Embolic ischemic optic neuropathy

On examining the postmortem enucleated eyes of a 68-year-old man, we found the left eye had focal infarction 3 mm behind the lamina cribrosa caused by thromboembolic compromise of three discrete pial and pial-derived arterioles. The optic nerve had been destroyed focally, whereas the retinal and choroidal tissue supplied by a similarly occluded vessel had been preserved. We diagnosed nonarteritis ischemic optic neuropathy.

X-linked ocular albinism in Blacks. Ocular albinism cum pigmento

X-linked ocular albinism can be an unsuspected cause of congenital nystagmus in blacks. In this study, eight of ten black ocular albinos from two kindreds had nonalbinotic, moderately pigmented fundi and no transillumination of the iris. We refer to this paradoxical condition as "ocular albinism cum pigmento." The only constant ophthalmoscopic feature was a foveal hypoplasia. Biopsy of clinically normal skin to demonstrate giant pigment granules is the most accurate means of diagnosis.

Adult cystinosis. A case report

A 41-year-old man, referred because of the suspicion of retinal detachment, was found to have retinoschisis, moderately severe renal disease, and adult cystinosis with crystals in the cornea and conjunctiva. Conjunctival crystals were demonstrated by light and electron microscopy, and chemical analysis confirmed the presence of excessive amounts of cystine. Studies of renal tissue showed changes that were interpreted as being due to hypertensive vascular disease. Light and electron microscopic examination of kidney tissue showed no cystine crystals, and chemical analysis indicated only trace amounts of cystine.

Pit-like changes of the optic nerve head in open-angle glaucoma

Six patients with open-angle glaucoma and acquired pit-like changes in the optic nerve head are presented. In 1 patient evolution of the pit-like defect is documented. In all 6 patients progression of associated visual field deficits is described. It is suggested that such pit-like changes in selected patients with glaucoma may not represent congenital lesions but rather local, progressive nerve head disease, occurring particularly in response to raised intraocular pressure. The management of patients with optic nerve head pitting and the pathogenesis of glaucomatous optic neuropathy are discussed with respect to this observation.

Drusen of the optic nerve head

Fifty-two eyes with drusen of the optic nerve head from the autopsy and surgical files of the Eye Pathology Laboratory of the Wilmer Institute from January 1967 through December 1975 were reviewed, and histochemical and electron microscopic studies performed. Histopathologic associations with the drusen included 19 eyes with associated optic nerve atrophy, 16 eyes with peripapillary crowding, one case involving prominent dilated vessels pushed aside by the drusen, and one eye with central retinal vein occlusion. Drusen appear to be composed predominantly of a mucoprotein matrix with significant quantities of acid mucopolysaccharides along with small quantities of ribonucleic acid and, occasionally, iron. The literature is reviewed and various correlations and pathogenetic theories are discussed.

Retinal pigment epithelial window defect

The clinical and histopathologic features of a solitary retinal pigment epithelial window defect are presented. Fluorescein angiography disclosed an area with early choroidal fluorescence but no late staining. Histopathologic studies showed an intact but attenuated retinal pigment epithelium with partial to complete loss of melanin granules, partial atrophy of the photoreceptor cells, and sclerosis of the choriocapillaris.

Inversion of the resonance line of Sr+ produced by optically pumping Sr atoms

We report inversion and lasing on the optically pumped resonance line of Sr+. A mode-locked frequency-doubled dye laser was tuned to excite the dipole-allowed two-electron transition, 5S(2) (1)S(0)-4d5p (3)P1(0), in Sr vapor. The same laser then ionized the excited atoms, selectively producing ions in the Sr+ 5p (2)p(3/2)(0) excited level. The inversion density with respect to the Sr+ ground level was approximately 10(13) cm(-3).

Retinitis pigmentosa and exudative vasculopathy

A patient with bilateral retinitis pigmentosa and exudative vasculopathy was initially seen with a blind and painful left eye, which was enucleated. Results of clinical study of the right eye and histopathologic and ultrastructural study of the enucleated left eye showed the abnormal vessels to be derived from the choroidal circulation. Previous clinical reports of retinitis pigmentosa with exudative vasculopathy have described retinal vascular abnormalities similar to those found in Coats' disease. From the comparison of our case with those previously reported, we conclude that different types of exudative vasculopathy may develop in the setting of retinitis pigmentosa.

Eye-cosmetic-induced conjunctival pigmentation

Light and electron microscopic study of conjunctival pigmentation in a 27-year-old woman who used eyelid cosmetics is presented. The deposited material consists of ferritin particles and probably iron oxide and carbon. A review of the literature on conjunctival pigmentation secondary to eyelid cosmetics is presented.

Fatal viscerotropic Rocky Mountain spotted fever. Report of a case diagnosed by immunofluorescence

A case of fatal viscerotropic Rocky Mountain spotted fever with virtual absence of cutaneous lesions was diagnosed at autopsy by specific immunofluorescent demonstration of Rickettsia rickettsii in spleen, kidney, epididymis and skin. The clinical presentation was that of insidious onset of fever, renal failure, hypotension, hyponatremia and obtundation over a 10 day period. The patient had respiratory insufficiency, hypocalcemia, increases in creatinine phosphokinase (CPK), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), lactic dehydrogenase (LDH), alkaline phosphatase, billirubin and serum phosphate, grand mal seizure, myalgia and unremitting shock with death occurring on day 12 of illness. Postmortem examination revealed severe vasculitis with interstitial nephritis and multifocal tubular necrosis, pericholangitis with bile stasis, glial nodules in the brain, multifocal rhabdomyonecrosis, interstitial pneumonitis and mild interstitial myocarditis. Risk factors which this patient shared with other patients with fatal Rocky Mountain spotted fever were failure to recognize a rash, failure to obtain a tick bite history, male sex, black race and age greater than 30 years.

Peripheral corneal degeneration and occlusive vasculitis in Wegener's granulomatosis

A 61-year-old white woman, who had progressive arthritis over a two-year period, developed bilateral peripheral corneal degeneration. The superior cornea thinned to a thickness of approximately two thirds of normal. She died suddenly in the hospital and a primary occlusive vasculitis of the anterior ciliary arteries within the superior rectus muscles was found. There was necrotizing arteritis in the lungs, kidneys, adrenal caps, spleen, fallopian tubes, and skeletal muscle. The observation of an occlusive vasculitis of the anterior ciliary arteries in this patient supports the belief that ischemia may play a major role in peripheral marginal degeneration of the cornea.

Peripheral Peters' anomaly: a histopathologic case report

The clinical and pathologic findings of a case of congenital bilateral, peripheral corneal leukoma associated with iris coloboma and anterior subluxation of the lens are reported. The changes in the region of keratolenticular apposition include partial absence of Bowman's membrane, stromal vascularization and thinning with large-diameter collagen fibrils, and absence of Descemet's membrane and endothelium. The authors postulate that dysembryogenesis of the tertiary vitreous, with iris coloboma, resulted in apposition of the lens to cornea during the second and third month of gestation and that this apposition resulted in the observed peripheral corneal abnormalities.

Ocular histoplasmosis: clinicopathologic correlation of 3 cases

The eyes of three patients followed clinically for many years with a diagnosis of macular disciform scarring, secondary to ocular histoplasmosis, were studied histopathologically. A fibrovascular scar interposed between the choroid and retina was observed in all cases. Vessels passing from the choroid through defects in Bruch's membrane into the nodule were demonstrated. Theories of the pathogenesis of the lesion are discussed.

Cytomegalovirus retinitis in adults. A manifestation of disseminated viral infection

Retinitis caused by cytomegalovirus (CMV) infection is unusual in adults. Sixteen of the 17 cases reported have occurred in immunologically compromised patients, most frequently renal transplant recipients. CMV retinitis is associated with a distinctive ophthalmoscopic appearance and, in the majority of cases, was the first clinical manifestation of systemic viral infection. Severe and permanent visual deficits are characteristic. Since retinitis is a reliable sign of disseminated disease and ophthalmoscopic examination a rapid method of establishing its presence, recognition of this manifestation should allow earlier diagnosis of serious CMV infection.

Recurrence of macular corneal dystrophy after lamellar keratoplasty

A 20-year-old man required bilateral lamellar keratoplasties for macular corneal dystrophy. Histochemical proof of macular corneal dystrophy was demonstrated in both of the excised lamellar corneal buttons. Eleven years later, the patient underwent a penetrating kiratoplasty in his left eye. Light microscopic, histochemical, and electron microscopic study of the excised button disclosed characteristic features of macular corneal dystrophy in the donor cornea. Recurrence of macular corneal dystrophy in a corneal graft appeared to be the result of replacement of the donor keratocytes by genetically defective host cells.

A non-permanent tonic pupil in rheumatoid arteritis

A 76-year-old male with a severely deforming rheumatoid arthritis, eosinophilia, polymyositis, and episcleritis developed a transient tonic pupil. The episcleritis, and a muscle biopsy revealing an occlusive arteritis with eosinophilia, suggest that a wide-spread rheumatoid arteritis caused a reversible ischemic insult to the ciliary ganglion and thus created a transient denervation of the pupil.

A histopathologic review of 168 cases of preretinal membrane

In 168 eyes with preretinal membranes studied histopathologically, five major distinct types of membranes were categorized: 61 glial, 28 fibrous, 22 cortical vitreous, 16 retinal pigment epithelium, 15 fibroinflammatory, 24 combinations, and one endothelial and melanomatous membrane each. The overall prevalence of preretinal membranes was 5.5% in 2,000 cases studied. Selected cases examined by electron microscopy were supportive of the origin of the cells in the preretinal membranes in the glial, fibrous, and retinal pigment epithelial types. Glial preretinal membranes occurred as the result of defects in the internal limiting membrane, such as retinal pits or holes, and from the optic nerve head in association with posterior vitreous detachment. Fibrous preretinal membranes were associated with proliferative retinopathy and long-standing retinal detachment. Studies of the cellular origin of these membranes were inconclusive. The cortical vitreous type of preretinal membrane was hypocellular and occurred in the absence of associated ocular abnormalities. Pigment epithelial preretinal membranes occurred in eyes with rhegmatogenous retinal detachment.

Vascular tufts of pupillary margin of iris

A 71-year-old woman complained of "smoky" vision, which was found to be caused by a hyphema with blood dripping from a vascular tuft located in the 12 o'clock meridian of the iris. Fluorescein angiography delineated vascular tufts and argon laser photocoagulation eradicated one of the tufts that bled. Histopathologic studies of iris obtained at the time of cataract extraction showed an aggregate of small vessels at the pupillary margin. Most patients with vascular tufts of the pupillary margin have no systemic disease but they are also observed in diabetes mellitus and myotonic dystrophy.

Spontaneous regression of retinoblastoma

Clinicopathologic evidence of bilateral spontaneous regression of retinoblastoma in three brothers is presented. The buphthalmic right eye and phthisical left eye of one of these persons were examined histopathologically. The two brothers of this patient both had phthisical left eyes, and those eyes were examined histopathologically. Both of those brothers also had clinically detected chorioretinal scars in their right eyes from regressed retinoblastoma. Three of eight children of one of the two brothers had bilateral retinoblastoma, and two of seven children of the other brother had bilateral retinoblastoma. Reports in the literature of 50 previous cases of total spontaneous regression of retinoblastoma from 1911 to 1975 are reviewed.

A clinical and histopathological study of François-Neetens speckled corneal dystrophy

A 57-year-old black man had François-Neetens speckled dystrophy of the cornea and orbital phycomycosis. Examination of family members confirmed an auto-somal-dominant pattern of inheritance. Light and electron microscopic study of the cornea of a blind eye disclosed that the corneal opacities were represented by swollen, vacuolated keratocytes filled with histochemically demonstrable acid mucopolysaccharide and complex lipids. Thus, this dystrophy may represent a dominantly inherited metabolic disorder confined to the cornea.

Retinal phlebitis in the Irvine-Gass syndrome

We reviewed the pathology records from January 1965 through July 1975 for aphakic eyes. After exclusion of unsuitable cases, ten eyes (nine patients) with cystoid macular edema and 142 eyes without cystoid macular edema were studied. Clinical ophthalmic records were available for five of the ten eyes with the Irvine-Gass syndrome. Histologic sections were examined, revealing a significant correlation between the Irvine-Gass syndrome and retinal phlebitis, which has not been reported previously, as well as cyclitis and vitritis. Anterior segment operative complications tended to be more prevalent in eyes with the Irvine-Gass syndrome than in those without the Irvine-Gass syndrome, although the assocation was not statistically significant (P less than .1). Retinal trypsin digestion showed the phlebitis to be distributed posteriorly within primary and secondary retinal veins, frequently occurring near points of bifurcation. The changes in permeability seen in the Irvine-Gass syndrome may be due to this retinal phlebitis and to a generalized inflammation-induced increase in capillary permeability. The case of the phlebitis is not known.

Senile macular degeneration: a histopathologic study

The histopathologic features of 176 eyes from 115 patients with senile macular degeneration have been studied. The results support the view that older persons with drusen are predisposed to the development of serous detachments, areolar retinal pigment epithelial atrophy, and subretinal pigment epithelial neovascularization. Direct clinicopathologic correlation was accomplished in 11 cases. Serial sections through the macular lesions were prepared and studied in 45 eyes. Five eyes were studied with stepped-serial sections through the macula at 0.1 mm intervals. Two-dimensional map reconstruction of the macular lesion of eight eyes was performed. Electron microscopic study of Bruch's membrane was performed in five eyes. A flow chart illustrating the interrelationships of the various morphologic forms of senile macular degeneration is proposed.

Rhodopsin and blindness

Systemic immunization with purified homologous rhodopsin from retinal outer segments induced blindness in primates (Macaca mulatta). Inflammation and characteristic retinal changes were the earliest clinical signs of the disease. Perivasculitis, subretinal exudations and bullous detachments of the retina were progressive and unrelenting pathological processes leading to rapid and irreversible visual deterioration. Electroretinographic responses (ERG) at this stage of the disorder became abolished. Antibodies and delayed hypersensitivity to rhodopsin were demonstrated only in the experimental diseased animals. Homologous visual purple appears to be organ and immunopathologically specific. Histological confirmation of these findings showed a pathological spectrum of destructive alterations confirmed specifically to the outer segments of the entire retina. The pathologic reaction was supported by a distinct and pronounced granulomatous inflammatory response.

Complement receptor lymphocytes in the rabbit I. an SIg-negative subpopulation in the appendix

Complement receptor lymphocytes (CRL) were detected in various rabbit lymphoid tissues by the ability of these CRL to form rosettes with sheep red blood cells coated sequentially with rabbit antiserum directed against sheep red blood cell stroma and horse serum as a nonhemolytic source of complement (EAC). The rosette assay was shown to be specific for complement receptor (CR) activity and the EAC capable of detecting both C3b and C3d specific receptors. With lymphocyte preparations containing less than 5% phagocytic cells, the average per cent CRL in the various tissues studied was as follows: thymus 1%, popliteal lymph node 18%, spleen 30%, appendix 35%, and peripheral blood 45%. Double assays in which the lymphocytes were prestained with an FITC-labeled Fab fragment of a goat anti-rabbit Fab antibody before rosetting indicated that CRL were a subpopulation of surface immunoglobulin (SIg)-bearing lymphocytes in popliteal lymph node, spleen, and peripheral blood. In the appendix, however, in addition to finding SIg+ CR+ and SIg+ CR- populations, an SIg- CR+ population was consistently found. Double assays employing FITC-labeled goat antibodies specific for mu, alpha, and gamma determinants were also performed to determine if there was any relationship between the class of Ig displayed and presence of CR. It appeared that an approximately equivalent percentage of both IgM- and IgG-bearing cells also displayed CR. Experiments in which appendix cells were treated with Pronase to remove SIg and CR and the cells cultured in vitro to allow regeneration of surface markers confirmed the existence of SIg+CR+, SIg+CR-, and SIg-CR+ lymphocyte subpopulations. Whether the SIg-CR+, population represents a developing B cell population which will eventually also express SIg or whether it belongs to the T or "null" cell populations is unclear at present.

X-linked ocular albinism. An oculocutaneous macromelanosomal disorder

Three unrelated kindreds with the Nettleship-Falls type of X-linked ocular albinism were studied. Postmortem examination of the eyes of an affected man revealed the presence of macromelanosomes in the pigment epithelia. Skin biopsy specimens of this patient, seven other affected male, and nine carrier female kindred members revealed the presence of Fontana-positive and dopa oxidase-positive macromelanosomes within the epidermis and dermis. Although clinically this disorder has been considered to be a form of albinism confined to the eyes, these findings indicate that an unusual disturbance in melanosome production characterized by macromelanosome formation affects the skin and the eyes. Histopathologic study of the skin is a useful adjunct in the diagnosis of X-linked ocular albinism, both in the affected and the carrier states. Linkage studies confirmed the close association of the Xg blood group with this disorder.