Retinocytoma Undergoing Retinoblastoma Transformation in an Adult Patient.

We report a 46-year-old male patient with retinocytoma who presented at the age of 31 asymptomatically. An intraocular retinal mass was incidentally found in his right eye, when he underwent ophthalmological assessment for refractive surgery. This tumor consisted of a calcified sessile basis partially covered by a pedunculated salmon-pink growth. Initially, the tumor was diagnosed as a retinocytoma with clinical suspicion of malignant transformation into retinoblastoma and treated by four sessions of laser photocoagulation. Six and a half years later, the tumor relapsed, and he was treated with a Ruthenium plaque. Following brachytherapy, he had two episodes of right-sided vitreous hemorrhage that spontaneously cleared up, and the remaining finding in the vitreous cavity was interpreted as asteroid hyalosis. He underwent vitrectomy about five years following brachytherapy. The analysis of the vitreous material revealed the presence of inactive vitreous seeds composed of small round blue cells, compatible with a type 2 regression.

A Case Report of Management of Medulloepithelioma of the Ciliary Body and Iris without Recurrence over an Observation Period of Twenty Years.

Intraocular medulloepithelioma is a rare embryonal tumor that is believed to arise from the epithelium of the medullary tube. We report a 37-year-old female with medulloepithelioma presented at the age of 17 with a one-month history of left-sided visual deterioration and visible iris lesion. Birth history and medical and family histories were insignificant. The left eye revealed a vascularized iris mass. Further examination revealed a grey-white ciliary body mass and a subluxated lens with best-corrected visual acuity (BCVA) of 0.5. The patient underwent partial lamellar corneo-sclerouvectomy. The histological and electron microscopic findings revealed medulloepithelioma. To reduce the risk of recurrence of the probable malignant tumor, she was treated with Ruthenium plaque therapy about six weeks following surgical removal. Pars plana vitrectomy and lensectomy with laser photocoagulation of the peripheral retina were performed at the removal of the brachytherapy plaque. She regained her BCVA of 1.0 in her left eye 3.5 months following pars plana vitrectomy. At 20-year follow-up, no tumor recurrence was seen and her BCVA remained 1.0.

Uveal melanomas with optic nerve extension: report of two cases diagnosed by transvitreal biopsy, one of them with a multicentric tumour.

PURPOSE: To report two cases of invasive uveal melanomas, one of which showed multifocality. METHODS: Clinical examination, ultrasonography, colour Doppler analysis, cytological and histopathological evaluations. RESULTS: Transvitreal biopsy (case 1) or fine needle aspiration biopsy (FNAB) (case 2) revealed malignant melanomas in both patients. Light microscopy and immunohistochemical examinations substantiated the diagnosis of mixed cell type melanomas. In addition, one patient had a multifocal melanoma with papilloedema and colour Doppler findings suggestive of optic disc involvement. CONCLUSION: Transvitreal biopsy for histology or cytology is a reliable procedure to obtain an accurate diagnosis without delay of a lesion adjacent to the optic nerve head. In our two cases the biopsy findings led to enucleation.

External beam irradiation therapy for choroidal haemangiomas. Visual and anatomical results after a dose of 20 to 25 Gy.

PURPOSE: To evaluate the visual and anatomic results of radiation therapy in ten patients with choroidal haemangiomas. METHODS: Nine patients with circumscribed choroidal haemangiomas and one with diffuse choroidal haemangioma have been reviewed retrospectively. They were treated by lens-sparing external beam radiation therapy (20--24 Gy) (9 eyes) and plaque brachytherapy (25 Gy) (1 eye), respectively. RESULTS: The visual acuity improved by two lines or more in 8 of 10 eyes. No eyes showed deterioration of visual acuity. In all cases the retinal detachment showed complete resolution. A regression in tumour thickness was observed in all cases, and a reduction of anisometropia in cases with submacular infiltration by the tumour. During follow-up (0.4--8.8 years) there were no signs of radiation cataract, retinopathy or optic neuropathy. CONCLUSIONS: External beam radiation (20--25 Gy) is a reasonable alternative for treatment of symptomatic choroidal haemangiomas.

[Clinical skills among interns]. / Turnuslegers ferdigheter i praktiske prosedyrer.

BACKGROUND: Previous reports have demonstrated variable and partly insufficient skills levels in common practical procedures among interns after internship in hospital. The aim of the present study was to examine the development in interns' skills levels in practical procedures in relation to their gender, medical school, hospital and supervision. MATERIAL AND METHODS: Between July 1996 and July 1999 all interns in Norway were asked to indicate their skills level in 88 practical clinical procedures before and after hospital internship. Of the 599 interns included, 472 replied (79%). RESULTS: Males reported significant higher skills levels than females. After internship, no differences between interns graduated from the four universities were observed. Our study shows that the hospital internship is an important part of the medical education. An overall improvement was found in all interns. Interns whose skills levels were low before internship, had the best improvement. INTERPRETATION: The finding of a variable skills level before and a variable development during internship indicates that teaching in practical procedures is unstructured and inadequate. A consensus on the skills to be acquired and on what level is needed. Improvements are also needed in the quality of supervision.

Bilateral diffuse uveal melanocytic proliferation and uterine cancer. A case report.

PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP), a rare paraneoplastic syndrome causing visual loss in patients with systemic carcinoma. RESULTS: A 70-year-old woman developed visual symptoms 13 months after surgery and local irradiation therapy for uterine cancer. Following bilateral external beam irradiation supplemented with subsequent drainage of subretinal fluid in the left eye, the visual acuity improved from 0.01 to 0.15 in this eye only. The visual acuity remained at this level until she died 4 1/4 years after the onset of eye symptoms. CONCLUSION: This is the fourth case that survived longer than 24 months after the onset of visual symptoms of the 22 previously reported cases with BDUMP. It demonstrates that radiotherapy may have a vision-preserving effect in this group of patients. The patient also developed two different paraneoplastic phenomena--a nephrotic syndrome before and BDUMP after treatment for uterine cancer.

A retrospective study of patients with retained nuclear fragments after cataract extraction.

PURPOSE: A registration and follow-up of patients who underwent pars plana vitrectomy after dislocated nuclear fragments to the vitreous following cataract extraction. MATERIAL AND METHODS: A retrospective study of 125 patients referred to The National Hospital during the years 1991 to 1998. Phacoemulsification and extracapsular technique were used in 115 eyes and 10 eyes, respectively. A pars plana vitrectomy was performed within an average of 13 days (1-99 days) after cataract extraction. Average follow-up period was 9 months (0.5-35 months). RESULTS: The visual acuity at follow-up was > or = 0.5 in 67 eyes (55.4%), <0.5->0.1 in 32 eyes (26.4%), and < or = 0.1 in 22 eyes (18.2%). The total number of retinal detachments was 26 (21.5%). CONCLUSION: Retained nuclear fragments in the vitreous is a serious complication and most eyes achieve acceptable visual results.

Fine-needle aspiration biopsy diagnosis of a uveal metastasis from a follicular thyroid carcinoma.

PURPOSE: To report a rare tumour of the eye, and to illustrate the importance of performing a fine-needle aspiration biopsy. CASE REPORT: An 80-year-old woman suffering from general malaise, dyspnea and abdominal pain was found to have multiple lung metastases, a large tumour in the upper part of the mediastinum, and a large orange-brown tumour (19 x 15 x 11 mm) situated nasally in the left eye. Fine-needle aspiration biopsy of the uveal tumour and of the goitre was performed. Cytological examination from the two sites disclosed cells compatible with a follicular thyroid carcinoma of oxyfil cell-type. RESULTS: The patient underwent a total thyroidectomy and has so far had 2 series of 131I therapy. Additionally, the eye tumour was treated locally with a 125I plaque, and three months later the tumour thickness had decreased from 11.0 to 6.4 mm. Best-corrected visual acuity is still unchanged. The patient's general state improved as her dyspnea decreased significantly. CONCLUSION: The treatment has improved the patient's quality of life, and probably prolonged her life expectancy. Fine-needle aspiration biopsy was necessary to establish the diagnosis.

Fine needle aspiration biopsy in selecting treatment for inconclusive intraocular disease.

PURPOSE: To evaluate the fine needle aspiration biopsy (FNAB) as a diagnostic tool in cases where it was impossible to make a definitive diagnosis with noninvasive techniques. METHOD: 80 consecutive patients with inconclusive diagnoses were examined by FNAB prior to decision of treatment. Biopsies were performed through a transscleral route in 50 eyes, an anterior chamber route in 16 eyes and a transvitreal approach in 14 eyes. The consequences of FNAB were analysed retrospectively. RESULTS: FNAB confirmed malignancy in 59 eyes. Inconclusive material was obtained from 5 eyes judged clinically to be malignant disorders. One melanoma was misinterpreted as being a metastasis. In 47.5% of our patients this procedure altered the therapeutic plan and 25 patients were spared enucleation. The biopsy material was correctly diagnosed as benign in 16 cases. CONCLUSION: In eyes where the diagnosis remained uncertain after non-invasive tests, FNAB gave important information which greatly influenced our choice of treatment. FNAB contained sufficient tissue elements for cytological diagnosis in 77 eyes. Cytopathological interpretation failed once in relation to tumour type. The procedure of FNAB can be recommended for use in ambiguous tumour cases of the eye. Probably it should only be used in tumour centres with adequate cytology service.

Primary laser photocoagulation of "small" choroidal melanomas.

PURPOSE: To evaluate primary laser photocoagulation of "small" posterior choroidal melanomas in eyes with good vision. METHOD: This study includes a case series comprising six patients treated with standard laser techniques for melanoma, which had a mean thickness of 3.1 mm (range 2.9-3.9 mm), largest basal diameter of 8.6 mm (mean, range 7.0-10.0 mm), and located 0.5-2 disk diameters from the fovea or 0.3-3 disk diameters from the optic nerve head. RESULTS: No metastatic death was observed in the follow-up period (range 3 1/2-7 1/2 years). Two local recurrences appeared, both were treated with plaques, one eye was later enucleated. Two additional cases were also treated with plaques. Only two of the irradiated eyes retained reading vision. CONCLUSION: Primary photocoagulation of "small" posterior choroidal melanomas with argon laser is not recommended.

A leiomyoma of the iris documented by immunohistochemistry and electron microscopy.

PURPOSE: To report an iris leiomyoma documented in accordance with today's stricter diagnostic criteria. METHODS: Light microscopy, immunohistochemistry and electron microscopy were performed on the 3 mm ball-like, greyish-white vascularized tumour of the iris, close to the sphincter pupillae. RESULTS: Light microscopy of the extirpated neoplasm showed the characteristic appearance of a leiomyoma with densely packed spindle-shaped cells, with oval nuclei and granular cytoplasm. On electron microscopic examination the tumour exhibited the characteristic features of a smooth muscle neoplasm. The immunohistochemistry was consistent with a myogenic tumour because the tumour cells were positive for smooth muscle actin and desmin, but negative for S-100 and melanin. CONCLUSION: The case illustrated the necessity of performing ancillary procedures such as electron microscopy and immunohistochemistry to substantiate a correct, although rare diagnosis.

External radiotherapy for circumscribed choroidal haemangiomas using a modified retinoblastoma technique.

This report describes two cases of circumscribed choroidal haemangiomas involving the fovea, complicated by serous retinal detachment. Laser photocoagulation, generally accepted as the treatment of choice for choroidal haemangioma, was considered either to be of no visual benefit or a risk for jeopardizing vision further due to the subfoveolar lesions. Fractionated radiotherapy using a lens-sparing, modified retinoblastoma technique, was given, using circular fields of 15 mm diameter. The dose was 24 Gy in 8 fractions. In both eyes the retina reattached completely. The visual acuity improved markedly in the first, and was restored to the prior level in the second. Normalization of a high intraocular pressure was also achieved in the second case. We believe this method to be a reasonable and effective therapy for some choroidal haemangiomas after careful individual consideration.

Ocular hemodynamic changes in patients with high-grade carotid occlusive disease and development of chronic ocular ischaemia. II. Clinical findings.

Ocular changes due to chronic ischaemia are described in 45 patients with hemodynamically significant carotid occlusive disease. Regarding the ophthalmic artery flow before and after vasodilatory stimulus, the patients were divided into four different groups. Eyes with permanent anterograde ophthalmic artery flow had evidence of embolic features, but no signs of chronic hypoperfusion. In the group where anterograde ophthalmic artery flow changed to retrograde after 1 g intravenous acetazolamide, the patients had symptoms of critical ocular perfusion, but only subtle structural changes could be demonstrated. Chronic ocular ischaemic syndromes were found in the cases with retrograde ophthalmic artery flow, especially where bilateral severe carotid obstruction was present.

An intraocular paraganglioma?

A tumour of the iris with the morphological and immunohistochemical characteristics of a paraganglioma is presented. Neither this type of tumour, nor the specialized nerve cells giving rise to the tumour, have previously been reported in the eye. A successful local resection was performed. The diagnosis and concept of paragangliomas are discussed briefly.

Simultaneous occurrence of primary choroidal and cutaneous malignant melanoma and skin metastasis.

This case report describes the clinical and histopathological findings in a 65-year-old woman enucleated for a malignant choroidal melanoma. Simultaneously, an excision was performed of a cutaneous melanoma together with a satellite nodule presumed to be a metastasis from the cutaneous, superficial spreading melanoma. Six months later, chemotherapy for liver metastasis was given without effect. There were no signs of dysplastic nevus syndrome. A 39-year-old cousin, however, had been enucleated for a malignant choroidal melanoma. This sporadic case might suggest a common etiologic factor in the pathogenesis of multicentric melanomas.

[Involvement of the visual system in multiple sclerosis]. / Affeksjon av det visuelle system ved multippel sklerose.

Ocular symptoms commonly occur in multiple sclerosis patients. Clinically, optic neuritis is considered to be the classic visual manifestation. Little attention is paid to other forms of visual pathway affections, such as intrabulbar inflammation and various types of visual field defects. We describe some unusual forms of visual pathway affections in multiple sclerosis, in which combined neuroophthalmological examination and magnet tomography were very effective both in diagnosing and during follow-up of multiple sclerosis patients.

Primary malignant melanoma of the lacrimal sac.

A case report of a primary malignant melanoma of the lacrimal sac is presented. After excision a local recurrence appeared one year later. Wide, but incomplete excision and postoperative irradiation resulted in local tumour control for 4 years. The patient succumbed to a uremic death caused by a rectal cancer removed 3 years before the occurrence of the malignant melanoma.

Chiasmal optic neuritis.

We describe two cases of chiasmal optic neuritis. The presenting symptoms were reduced visual acuity and bitemporal visual field defects. The enlargement of the optic chiasm in the acute stage and normalization after recovery is demonstrated by magnetic resonance imaging (MRI).

Retinal detachment after YAG-laser capsulotomy.

Preoperative findings and postoperative results in 8 patients with retinal detachment after YAG-laser capsulotomy are described. In this period the over-all incidence of clinical retinal detachment in pseudophakic eyes after YAG capsulotomy in our hospital was 1.0% (2 of 193). Possible relationships between YAG-laser capsulotomy and retinal detachment are discussed. Two risk factors for developing retinal detachment were found in 6 of 8 patients. After surgical repair 7 retinas were re-attached. The final visual acuity was better than 0.5 in 5 patients.

[Retinal detachment after cataract surgery with intraocular lens implantation]. / Netthinneavløsning etter kataraktoperasjoner med implantasjon av intraokulaere linser.

92 pseudophakic retinal detachments were treated in our hospital over a period of six years. These cases are reviewed retrospectively, with special emphasis on the factors that influenced the surgical outcome. The overall rate of success was 80%. Visual acuity was better than 0.1 in 77% of the cases. The major cause of failure was proliferative vitreoretinopathy, which was responsible for seven of ten failures. Postoperative proliferative vitreoretinopathy was the only factor that gave a significantly poorer prognosis after surgical treatment, although the presence of high myopia and preoperative proliferative vitreoretinopathy tended to give a less successful outcome. Likewise, there was a tendency for better prognosis in eyes with posterior chamber intraocular lenses.