Vitreous histocytology of primary choroidal malignant melanoma

The cytomorphologic findings of a vitrectomy specimen from the right eye of an 80-year-old woman with an unsuspected primary choroidal malignant melanoma are described. The patient had undergone a closed vitrectomy because of chronic vitreous hemorrhage. Histocytology of the vitreous fluid specimens revealed melanoma cells of variable shape and size (from 30-150 microns) with eccentric nuclei. Many of these cells were binucleated or multinucleated with small, uniform, evenly dispersed intracytoplasmic melanin granules. The histocytologic findings together with the postoperative tumor characteristics by ultrasonography and fluorescein angiography suggested the diagnosis of choroidal malignant melanoma.

Ophthalmologic manifestations of X-linked childhood adrenoleukodystrophy

The ophthalmologic findings in 15 patients with childhood adrenoleukodystrophy (ALD) are reviewed. In this X-linked demyelinating disease with adrenal dysfunction, relentlessly progressive visual loss followed by optic atrophy occurs months to years after the diagnosis is established based on neurologic symptoms and biochemical abnormalities. Visual loss is mainly due to central nervous system (CNS) demyelination involving the visual tracts, but primary retinal ganglion cell degeneration may also be operative. All patients in this study were male. Vision ranged from 20/20 to no light perception (NLP). All but one patient with bilateral cataracts had normal anterior segment examinations. Seven patients had exotropia, and esotropia developed in one patient. Electroretinography (ERG) and electrooculography (EOG) findings were normal in two patients with severe visual loss. Macular pigmentary changes were observed in three patients. Optic pallor was noticed in seven patients. Optic nerve hypoplasia was seen in one patient. Visual-evoked responses were abnormal in two patients and borderline in one. Progressive visual field abnormalities were noticed in three patients, large field cuts in two patients, and normal fields in another two patients. The diagnosis of ALD should be considered in all boys presenting with unexplained visual loss, dementia, and adrenal dysfunction.

Ophthalmologic findings in mucolipidosis III (pseudo-Hurler polydystrophy)

Of eight patients with mucolipidosis III, hyperopic astigmatism, and corneal clouding, five had retinal and optic nerve abnormalities. Two patients had surface wrinkling maculopathy, four patients had various degrees of optic nerve head swelling, and two patients had retinal vascular tortuosity. Electrophysiologic studies of the retina gave normal results in the four patients tested. Visual field defects were present in three of the four patients examined. Color vision was normal in three of the patients. Visual acuity remained unchanged in the seven patients clinically followed from one to 11 years (average, six years).

Hereditary pigmented paravenous chorioretinal atrophy

An affected, but asymptomatic, mother and her three sons presented with pigmented paravenous chorioretinal atrophy. The patients had coarse pigment clumps and areas of chorioretinal atrophy in a paravenous distribution. The severity of chorioretinal changes was variable; two of the patients had macular involvement. Signs of vitreoretinal degeneration were seen in all patients; the sons had associated hyperopia and esotropia. Electroretinography revealed decreased photopic responses with normal scotopic responses in five of six eyes tested. To our knowledge, this is the second account reported of familial occurrence of pigmented paravenous chorioretinal atrophy. The present pedigree is compatible with X-linked or dominant inheritance.

Aniridia, atypical iris defects, optic pit and the morning glory disc anomaly in a family

A two-month-old girl with aniridia was found to have an optic pit in one eye and the morning glory disc anomaly in the other eye. The patient's mother had corectopia and atypical iris defects. The findings are described and the embryology of the various abnormalities briefly reviewed. This is the first report of such an association of findings in a family with aniridia. Failure of normal neuroectodermal development may play a role in the development of optic pits and the morning glory disc anomaly.

Extraocular muscle aplasia in Moebius syndrome

A case of Moebius syndrome with bilateral aplasia of the medial and lateral recti is reported. The fibrous bands that replaced the medial recti were inserted posteriorly on the globe resulting in a restrictive large angle esotropia. Surgical intervention resulted in alignment in the primary position. The present case favors a primary mesodermal dysplasia of the extraocular musculature in Moebius syndrome.

Persistent hyperplastic primary vitreous and recessive oculo-dento-osseous dysplasia

We report on a patient with oculo-dento-osseous dysplasia and bilateral persistence of the hyaloid system. Autosomal recessive inheritance may be the cause of this patient's condition since she was born to unaffected first-cousin parents. Ocular findings in the recessive variety of this syndrome seem to be more severe than those in the more common dominant form.

Retinoblastoma in Lebanon

The data on 58 patients with retinoblastoma managed at the American University of Beirut, Medical Center over the last 35 years is reviewed. The epidemiology, genetics and clinical features of this tumor appear to be the same in the Middle-East as well as the rest of the world. The notable difference between the data in this study and that from other studies is the marked delay in diagnosis of the tumor in this part of the world leading to a higher incidence of extraocular extension, a more advanced stage of the disease and poorer survival rates. This seems to be a feature of medically underdeveloped societies. Increased public awareness of the early signs and symptoms of the disease, as well as routine fundoscopy on all infants are advocated to improve early detection, leading to improved survival rates and prevention of unnecessary enucleations.

Waardenburg's recessive anophthalmia syndrome

A family with a rare form of autosomal recessive anophthalmia, syndactyly and multiple congenital deformities is reported. The authors propose that this be recognized as a well defined autosomal recessive syndrome.

The ocular findings in Kniest dysplasia

We studied seven patients who had Kniest dysplasia. All of the patients had congenital severe myopia and vitreoretinal degeneration. Four patients developed rhegmatogenous retinal detachments. Early surgery on one patient resulted in successful reattachment and 20/50 vision at a three-year follow-up visit. Other ocular findings included cataracts in two patients, dislocated lenses in one patient, and blepharoptosis in one patient.

Retinal pigment epithelium tear as a cause of vitreous hemorrhage

Tearing of the retinal pigment epithelium (RPE) can complicate its detachment in the course of senile macular degeneration. In the majority of cases, there is progression to the formation of a macular fibrous scar with poor visual outcome. There have not been any previous reports of vitreous hemorrhage complicating RPE tear. We describe the findings in a 65-year-old man who was observed pre- and posttearing of a serous RPE detachment. He was receiving chronic aspirin therapy for recurrent headaches and developed a vitreous hemorrhage five weeks following the RPE tear.

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.

Melanocytoma of the ciliary body: presentation of four cases and review of nineteen reports

A clinical and histopathologic review of 23 cases of melanocytoma of the ciliary body discloses that the tumor is unilateral, extends into contiguous structures, slowly enlarges, and commonly undergoes necrosis. We report the clinical and histopathologic features of four cases of melanocytoma of the ciliary body, review the previously reported and presented cases, and discuss the differential diagnosis of melanocytoma of the ciliary body.

The retinopathy of primary hyperoxaluria

The ophthalmoscopic and fluorescein angiographic findings in a seven-year-old boy with primary hyperoxaluria presented. The retinal findings in this condition have been reported previously in only ten patients. The fluorescein pattern which is considered to be very suggestive was reported previously in only one patient. In this report, ocular oxalosis is discussed, and the crystalline retinopathies are briefly reviewed.

Occipital cortical infarction complicating respiratory failure

We describe the occurrence of bilateral occipital cortical infarction following respiratory failure in two patients of differing ages. The precipitating factors, clinical manifestations, and ophthalmologic findings also differed, but the hypoxic effects on the cortex were the same as evidenced by the CT scanning studies.