Amelanotic corneal melanoma after a blast injury.

PURPOSE: To report a case of a corneal melanoma after trauma. METHODS: Case report. RESULTS: A 68-year-old man sustained an ocular injury from a blast furnace explosion in 1958. In 1998, he underwent a penetrating keratoplasty for a corneal scar. Histologic examination and cell markers of the host button revealed intrastromal and subepithelial melanoma. No clinical or microscopic evidence of adjacent conjunctival or uveal melanoma was found. CONCLUSION: Melanoma of the cornea can present as a stromal opacity after trauma.

Visual field defect associated with laser in situ keratomileusis.

PURPOSE: To report a case of visual field defect associated with laser in situ keratomileusis. METHODS: Case report. A 28-year-old woman with high myopia (-10D) and a family history of normal tension glaucoma underwent bilateral laser in situ keratomileusis keratorefractive surgery. Preoperatively, both eyes had normal intraocular pressure and visual field. RESULTS: At the first postoperative visit 1 day after apparently uncomplicated laser in situ keratomileusis, the patient reported a scotoma in the right eye. At 3-month follow-up, visual fields revealed the patient had developed a near-superior altitudinal visual field defect in the right eye. The defect did not progress over 1 year of follow-up examinations. CONCLUSION: Increased intraocular pressure associated with the microkeratome vacuum ring used during laser in situ keratomileusis may have precipitated optic nerve head ischemia and visual field defect.

Rapidly expanding exophthalmos: an unusual presentation of small cell lung cancer.

A 61-year-old male presented with a rapidly progressive exophthalmos from small cell lung cancer metastatic to the right orbit. His vision in that eye was 20/200, and his intraocular pressure was 36 mmHg. The orbital metastasis responded dramatically to chemotherapy. One week after starting the chemotherapy the patient did not have exophthalmos, his vision was 20/20, and three weeks later the intraocular pressure was 12 mmHg.

The prognosis for keratoplasty in keratoconus.

The long-term results in 326 eyes grafted for phakic keratoconus by the same surgeon were reviewed. All consecutive grafts performed for this disease with a minimum of five-year follow-up were included in the study. The mean follow-up was 11.3 years, with a range of 5 to 34 years. Ninety percent of grafts remained clear, 3% were nebulous but retained 20/40 vision, and 7% failed. Donor age was available for 188 of the 326 grafts. No relationship was found between donor age and long-term graft clarity even when older (more than 70 years) donor tissue was used. The visual acuity was measured with the patient's preferred optical device worn daily. Seventy-three percent of eyes achieved 20/40 or better vision after their initial graft.

Specular microscopic and histologic observations in nonguttate corneal endothelial degeneration.

Six phakic patients with unilateral corneal edema and clinically normal-appearing fellow eyes were examined with specular microscopy and found to have endothelial pleomorphism and reduced cell counts in the nonedematous cornea. None of these patients had any previous eye disease, trauma, inflammation, or surgery. Clinically unrecognized endothelial disease was proposed as a cause for the unilateral corneal edema and was verified by light and electron microscopic studies in five patients. These pathologic findings vary somewhat from those found in Fuchs' dystrophy and may represent either a variant or a form of endothelial cell degeneration of as yet undetermined etiology. Our studies suggest that this condition is not detectable in the nonedematous cornea by standard high magnification biomicroscopy and requires the use of the clinical specular microscope to confirm the diagnosis in suspected cases.