Central nervous system malignant B-cell lymphoma identified with standardized echography of the optic nerve

Ocular-central nervous system malignant B-cell lymphoma initially caused diplopia and morning headaches in a 10-year-old boy. After initial diagnosis of pseudotumor cerebri was made, based on normal findings from magnetic resonance imaging and magnetic resonance angiography elsewhere, he was treated with acetazolamide. Standardized echography demonstrated a combination of solid infiltration and fluid within the optic nerve sheaths. Lumbar puncture showed elevated opening pressure and cerebrospinal diagnostic of central nervous system (CNS) B-cell lymphoma, which was confirmed by gene rearrangement. Results of peripheral blood study were negative. Aggressive treatment with chemotherapy and external-beam radiation produced complete resolution of solid optic nerve sheath infiltration in both eyes. This report discusses the clinical and ultrasonographic characteristics of CNS malignant B-cell lymphoma with ocular involvement and its differentiation from pseudotumor cerebri.

Comparison of standardized echography with magnetic resonance imaging to measure extraocular muscle size

Using both standardized echography and high-resolution, surface coil magnetic resonance imaging, we measured the transverse diameter of recti extraocular muscles to evaluate comparative accuracy. Maximum transverse diameter of each rectus muscle in primary gaze was measured in 39 orbits of 20 subjects by using standardized A-scan echography. In the same orbits, we obtained multiple coronal magnetic resonance imaging planes by using a surface coil to span the anteroposterior extent of each orbit. Digital image analysis with the National Institutes of Health Image program was used to measure transverse muscle diameter. Average size for each rectus muscle was similar for the echographic and magnetic resonance imaging techniques. However, linear regressions of individual ultrasound against magnetic resonance imaging measurements showed coefficients of determination (R2) moderate (0.29) for inferior recti muscles and low (< or = 0.11) for other recti muscles. For most recti muscles, significant variability in echographic estimates of muscle width results from factors other than true muscle size. Results indicate that ultrasound measurements of muscle size in individual patients should be interpreted cautiously.

Small malignant melanoma of the choroid with extraocular extension

A disciform macular lesion in the hyperpigmented eye of a patient with melanosis oculi demonstrated slowly progressive increase in size during eight years. Clinical observation and serial fundus photography indicated increase in anteroposterior thickness of the lesion to 2.0 mm and in greatest diameter from 3.5 to 6.0 mm. Subsequent echography revealed an overall anteroposterior dimension of 3.4 mm and an increase to 5.5 mm in 20 months. Enucleation of the affected eye with the intact extraocular tumor mass and a local tenonectomy demonstrated a choroidal malignant melanoma of the epithelioid cell type with extraocular extension, peripapillary scleral infiltration, focal invasion of the juxtalaminar optic nerve, and tumor cells in the subarachnoid space. This experience emphasizes the importance of echography in the periodic evaluation of small choroidal malignant melanomas to detect growth not apparent by ophthalmoscopy.

B-scan ultrasonography of retinal detachments

Characteristic ultrasonsographic patterns of retinal detachment in a variety of clinical circumstances are demonstrated and discussed. Uncomplicated retinal detachment consists of ultrasonically detected retinal detachment without associated pathology in the vitreous, subretinal space, or choroid. The simultaneous detection of lesions in one or more of these areas may be a source of diagnostic confusion. Acoustic diagnostic criteria for differentiation of associated conditions in complicated retinal detachments are demonstrated and discussed. High resolution A-scan and B-scan ultrasonography provides a method for detection and diagnosis of retinal detachment, associated ocular pathology, and simulating conditions.

Resorption of intravitreal blood following vitrectomy

Eight rhesus monkeys underwent unilateral vitrectomy and subsequent injection of blood into both vitreous cavities. There was no significant inflammation, cataract, delayed corneal healing, or elevated intraocular pressure. Blood in the operated eyes dispersed immediately while blood in the control eyes did not disperse until seven to 14 days after injection. All operated eyes showed more rapid clearing of blood than control eyes containing formed vitreous. This result occurred in the presence or absence of the crystalline lens.