Aspiration cytodiagnosis of amyloid from vitreous fluid.

Amyloidosis of the vitreous body is a rare disorder that causes progressive visual loss. In this report, a 36-yr-old female with familial amyloidosis is described in whom a progressive reduction of vision in both eyes over the last 4 yr was ascribed to vitreous opacities due to amyloid. A left pars plana vitrectomy was performed and an aspirated sample of the vitreous on cytologic examination showed vitreous strands admixed with abundant dense, pink, globular material which was intensely positive on Congo red staining and exhibited yellowish-green birefringence indicative of amyloid. This was further confirmed ultrastructurally, which showed the classical appearance of amyloid fibrils. The case is of interest not only in view of the rarity of the condition but also in view of the fact that as far as we are aware the cytodiagnosis of amyloid from an aspirate sample from the vitreous has not been previously described in the literature.

How fair is cataract prioritisation?

AIM: The purpose of the study was to examine the reliability of cataract prioritisation assessments. METHOD: Thirty-nine subjects awaiting cataract surgery were independently assessed by two examiners, each using two different prioritisation forms, to assign priority scores. The scores obtained by the two examiners were analysed for consistency. RESULTS: The scores awarded to the same subjects by different examiners varied by as much as 26 points (out of a possible 100). CONCLUSIONS: The current cataract assessment process is inconsistent and of questionable validity for establishing a prioritised list of individuals awaiting cataract surgery. The policy of setting a rigid threshold score, below which patients do not qualify for surgery in the public sector, is inequitable and must be reviewed in the interests of fair delivery of health care. Prioritisation methods for other disorders should be reviewed to determine their validity.

Cytodiagnosis of Coats' disease from an ocular aspirate. A case report.

This paper describes the cytologic findings in a rare condition, Coats' disease, which was diagnosed from a sample of ocular aspirate in a 19-month-old boy. The cytologic findings were characterized by the presence of numerous cholesterol crystals, rare foamy macrophages, several pigment-laden macrophages, pigment-bearing epithelial cells and free pigment, which stained positive for melanin by Schmorl's stain. The case was unusual in that the clinical diagnosis was persistent hyperplastic primary vitreous, and other diagnoses, such as Coats' disease, were unsuspected. The cytologic findings suggested Coats' disease and seemed to exclude retinoblastoma or another malignancy, although the negative findings with the presence of cholesterol crystals and macrophages were regarded as somewhat nonspecific for unequivocally excluding any of the above.