Malignant transformation of an iris melanocytoma. A case report.

A 34-year-old Caucasian woman was diagnosed as having a pigmented iris tumor showing recent growth and satellite lesions. The tumor was associated with pigmentation of the anterior chamber angle and secondary unilateral glaucoma. After local excision, histopathologic studies revealed the plump polyhedral cells typical of melanocytoma. However, the examination of additional sections showed evidence of malignancy. The diagnosis of a melanocytoma that transformed into malignant melanoma was made and later confirmed by electron microscopic studies. Following surgical excision of the tumor, the eye maintained normal intraocular pressure. There was no evidence of recurrence 4 years after surgery.

Removal of anterior chamber intraocular lenses: a surgical technique.

With the increasing trend toward intraocular lens implantation we are finding more cases in which explantation is indicated. The criteria and surgical techniques for explanation should be individualized depending on the type of lens. We describe removal of anterior chamber intraocular lenses.

Bilateral endogenous Escherichia coli endophthalmitis.

Bilateral endogenous endophthalmitis developed in a 68-year-old woman with diabetic ketoacidosis and Escherichia coli septicemia secondary to a urinary tract infection. She was started on large doses of ampicillin, and later, during her hospitalization, she received steroids. When the vitreous cleared, the fundus revealed extensive bilateral occlusion of retinal arterioles that showed the appearance of white threads. The electroretinogram was nonrecordable in both eyes except for a very small a-wave in the left eye when tested with a strong photic stimulus. The septicemia was controlled, but vision did not recover in either eye.

Chronic macular edema in retinal branch vein occlusion: role of laser photocoagulation.

We used the monochromatic green argon laser to treat 41 eyes with retinal branch vein occlusion (RBVO) and decreased vision because of chronic macular edema of at least six months duration after the onset of RBVO. The average follow-up period after treatment was 19 months. Cystoid macular edema (CME) occurred in 34 eyes and noncystoid macular edema in seven eyes. In eyes with chronic CME we decreased intracapillary pressure in the portion of the macula drained by the occluded vein by segmental retinal arteriolar narrowing using photocoagulation to the retinal arterioles that perfused the involved portion of the macula. Partial or complete resolution of macular edema occurred in 27 eyes. Vision improved in 19 eyes and was stabilized in seven eyes. In eyes with chronic noncystoid macular edema treatment consisted of focal closure of leaking microaneurysms and retinal telangiectasias with photocoagulation. Closure of these leaking vessels associated with partial or complete resorption of hard exudates that had accumulated in the macula secondary to the leakage occurred in six of the seven photocoagulated eyes. Vision improved in four eyes and was stabilized in two eyes.

Intraocular invasion by papillary squamous cell carcinoma of the conjunctiva.

Two patients with incompletely excised invasive papillary squamous cell carcinoma of the corneoscleral limbal conjunctiva had subtle clinical signs suggesting incomplete transmural extension or localized intraocular tumor invasion. We attempted a wide en bloc resection procedure in each case. Histopathologic examination disclosed that the surgical margins were involved with tumor cells and the eyes were subsequently enucleated. The enucleated eyes disclosed more extensive microscopic intraocular involvement than had been anticipated.

Malignant melanoma. Analysis of an autopsy population.

This report analyzes 92 malignant melanoma cases from a series of 12,383 consecutive autopsies. There were 12 cases of primary ocular malignant melanoma, 76 cases of primary nonocular malignant melanoma, and 4 cases of unknown primary site. Subjects with malignant melanoma were characterized by age, sex, and race; metastatic disease patterns as well as survival periods were analyzed. In the 12 ocular malignant melanoma cases, tumor size, cell type, and survival were considered. Discussion is concerned with the distribution of primary tumor site, the location of metastatic lesions secondary to malignant melanoma, and survival in cases with primary ocular malignant melanoma.

Leukemic iris infiltration.

A 7-year-old boy with acute lymphocytic leukemia developed iris infiltration, blood-streaked hypopyon, and high intraocular pressure. A diagnostic anterior chamber paracentesis was performed, which provided a cytologic diagnosis. The aspirate was studied by both the millipore filter technique with Papanicolaou stain and a dried smear using the Wright's stain. Wright's stain provided more distinct cellular details. Irradiation of the anterior segment resulted in clearing of leukemic iris infiltration, hypopyon, and glaucoma.

Posterior vitreous detachment in diabetic subjects.

Posterior vitreous detachment (PVD) and vitreous synchysis were studied in autopsied diabetic subjects and compared with general autopsy population. PVD was significantly more common in diabetics, including eyes with no retinopathy. Synchysis in diabetics increased with age and with PVD, but was less than in non-diabetics for given age and PVD status. We conclude that synchysis contributes to the precocious and exaggerated PVD in diabetics, but other factors are operative.

Metastatic tapioca iris melanoma.

A case of metastatic tapioca melanoma of the iris in a 12-year-old girl is reported. The patient had heterochromia, a red painful eye, and was treated for iritis with secondary glaucoma. In the course of 5 months iris lesions with the clinical appearance of tapioca pudding developed, and biopsy disclosed a melanoma. The eye was immediately enucleated, and pathological examination showed a melanoma with predominantly epithelioid-type cells which had infiltrated the angle, the posterior chamber, and the surgical wounds. Conjunctival extension was noted 10 months after enucleation, and regional lymph node metastases were found 4 months later. Previously reported cases are reviewed and compared with the present case.

Opticociliary veins in a primary optic nerve sheath meningioma.

A 59-year-old man developed painless visual loss in his left eye over a one-year period, with rapid progression to blindness over three months. Ocular examination of the left eye revealed proptosis, marked optic disk pallor, dilated retinal veins, and congeries of vessels at the disk margin (opticociliary veins). His right eye was unremarkable. Fluorescein angiography and histopathologic examination confirmed the presence of opticociliary veins communicating between branches of the central retinal vein and the adjacent choroidal vasculature. Primary orbital optic nerve meningioma associated with opticociliary veins was diagnosed.

Intraocular coccidioidomycosis.

A case of unsuccessfully treated coccidioidomycosis with intraocular manifestations is presented. Fever, skin lesions and a variety of constitutional symptoms dominated the clinical course. At autopsy there were extensive systemic dissemination and conspicuous intraocular lesions involving the uveal tract. The ocular and systemic features and the immunologic aspects of Coccidioidomycosis are discussed. Previously reported intraocular cases are reviewed and compared to our case.