Although anomalies affecting the optic nerve head are usually clinically innocuous, they can sometimes cause significant symptoms and lead to visual loss. It is important to be able to recognize even the relatively benign lesions in order to differentiate them from other more threatening lesions or disease processes which they may clinically resemble. An awareness of the clinical appearance of disc anomalies is especially important in the differential diagnosis of optic nerve glaucomatous changes. Some anomalies cause various types of visual field loss which, if the actual disc lesion is not recognized, may lead to unnecessary neurologic evaluation or even to intracranial surgery. The optic nerve changes in acquired myopia and in the congenital tilted disc syndrome should be clearly defined and differentiated: high (pathologic) myopia may be highly progressive with many dangerous secondary sequelae, while the latter anomaly is stationary. Finally, there is a group of conditions, collectively termed "elevated anomalies of the disc," which must be considered in the differential diagnosis of papilledema and potentially dangerous intraocular tumors, particularly retinoblastoma. This review provides a clinicopathologic correlation comparing the characteristics of the normal optic disc to those of the most important congenital anomalies of the disc.

Coloboma↗

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Complications of intraocular lenses. A historical and histopathological review.

Recent improvements in intraocular lens (IOL) design, manufacturing techniques, and surgical techniques have greatly reduced the incidence of complications following implantation, and many authors now consider IOL implantation to be among the most safe and effective major surgical procedures. However, adverse reactions are still seen--some as late sequelae of earlier IOL designs and implantation techniques and some as sequelae of more recent implantations using "state-of-the-art" lenses and surgical techniques. Complications may be due to various factors, including surgical technique, IOL design, or the inability of some eyes with preexisting disease to tolerate an implant. The authors trace the evolution of IOLs since Ridley's first implant, summarizing the modifications in lenses and surgical techniques that were made as complications were recognized. They then review the clinical and histopathological features of selected cases from more than 200 IOLs and/or globes removed due to IOL-related complications and studied in the University of Utah Ocular Pathology Laboratory. It is hoped that this review will provide insights into the pathogenesis of IOL complications, enhancing the current success of implant procedures and stimulating further basic and clinical research in this area.

Anaphylaxis↗

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Pyogenic granulomas of the cornea.

Pyogenic granulomas are vasoproliferative, inflammatory lesions composed of granulation tissue, which occur on cutaneous or mucosal tissues, often arising secondary to other processes such as trauma or infection. Conjunctival pyogenic granulomas are not rare, but corneal involvement is very unusual and can occasionally lead to problems in the differential diagnosis of corneal masses. We report three cases of pyogenic granuloma involving the cornea. The clinicopathologic features of these cases and a review of the literature on the ocular manifestations of this condition are presented.

Actinomycosis↗

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Congenital orbital teratoma: a review and report of two cases.

Congenital orbital teratomas are rare tumors derived from more than one germinal cell layer. These tumors may arise within the orbit, or may originate intracranially and extend into the orbit. Recent advances in ultrasonography have made in utero diagnosis possible. We present the case reports of a primary orbital teratoma and an intracranial teratoma with secondary orbital involvement. The clinical features, histopathologic findings, treatment, and pathogenesis of orbital teratomas are discussed.

Adolescent↗

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Melanocytoma: nomenclature, pathogenesis, natural history and treatment.

A melanocytoma (magnocellular nevus) is a benign pigmented tumor that may arise wherever uveal melanocytes are present. The most commonly observed site is on or adjacent to the optic nerve head. In the past this tumor was frequently misdiagnosed as a malignant melanoma and many unnecessary enucleations were carried out. Its clinical features are now well recognized and, fortunately, specimens of melanocytomas are rarely received in ocular pathology laboratories today. A review of the literature concerning this tumor is presented, with special reference to the changing concepts in nomenclature, pathogenesis, natural history, and treatment that have evolved in the past one hundred years. We also define the clinical and histopathological features of this tumor.

Cell Transformation, Neoplastic↗

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Vitreous hemorrhage secondary to age-related macular degeneration.

The clinical features of two patients with vitreous hemorrhage secondary to age-related macular degeneration and the histopathological findings in one of these cases are reported. Twenty additional cases are reviewed and compared with previously reported series. In patients with vitreous hemorrhage secondary to age-related macular degeneration, the appearance of vitreal blood is often preceded by extensive subretinal hemorrhage. Although this condition may be confused with a vitreous hemorrhage accompanying choroidal malignant melanoma, the correct diagnosis is usually apparent from clinical findings and ultrasonography. In most patients the prognosis for visual improvement is poor because of macular degeneration and extensive subretinal hemorrhage. A vitrectomy to remove the vitreous hemorrhage associated with macular degeneration is rarely beneficial.

Aged↗

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Cytomegalovirus retinitis.

Cytomegalovirus retinitis is a frequent and serious complication of various conditions, including diseases characterized by impaired immunity, such as the acquired immunodeficiency syndrome. Due to recent advances in the treatment of cytomegalovirus retinitis, accurate diagnosis and management have become increasingly important. In this review, the authors present the epidemiology, clinical features, diagnostic testing, treatment with complications, and prognosis of cytomegalovirus retinitis. A differential diagnosis is presented and the characteristic ocular lesions are illustrated.

Acquired Immunodeficiency Syndrome↗

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Posterior capsule opacification.

A complication of extracapsular cataract extraction with or without posterior chamber intraocular lens (PC-IOL) implantation is posterior capsule opacification. This condition is usually secondary to a proliferation and migration of residual lens epithelial cells. Opacification may be reduced by atraumatic surgery and thorough cortical clean-up. Clinical, pathological and experimental studies have shown that use of hydrodissection, the continuous curvilinear capsulorhexis and specific IOL designs may help reduce the incidence of this complication. Capsular-fixated, one-piece all-polymethylmethacrylate PC-IOLs with a C-shaped loop configuration and a posterior convexity of the optic are effective. Polymethylmethacrylate loops that retain "memory" create a symmetric, radial stretch on the posterior capsule after in-the-bag placement, leading to a more complete contact between the posterior surface of the IOL optic and the taut capsule. This may help form a barrier against central migration of epithelial cells into the visual axis. Various pharmacological and immunological methods are being investigated but conclusive data on these modalities are not yet available.

Cataract↗

PubMedDate not supplied

Sir Harold Ridley receives England's highest honor.

Explore the source record for details and available documents.

Awards and Prizes↗

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Harold Ridley and the invention of the intraocular lens.

On November 29, 1949, Harold Ridley implanted the first intraocular lens (IOL). This marked the beginning of a major change in the practice of ophthalmology and, for Ridley, the beginning of an era of inspiration, reward and challenge, unfortunately marred by the disdain and discourteous actions of many colleagues within the academic establishment in Europe and the United States. By the late 1970s IOLs and implantation procedures had undergone many improvements, and Ridley's invention had become an accepted option for the optical correction of aphakia. Since that time Ridley has been accorded the recognition due him for his unique contribution to ophthalmology through the conferring of numerous awards and honors. This colorful biographical account is based on published history, statements from Ridley's colleagues, and recent interviews with Ridley himself.

England↗

PubMedDate not supplied

Histopathology and ultrastructure of krypton and argon laser lesions in a human retina-choroid.

The authors studied a normal eye 24 hours after retinal treatment with argon and krypton photocoagulation. The findings indicate the relative sparing of the inner retina and greater choroidal effects of krypton when compared with argon photocoagulation. Bruch's membrane was not completely ruptured as long as the energy densities of burns were kept low. Krypton wavelengths are transmitted more effectively to the pigment epithelium and choroid. Therefore, the use of relatively lower and therefore safer power densities compared with the argon laser should suffice for the treatment of diseases at this level.

Argon↗

PubMedDate not supplied

Macular translocation: histopathologic findings in swine eyes.

PURPOSE: Macular translocation has been proposed as an alternative technique in the treatment of some cases of choroidal neovascularization. The purpose of the paper is to report the histopathologic findings in the retina of swine eyes undergone macular translocation. METHODS: Ten eyes of ten Yucatan pigs underwent posterior pars plana vitrectomy and scleral imbrication to achieve macular translocation. Mattress sutures were preplaced at the equator of the eyes. After a pars plana vitrectomy, balanced saline solution was injected under the temporal retina to produce a retinal detachment. Scleral imbrication was achieved by tightening the mattress sutures. An air-fluid exchange was performed and the eye was filled with sulfur hexafluoride 18%. The eyes were enucleated 2, 4, 8 and 12 weeks after surgery and analyzed under light and electron microscopy. RESULTS: Macular translocation was achieved in all cases. The major findings consist of a minimal decrease in the number of photoreceptors outer segments; also a change in the morphology was noted. This included some degree of loss of vertical alignment and an increase in the interphotoreceptor space. There was a recovery in the morphology of the photoreceptors over time. CONCLUSIONS: Minimal changes in the photoreceptors and retinal pigment epithelium are observed when macular translocation is performed with recovery of these changes over time. Scleral imbrication is an effective technique to achieve translocation of the fovea.

Animals↗

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Persistent hyperplastic primary vitreous in an adult: case report with fluorescein angiographic findings.

The clinical features and fluorescein angiographic findings of an 18-year-old man with PHPV are reported. The case is unusual in that the eye survived into adulthood. The lens resorbed spontaneously, thereby permitting study of the retrolental mass by fluorescein angiography. Fluorescein leakage from the persistent vessels was very slow but present, thus indicating a probable disruption of the endothelial tight junctions of the tunica vasculosa lentis.

Adolescent↗