatively rare complication of Molteno implant surgery. This study was undertaken to evaluate the clinical features including the surgical management and postoperative outcome of patients with rhegmatogenous RD after Molteno implant surgery. METHODS: The authors reviewed 350 consecutive patients who had Molteno surgery and identified 16 patients with subsequent rhegmatogenous RD. They also studied one patient referred for RD repair after Molteno surgery at another institution. RESULTS: The risk of rhegmatogenous RD was 5%. Seventy percent (12/17) of the patients presented within 4 months of the Molteno procedure. Dialysis and flap tear were the most common types of retinal break found. Forty-one percent (7/17) of the patients had proliferative vitreoretinopathy. In three patients, clinical features suggested RD resulting from the Molteno procedure. In other patients, previous ocular surgery and underlying ocular disease may have contributed to the development of RD. Retinal detachment repair was attempted in all patients. Among 16 patients with at least 6 months of follow-up, 56% (9/16) had successful retina attachment. Forty-four percent (7/16) of the patients maintained formed vision. Eighteen percent (3/16) of the patients maintained visual acuity of at least 20/40. Intractable glaucoma did not develop in any of the patients with an attached retina. Recurrent RD, endophthalmitis, cyclitic membrane, or intractable glaucoma led to phthisis bulbi or enucleation in 44% (7/16) of the patients. CONCLUSION: A combined approach by vitreoretinal and glaucoma surgeons can restore vision and maintain glaucoma control in patients with rhegmatogenous RD associated with Molteno implant surgery.

Successful strabismus surgery in a child with Moebius syndrome.

Moebius syndrome is characterized by congenital paralysis, usually bilateral, of the lateral rectus muscles and the muscles of facial expression. Esotropia is common in these patients. Few reports exist of the surgical results after treatment of strabismus in such patients. We report the case of a 19-month-old white boy with Moebius syndrome who demonstrated an A-pattern esotropia with orthotropia in down-gaze. Use of a conventional surgical approach for an A-pattern esotropia and a bilateral medial rectus recession with a one-half tendon-width supraplacement produced the desired result of orthotropia in primary gaze in our patient.

Bilateral ciliary body melanomas.

We describe a 78-year-old woman with bilateral primary ciliary body melanomas. The tumours presented 6 months apart and were treated with iridocyclectomy. Histopathological examination revealed type B spindle cell melanomas. To our knowledge this is the first reported case of bilateral ciliary body melanomas.

Identification of alpha-fetoprotein polymers. Artifacts of the isolation procedure.

By combining polyacrylamide gel electrophoresis and radioimmunoassay, a method has been developed to detect polymeric forms of alpha-fetoprotein (AFP) during the isolation procedure. The method is capable of detecting AFP polymers in the presence of other serum proteins in serum samples that contain as little as 100 ng of AFP. Using this method, we have found that AFP polymers do not exist in cord serum; if encountered, we feel they should be considered to be artifacts of the isolation procedure AFP polymers appear in 7.5% polyacrylamide gel as multiple bands. We believe the multiple bands to be AFP polymers and not serum protein contaminants for the following reasons: (1) the electrophoretic pattern is very similar to that of serum albumin; (2) the polymers do exhibit AFP activity, although less than the monomeric form does; (3) the molecular weight of the dimer is exactly twice that of the monomer; (4) in the presence of sodium dodecyl sulfate and mercaptoethanol, the polymers move to the same position as do the monomers in polyacrylamide gel electrophoresis; (5) the polymers cannot be removed by repeated use of an immunoadsorbent affinity column designed to remove contaminant serum proteins.