A newly described complication of neodymium-YAG laser capsulotomy: exacerbation of an intraocular infection. Case report.
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Aged↗
Biomedical subjects
M C Kincaid
Publications and source records attributed to M C Kincaid.
Breast carcinoma metastatic to the eyelids.
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Adenocarcinoma↗
Bilateral retrobulbar optic nerve infarctions after blood loss and hypotension. A clinicopathologic case study.
A 59-year-old woman with anemia became totally blind after repeated gastrointestinal bleeding and acute hypotension. Neuropathologic examination was normal apart from bilateral infarctions centered on the orbital portion of the optic nerves. This is the only "pure" histopathologic study of visual loss after hemorrhage and hypotension in the recent literature, the single previous case being complicated by arteriosclerosis and vasculitis. The authors suggest that visual loss after hypotension is of three types. Profound hypotension in patients with neither anemia nor arteriosclerosis generally causes water-shed infarctions in the parietal and occipital lobes. Brief hypotension combined with arteriosclerosis favors juxtalaminar optic nerve infarction indistinguishable from spontaneous anterior ischemic optic neuropathy. In anemic patients without arteriosclerotic risk factors, hypotension is likely to cause infarction in the orbital optic nerve, where pial end vessels are subject to compression from hypoxic edema.
Blindness↗
Chronic hematic cyst of the orbit.
A chronic hematic cyst of the orbit caused unilateral globe displacement in four patients, two of whom had a past history of orbital trauma. The onset of a painless vertical displacement of the globe ranged from 3 weeks to 4 years. Computed tomographic (CT) findings demonstrated a homogeneous, nonenhancing, subperiosteal mass in the superior orbit in three patients and the inferior orbit in one. At surgery, all patients had masses surrounded by a pseudocapsule without epithelial or endothelial lining. The history, age distribution, and CT findings help to differentiate this entity from other causes of unilateral exophthalmos.
Adolescent↗
Localized endophthalmitis: a newly described cause of the so-called toxic lens syndrome.
We report five cases of post-extracapsular cataract extraction infection in which subsequent pathologic analyses identified the organisms and found the infection to be localized or confined to the lens capsular sac. The most common offending organisms were gram-positive pleomorphic bacilli. In one case, we were able to identify the bacteria as Propionibacterium acnes. We designate this condition a localized endophthalmitis. It should be considered any time a persistent, smoldering, postoperative inflammation occurs, and in the differential diagnosis of phacoanaphylactic endophthalmitis. The condition itself is not new, but undoubtedly many such cases have gone unrecognized or have been misdiagnosed as the so-called toxic lens syndrome. In localized endophthalmitis, a clinically visible inflammatory process may occur even when multiple diagnostic taps are negative, although when the cases first appeared, the surgeons were not aware of the entity and anaerobic cultures were not always obtained. A negative tap may be explained by the fact that metabolic products from the organisms are released from the bag into the anterior segment and vitreous. A synergistic reaction may occur between these organisms and retained lens cortical remnants that may cause or exacerbate a hypersensitivity reaction. The condition may be worsened by Nd:YAG capsulotomy. The pathogenesis of localized endophthalmitis has nothing to do with the type of intraocular lens fixation (lens capsular sac or ciliary sulcus); rather, the simple presence of a capsular sac after extracapsular cataract extraction is the prerequisite for the clinical condition.
Aged↗
Antibiotic resistance of crystalline bacterial ingrowth in a corneal graft.
Four recent reports have described the clinical appearance of fine needle-like opacities in the corneal stroma of six patients. In five of these patients these developed in a corneal graft. Histologically, all the corneal buttons had bacterial ingrowth between the stromal lamellae, with a striking lack of inflammatory response. We report a patient in whom this process occurred following penetrating keratoplasty. Intensive topical antibiotic treatment failed, and she underwent a second, successful, penetrating keratoplasty. Postoperatively, this patient has maintained good vision with no recurrence for over three years. Histologic and ultrastructural study of the corneal button revealed viable and nonviable gram-positive cocci with a marked paucity of inflammatory infiltrate.
Aged↗
Congenital orbital teratomas.
Teratomas of the orbit, rare congenital tumors consisting of normal tissues derived from all three germ cell layers, are probably choristomas rather than true neoplasms, and must be considered in the differential diagnosis of neonatal orbital masses. They typically grow rapidly after birth, causing destructive proptosis and exposure keratopathy; however, they may take a slowly progressive course, expanding slightly over several years. We studied two cases of histopathologically proven orbital teratomas. In one patient, a 2-month-old girl, the tumor was solid and enlarged rapidly after birth. In the other patient, a 15-year-old girl, the mass was cystic and grew at a very slow rate. In the latter case, vision was preserved, presumably because of the ease with which the tumor could be bluntly dissected from the ocular tissue. We believe that, when possible, early and complete extirpation is the procedure of choice, to ensure the greatest likelihood of visual preservation and symmetric orbital growth.
Adolescent↗
Retinal toxicity of intravitreal cefoperazone.
Cefoperazone is a broad spectrum, third-generation cephalosporin with potential usefulness in treating endophthalmitis because of its in vitro activity against Gram-negative organisms. Retinal toxicity was evaluated via serial indirect ophthalmoscopy, electrophysiologic testing and histopathologic examination of 43 Dutch-belted rabbit eyes injected intravitreally with 2, 4, 8, 16 or 32 mg of cefoperazone in a volume of 0.1 cc each. They were compared with seven eyes injected with sterile saline. Results show electroretinographic and histological evidence of retinal toxicity at concentrations of 16 mg or greater, while a single intravitreal dose of 8 mg or less of cefoperazone produced no evidence of retinal toxicity.
Animals↗
Angiographically normal central retinal artery following the total resection of an optic nerve glioma.
Although the central retinal artery and its collateral circulation, especially within the anterior optic nerve, have been extensively studied, there continues to be controversy regarding the existence and significance of anastomoses between the central retinal artery and ciliary circulation. We present the case of a 16-year-old boy who underwent total resection of an optic nerve glioma beginning proximally at the chiasm and ending distally flush with the globe. After resection, heavy bipolar cautery was applied. Postoperatively, normal central retinal artery circulation was documented angiographically, suggesting that, at least in some cases, significant anastomoses can develop between the central retinal artery and ciliary circulation in the laminar and prelaminar areas.
Adolescent↗
Proptosis with mastication: an unusual presentation of an orbital dermoid cyst.
A 25-year-old woman presented in 1973 with the complaint of proptosis of the left eye with mastication. A firm retrobulbar orbital mass was detected, and diagnosis of possible dermoid cyst was made. She was subsequently lost to follow-up. Computed tomographic (CT) scanning and surgical excision done in 1984 confirmed the presence of an orbital dermoid cyst communicating with the temporal fossa through a bony defect in the lateral orbital wall. We suspect that pressure by the temporalis muscle on the dumbbell-shaped cyst caused the proptosis with mastication.
Adult↗
Histopathologic correlative study of Kelman-style flexible anterior chamber intraocular lenses.
Three of 16 eyes in which Kelman flexible anterior chamber lenses were implanted were obtained for postmortem examination, and the lenses and globes were analyzed histopathologically. Thirteen additional lenses, removed surgically secondary to various complications, were studied by scanning electron microscopy. All of the lenses ere well finished and none showed evidence of degradation or cracking of the polymethylmethacrylate optics or foot plates. Some of the lenses showed deposition of inflammatory debris or erythrocytes, reflecting a clinical history of uveitis. In some cases, the problems seemed to be related to variations in surgical technique or improper sizing.
Aged↗
Diagnostic methods in orbital diseases.
Development of diagnostic methods for orbital diseases have practically revolutionized the approach to the patient with orbital disease. These newer methods have helped the clinician to improve the accuracy of the clinical diagnosis prior to biopsy, to localize the area to be biopsied, and to prevent inappropriate surgery. These techniques have also allowed the pathologist to render more definitive diagnosis. These methods include ultrasound, computerized axial tomography, nuclear magnetic resonance imaging, fine-needle aspiration biopsy, histochemistry, immunohistochemistry and electron microscopy. The techniques are complementary, and use of each depends on the clinical situation. Some techniques require collaboration between the surgeon and pathologist to assure proper fixation and preparation of tissues.
Biopsy, Needle↗
Phthirus pubis infestation of the lashes.
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Child↗
Ocular copper deposition associated with pulmonary carcinoma, IgG monoclonal gammopathy and hypercupremia. A clinicopathologic correlation.
Hypercupremia with central deposition of copper in Descemet's membrane and lens capsule has been reported previously in lymphoproliferative disorders in two cases. A 60-year-old white man presented with visual acuity loss and was found to have an iridescent brown corneal and lenticular discoloration. Laboratory investigation revealed hypercupremia secondary to a poorly differentiated adenocarcinoma of the lung. Presence of copper in the eye was confirmed by specific atomic absorption spectra and histochemical stains of ocular tissue. This appears to be the first report of a carcinoma with associated hypercupremia presenting initially with ocular copper deposition.
Adenocarcinoma↗
An ocular clinicopathologic correlative study of six patients from the Diabetic Retinopathy Study.
The authors studied the eyes postmortem from six patients who were enrolled in the multicenter Diabetic Retinopathy Study and treated by photocoagulation. All were patients of the Wilmer Institute, The Johns Hopkins Hospital. Of these six patients, four had equal or better vision in the treated eye at their last visit. Two patients had worse vision, due primarily to cystoid macular edema. All but one patient had clinically significant field loss in the treated eye, and this correlated with the retinal damage induced by photocoagulation. This treatment produced local retinal and choroidal effects and did not alter the histopathologic appearance of the anterior segment of the eye.
Adult↗
Fibrous histiocytoma of the lacrimal sac.
Fibrous histiocytoma is a rare tumor whose ocular manifestations usually involve the orbit or, less commonly, the conjunctiva and ciliary body. We have treated two patients with fibrous histiocytoma of the lacrimal sac. One, a 62-year-old woman who had had hordeolum and trachoma, had a visual acuity of counting fingers at 1 m in the affected eye. The fellow eye had been enucleated ten years previously. The entire lacrimal sac was surgically removed and a brown cystic tumor measuring 28 x 12 x 10 mm was found. The second patient, a 32-year-old man, had undergone an unsuccessful dacryocystectomy for epiphora. When he underwent a dacryocystorhinostomy some months later, a mass measuring 20 x 15 x 12 mm was found in the wall of the lacrimal sac. Microscopic examination of the two excised lacrimal sacs showed that the walls were thickened by cells resembling fibroblasts and by cells resembling histiocytes. The fibroblasts were characterized by collagen production, were fusiform or oval in shape, and were arranged in bundles. The histiocytes were larger and had abundant (and sometimes vacuolated) cytoplasm. All the cells appeared to be mature.
Adult↗
An unusual case of ocular involvement in primary systemic nonfamilial amyloidosis.
A case of primary amyloidosis with vitreous involvement was diagnosed by study of a specimen obtained by pars plana vitrectomy. Vitreous opacities had been interpreted clinically as a vitreous hemorrhage. Medical evaluation after study of the vitreous specimen failed to demonstrate evidence of amyloidosis, although postmortem examination 19 months later established the systemic diagnosis of nonfamilial systemic primary amyloidosis. Both eyes were obtained postmortem. Amyloid involvement of the vitreous, retina, and choroid was found. There was also amyloid deposition in the trabecular meshwork, although the intraocular pressure was normal. Amyloid was deposited along the anterior, pupillary, and posterior surfaces of the iris. The histochemistry, ultrastructure, and treatment of this condition are discussed.
Amyloid↗