Macular serpiginous choroiditis

The authors describe in seven eyes of four patients a form of serpiginous choroiditis beginning in the macula without initial peripapillary activity. Eyes with macular serpiginous choroiditis often had a poor visual prognosis and sometimes developed subretinal neovascularization. Fluorescein angiography of the acute lesions showed hypofluorescence; some cases were thus initially diagnosed as having choroidal ischemia. Fluorescein angiography in one eye, however, suggested that at least some of the hypofluorescence seen acutely in eyes with serpiginous choroiditis is secondary to blocked fluorescence from "opaque" retinal pigment epithelium.

Cutting device in ocular pathology

Preservation of intraocular pressure during routine opening of an eye in the pathology laboratory is important to retain the anatomic interrelationships. For this purpose we have devised a closed-chamber system by which the globe is held intact while it is bisected or while a calotte is excised.

Ocular findings in the velo-cardio-facial syndrome

Velo-cardio-facial syndrome is a common genetic syndrome of cleft palate, learning disability, heart disease, and abnormal facial appearance. Ocular findings include retinal vascular tortuosity, posterior embryotoxon, narrow palpebral fissures, suborbital discoloration, small optic nerves, iris nodules, and cataracts. Retinal vascular tortuosity was found to be associated intrinsically with the syndrome and not secondary to the heart disease. The ocular and systemic findings suggest a primary developmental anomaly of neural crest derivatives in the pathogenesis of the syndrome.

Metastatic eyelid disease

The authors conducted a clinicopathologic study of 31 patients with metastatic disease to the eyelid at the Armed Forces Institute of Pathology. Metastasis was found predominantly in women (female/male = 4:1). The mean age was 69 years (range, 3-92). The most common primary sites were breast (35%), skin (16%), and gastrointestinal and urogenital tracts (each 10%). Aside from breast carcinoma, there was no sex predilection for the extramammary malignancies to metastasize to the eyelids. Metastasis was suspected in only 32% of the cases. Most common misdiagnoses were chalazion, cyst, granuloma, and xanthoma. The lid lesions were detected before the primary focus in 45% of the cases. The authors conclude that metastatic disease should be considered in the differential diagnosis of eyelid lesions.

Arteriovenous anastomoses of the retina

The authors reviewed the clinical findings in 13 patients followed at Montefiore Medical Center and in 85 cases described in the literature with primary arteriovenous communication of the retina (AVCR). The characteristics of AVCR include: young age at detection; both sexes affected; detected on routine examination, and less frequently after decreased vision or referral after diagnosing systemic arteriovenous communication (AVC); unilateral involvement; single or multiple sites in the same fundus; and predilection for the papillomacular area and the superotemporal quadrant. Vision correlated inversely with the grade of AVCR. The presence of concomitant systemic AVC correlated directly with the grade of AVCR. It is concluded that grade I AVCR and the majority of grade II AVCR represent isolated retinal vascular anomalies, and there is no need for extensive search for systemic AVC if these patients remain asymptomatic.

Ocular complications in strabismus fixus convergens

Two cases of strabismus fixus are described. Histopathological examination of the eyeballs from both patients revealed the following complications of this rare disorder: ocular ischemia, atrophy of the optic nerve, and old central retinal artery occlusion. These complications are likely to be secondary to the mechanical stretching and torsion of the optic nerve with subsequent strangulation of its blood supply. Early surgical correction of strabismus fixus is recommended.

Fibrinogen-induced vitreous membranes

Fibrinogen was injected in the vitreous cavity of 29 rabbits with follow-up for 75 days. Vitreous membrane formation was detected by indirect ophthalmoscopy and confirmed by histopathological study. Membrane formation was significantly more common in the fibrinogen group than in the control group. Fifteen days after injection, the membranes decreased in size and gave place to vitreous liquefaction in the majority of eyes in the fibrinogen group. Histochemical stains for fibrinogen were positive in half of the vitreous membranes. Fibrinogen is thought to be transformed into a long fibrin polymer forming a matrix for surrounding cells to proliferate in the vitreous. An effective fibrinolytic system in the vitreous explains the ultimate resolution of most of the fibrinogen-induced membranes. Simple fibrinogen injections do not provide a good model for long-term vitreous band formation, yet they add more evidence to the role of fibrin in the pathogenesis of vitreoproliferative diseases. The spontaneous resolution of some proliferative vitreoretinopathies parallels the reversibility of most of the fibrinogen-induced vitreous membranes.

A family with iridoschisis, narrow anterior chamber angle, and presenile cataract

Familial iridoschisis is a rare ocular disease and is probably transmitted as an autosomal dominant trait. The underlying abnormalities are not understood. Family members should be screened for this condition as well as for associated ocular abnormalities, namely presenile cataracts and narrow anterior chamber angle.

Krypton red laser photocoagulation of peripapillary subretinal neovascular membranes

The visual outcome of 20 eyes of 20 patients with peripapillary subretinal neovascular membranes (SRNVM) treated with krypton red laser photocoagulation (KRLP) was studied. Complete obliteration of the SRNVM was achieved in all eyes in the study. In 18 of 20 patients, the visual acuity improved or remained the same during an average follow-up of 9.9 months. There were no treatment-related complications. The efficacy of KRLP in the management of patients with peripapillary SRNVM is discussed.

Sarcoid optic disc edema and optociliary shunts

We report the case of a patient with sarcoid granulomatous optic disc edema with optociliary shunts, normal visual acuity, and negative orbit computed tomographic studies. A literature review disclosed four cases of optociliary veins associated with sarcoid optic neuropathy, all the patients having very poor vision. Optociliary shunts may not carry a poor visual prognosis in optic nerve sarcoidosis.

Central trochlear palsy

Historically, the trochlear (IV) nerve has been "neglected" by neurologists and ophthalmologists. However, the reported incidence of trochlear palsy in two large series has more than doubled in the past two decades, indicating increasing awareness of this nerve. Trauma is the most common cause of trochlear palsy, as the trochlear nerve is anatomically more vulnerable to trauma than the other ocular motor nerves. Trochlear palsy can also be caused by vascular and inflammatory diseases, congenital factors, toxic substances and tumors. Diplopia secondary to vertical and horizontal deviation is the most common presentation. The trochlear nerve has a relatively high recovery rate after the underlying cause of injury has been corrected. In this article, the anatomy and physiology of the trochlear nerve are described, and the various etiologies, methods of diagnosis and differential diagnosis of trochlear palsy are reviewed.

Bilateral total corneal and conjunctival choristomas associated with epidermal nevus

A 4-year-old boy had been noted from birth to have bilateral masses obscuring the entire outer portion of the eyes. Systemic findings included mild growth retardation, multiple cortical lesions of the distal metaphyseal ends of the lower extremities, and diffuse skin pigmentation of the right side of the body. The epibulbar lesions were excised; on the right side, there was a thin cornea that necessitated corneal transplantation. The diagnosis of composite epibulbar choristomas associated with linear epidermal nevus was established by pathologic examination. This case report as well as a literature review establish the association of epibulbar choristomas with cutaneous linear nevi of the epidermal and sebaceous types.

Nontraumatic ghost cell glaucoma--a case report

Ghost cell glaucoma (GCG) has recently been described following vitrectomy, cataract extraction, and penetrating or blunt trauma. We describe the occurrence of GCG in a phakic eye with no prior ocular trauma or surgery following vitreous hemorrhage from diabetic retinopathy. We postulate the occurrence of a spontaneous rupture of the anterior hyaloid face which allowed passage of ghost cells into the anterior chamber. A therapeutic vitrectomy was complicated by intraoperative vitreous hemorrhage. Two weeks postvitrectomy, GCG recurred and was successfully controlled by irrigation through an anterior chamber approach. This is the procedure of choice in GCG following vitrectomy and may eliminate the need for a second vitrectomy.

Ocular findings in the facioauriculovertebral sequence (Goldenhar-Gorlin syndrome)

We reviewed the ocular findings in 57 consecutive patients with the facioauriculovertebral sequence (Goldenhar-Gorlin syndrome). Epibulbar choristomas were detected in 18 cases (32%), a much lower occurrence than reported previously. Various motility disorders (11 cases, 19%), blepharoptosis or narrow palpebral fissures (seven cases, 12%), eyelid colobomas (six cases, 11%), and lacrimal drainage system anomalies (six cases, 11%) were more frequent than previously noted. These ocular findings were more common in the patients with epibulbar choristomas. Of the various features of the Goldenhar-Gorlin syndrome (skin tags, microtia, hemifacial microsomia, and vertebral anomalies), only skin tags correlated positively with the laterality of epibulbar choristomas. Preauricular and facial tags represent choristomas, explaining their association with epibulbar choristomas and the laterality they share.

Failure of pupillary dilation in early choroidal detachment

Transient miosis presents a challenge in extracapsular cataract extraction and retinal detachment surgery, despite the advent of the small-pupil ophthalmoscope. Mechanisms have been proposed and preventive measures described. We describe a case of transient miosis that led to cancellation of the repair of retinal detachment and was the first sign of early choroidal detachment.

Homonymous hemianopia and systemic lupus erythematosus

The case of a 23-year-old woman with systemic lupus erythematosus and homonymous hemianopia is presented. A calcarine cortical infarct occurred as a result of a postpartal exacerbation of her disease and was demonstrated by CT scanning of the brain. The neuro-ophthalmic manifestations of SLE are reviewed briefly. The authors propose to include collagen vascular disease in the differential diagnosis of homonymous hemianopia in the young age group.

Association of epibulbar choristomas with linear cutaneous nevi. Review of the literature

The authors describe the association of epibulbar choristomas with linear cutaneous nevi of the epidermal and sebaceous variety in 24 cases reported in the literature. The choristomas are of the bilateral, extensive, multiple and complex type. The associated ocular and systemic findings include lid and uveal coloboma, lid choristoma, alopecia, convulsions and growth retardation.

Eye findings in interstitial deletion of band q12 of chromosome 5

An 18-month-old girl presented with the ocular findings of severe ptosis of the right upper lid, astigmatism and the Adduction Fixation Preference. She also had psychomotor retardation and multiple congenital anomalies. The karyotype revealed an interstitial deletion of the long arm of chromosome 5 at q 12. This is the first description of the ophthalmological findings in this chromosomal disorder.

The use of a cautery for trimming exposed nylon sutures

Ophthalmic nylon sutures (9-0 or 10-0) that become exposed postoperatively are irritating to the patient, especially if the knots are not buried, or if the sutures are not well covered by (or protrude through) the conjunctiva. Obviously, these sutures cannot be removed safely less than six to eight weeks after surgery. The symptoms may even be aggravated by trimming the suture ends, as these become more stiff and pointed when shortened. Moreover, trimming sutures can be a difficult task in some uncooperative patients.

Isolated trochlear nerve palsy secondary to a juvenile pilocytic astrocytoma

A 9-year-old female developed a fourth nerve palsy which was the first sign of a posterior fossa astrocytoma. The fourth nerve palsy was believed to have resulted from direct invasion of the trochlear nerve rather than compression by hydrocephalus. Sagittal reconstruction of a computed tomogram revealed extension of the tumor into the dorsal midbrain where the trochlear nerve exits.

Fibrinogen concentration in the aqueous humor of buphthalmic rabbits

Fibrinogen concentration in the aqueous humor of buphthalmic rabbits, AXBU/J, and those of the normal parent strain AX/J are 0.36 +/- 0.14 and 0.08 +/- 0.01 mg/ml, respectively. There was no detectable fibrinogen in the aqueous humor of normal inbred strain III/J rabbits. Among the buphthalmic rabbits, elevated fibrinogen concentration in the aqueous humor was observed in two month old prodromal rabbits, indicating a small leakage of fibrinogen into the anterior chamber before the development of buphthalmia. Protein concentration in the aqueous humor was close to normal, in spite of an elevated level of fibrinogen in the young buphthalmic rabbits. Severe protein leakage was seen in only some of the old buphthalmic rabbits.

RNA synthesis in rat liver after cortisol treatment: a possible mitochondrial-nuclear relationship

Liver mitochondrial RNA synthesis (as measured by an RNA polymerase assay) in adrenalectomized ovariectomized rats increased (42 %) 1 h after injection of 0.5 mg cortisol/100 g b. wt. Nuclear RNA synthesis increased (130–171 %) 4 h after injection of 4 mg cortisol/100 g but did not increase after treatment with the lower dosage of cortisol after 4 h. There was no effect on the nuclei from either 0.5 or 4 mg cortisol after 1 h. If either ethidium bromide, rifampicin or actinomycin D were injected 10 min before the hormone injection, a complete inhibition of the hormonal action on mitochondrial RNA synthesis was found. On the other hand, nuclear RNA synthesis was partly inhibited if either ethidium bromide or rifampicin preceded the hormone injection. Actinomycin D inhibited nuclear RNA polymerase below the saline control level.

Assuming that ethidium bromide and rifampicin act specifically on mitochondrial RNA synthesis, it would appear that there is a mitochondrial component to the RNA synthesis measured in the nucleus after cortisol treatment.

The effect of exogenous ribonucleic acid on alkaline phosphatase activity in the ovarectomized mouse uterus

RNA from tissues subjected to very high doses of 17β-oestradiol in vivo and in vitro was injected into the uteri of ovariectomized mice before and after ether washing of the RNA.

Alkaline phosphatase content of the atrophied uterus was measured after the RNA injections.

Results indicate that alkaline phosphatase induction is due to RNA and that ether washing completely eliminates hormonal contamination.

The role played by the hormone-cytoplasm requires further attention.