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Biomedical subjects

R C Eagle

Publications and source records attributed to R C Eagle.

At least 91 records · Page 5Linked to original sources
PubMed1998

Periorbital cellular blue nevus leading to orbitopalpebral and intracranial melanoma.

OBJECTIVE: To report the rare occurrence of orbitopalpebral and intracranial melanoma in patients with periorbital cellular blue nevus. DESIGN: A case series. INTERVENTION: The clinicopathologic records of two patients with periorbital cellular blue nevus were reviewed. RESULTS: In case 1, a 32-year-old woman with congenital blue discoloration of her eyelids had gradual increase in nodularity of the eyelid tissue develop over the prior 20 years. The lesion enlarged to the point that the eyelids were almost completely closed from the massive tumor. Results from a biopsy disclosed orbitopalpebral melanoma arising from cellular blue nevus. Because of the diffuse infiltrative pattern of the lesion, she was treated by surgical debulking of the mass. She had a separate focus of ipsilateral intracranial melanoma develop at 40 years of age and eventually died of meningeal melanoma. In case 2, a 29-year-old man with blue discoloration of his left lower eyelid since 10 years of age had an anterior orbital mass develop. He underwent excisional biopsy, the results of which showed an orbitopalpebral melanoma arising from the periorbital cellular blue nevus. Orbital melanoma recurrence and ipsilateral lymph node metastasis were found 9 years later and treated with resection and chemotherapy. He was free of recurrence or metastasis 2 years later. CONCLUSIONS: Patients with periorbital cellular blue nevus may present in the preteen years with a bluish eyelid discoloration. They are at risk of having orbitopalpebral and intracranial malignant melanoma develop.

Adult↗
PubMed1998

Delayed-onset fungal keratitis after endophthalmitis.

PURPOSE: This study aimed to present two patients with delayed-onset, endogenous fungal keratitis after treatment for fungal endophthalmitis after cataract surgery. METHODS: The authors retrospectively reviewed the clinical course of two patients in whom deep stromal fungal keratitis developed 2 weeks and 3 months, respectively, after apparent successful aggressive therapy for fungal endophthalmitis. Before the onset of the keratitis, both patients underwent vitrectomies with intraocular injection of 7.5 to 10.0 mcg amphotericin B, as well as treatment with systemic fluconazole and topical antifungal therapy. In case 1, a pre-existing prosthetic intraocular lens and lens capsular bag were removed at the time of vitrectomy, whereas in case 2, the intraocular lens was left in place and a posterior capsulectomy was performed. RESULTS: The keratitis worsened in both patients, despite intensive systemic and topical antifungal therapy. Both patients underwent therapeutic penetrating keratoplasties. In case 1, this resulted in successful resolution of the infection and no recurrences 3 months after the transplant. The corneal transplant was complicated by an expulsive choroidal hemorrhage in the other patient. Fusarium solani was cultured from the initial vitrectomy specimen in patient 1, and although it was not cultured from the keratitis, septate hyphal elements were present on histopathologic examination. The causative organism in case 2 was Acremonium kiliense, which was cultured from both the original vitrectomy specimen and the deep corneal stromal infiltrate. CONCLUSIONS: Fungal organisms may not be eradicated completely from eyes with endophthalmitis despite aggressive therapy and apparent initial successful treatment. These patients need to be monitored for prolonged periods, and treatment should be reinitiated at the earliest sign of recrudescence of infection.

Acremonium↗
PubMed1998

Melanocytomalytic glaucoma in eyes with necrotic iris melanocytoma.

OBJECTIVE: Iris melanocytoma, although histologically benign, may undergo spontaneous necrosis with the resultant pigment dispersion causing secondary open-angle glaucoma. The authors describe the clinical findings in three patients with this syndrome and review the current literature. DESIGN: The study design was a small case series. PARTICIPANTS: Three patients with secondary glaucoma caused by a necrotic iris melanocytoma participated. INTERVENTION: Clinical records and pathologic preparations were reviewed. The diagnosis of iris melanocytoma was confirmed by histopathologic examination in all three cases. RESULTS: All patients had intrinsically pigmented localized iris tumors and pigmentation of the angle. Hyperchromic heterochromia iridum was noticeable in all patients. In two instances, a central crater in the lesion signified tumor necrosis. Two patients were treated successfully by surgical resection of the iris tumor and the glaucoma resolved. One patient was treated with enucleation. In all patients, histopathologic analysis disclosed extensively necrotic tumor comprised of maximally pigmented nevus cells with bland nuclei and infiltration of the trabecular meshwork by melanophages. CONCLUSION: Secondary glaucoma may result from obstruction of the trabecular meshwork with necrotic iris melanocytoma. Resection of the tumor may relieve the glaucoma.

Adult↗
PubMed1998

Cutaneous melanoma metastatic to the vitreous cavity.

OBJECTIVE: The authors report their experience with cutaneous melanoma metastatic to the vitreous and elaborate on the features of this entity. DESIGN: The study design was a retrospective review. PARTICIPANTS: Three patients with four affected eyes from cutaneous melanoma metastatic to the vitreous participated. INTERVENTION: All three patients were white men, and their mean age was 58 years. The previously excised cutaneous melanomas were all Clark level IV. The mean interval from diagnosis of the primary cutaneous melanoma to vitreous metastasis was 25 months. Ocular findings included clumps of cells arranged in sheets or linear strands on the vitreous framework. The vitreous cells were nonpigmented in two cases and pigmented in one case. Neovascular glaucoma was found in all three cases. After the diagnosis of vitreous melanoma was made by cytopathologic examination, external beam irradiation (5000 cGy) was given in all patients. MAIN OUTCOME MEASURES: Local tumor control and survival were measured. RESULTS: At a mean follow-up of 14 months from diagnosis of vitreous melanoma, tumor control was achieved in only one of the four affected eyes. One eye was enucleated because of painful neovascular glaucoma, and the other two eyes had progressive vitreous disease. After a mean follow-up of 14 months (from ocular diagnosis), all three patients had died. CONCLUSION: Cutaneous melanoma metastatic to the vitreous can present with nonpigmented or pigmented cells. Neovascular glaucoma frequently is found. External beam radiation therapy often is unsuccessful in local tumor control, and systemic prognosis is poor.

Adult↗
PubMed1998

Cavitary melanoma of the ciliary body. A study of eight cases.

PURPOSE: The authors present the unique clinical features of cavitary uveal melanoma. DESIGN: Retrospective chart review. PARTICIPANTS: Eight patients with cavitary uveal melanoma. MAIN OUTCOME MEASURES: The clinical, ultrasonographic, and histopathologic features of eight patients with cavitary melanoma of the ciliary body were studied. RESULTS: In all eyes there was a brown ciliary body mass that blocked transmission of light on trans-scleral transillumination. Ocular ultrasonography revealed a large, single hollow cavity (unilocular "pseudocyst") in five cases and multiple hollow cavities (multilocular "pseudocyst") in three cases. The cavity occupied a mean of 55% of the entire mass thickness (range, 31%-79%). In five cases, a basal uveal mass was noted on ultrasonography. Four patients underwent tumor resection; one had enucleation, and three had 125I radioactive plaque treatment. In the five cases confirmed histopathologically, the cavitation was empty, contained erythrocytes, serous fluid, and/or pigment-laden macrophages. In no case was the cavity lined by necrotic tumor, endothelial cells, or epithelial cells. CONCLUSION: Ciliary body melanoma can develop an intralesional cavity resembling an intraocular cyst. The presence of a solid mass at the base and a thick wall surrounding the cavity can assist in the differentiation of cavitary melanoma from benign cyst.

Adolescent↗
PubMed1998

Gore-Tex as an orbital implant material.

The use of Gore-Tex (W. L. Gore & Associates, Flagstaff, AZ, U.S.A.) spheres as orbital implants is investigated. The left eyes of six New Zealand white rabbits were enucleated and spherical implants made of modified Gore-Tex were implanted. After 6 weeks of follow-up, the implants were harvested. No rabbit developed a postoperative infection and no cases of exposure or extrusion were noted. Histopathologic study revealed varying degrees of acute and chronic inflammation surrounding each implant. There was also evidence of inflammatory infiltration and fibrovascular ingrowth into each implant to a maximum distance of 500 microns. This preliminary study demonstrates that the Gore-Tex implant is well tolerated in vivo, allows cellular ingrowth, and may have a role as a permanent implant.

Animals↗
PubMed1998

Management of primary corneal graft failure.

PURPOSE: We report two patients with primary graft failure (PGF) from a mutual donor. The surgery in each case was done by a different surgeon experienced in penetrating keratoplasty (PK). The cases were managed differently in the postoperative period with good visual results in both cases. We discuss the various management options available when confronted with apparent PGF in the early postoperative period. METHODS: Both patients had excessive graft edema and haze in the immediate postoperative period. Case 1 received a repeat graft after 4 weeks because there was no improvement in graft clarity despite intensive topical steroids. In case 2, repeat surgery was deferred with ultimate gradual improvement in the clarity of the graft over a period of 6 months. RESULTS: Both patients obtained clear grafts with a visual acuity of 20/30 at 15 months after surgery. CONCLUSION: Primary graft failure is a rare complication of PK. Repeat PK is the most definitive therapeutic alternative, although some grafts may clear without any additional surgery. We suggest all cases of PGF be observed for > or = 3-4 weeks for signs of graft clearing before proceeding with a repeated PK.

Cornea↗
PubMed1998

Ultrasound biomicroscopy and histopathology of sclerocornea.

PURPOSE: We present a clinicopathologic case report of sclerocornea with the intent of showing the usefulness of ultrasound biomicroscopy (UBM) and the correlation of histopathologic findings. METHODS: An infant with congenital bilateral sclerocornea was seen for an evaluation under anesthesia. Dense opacification of both corneas prevented adequate examination of both anterior and posterior segments of the eye. UBM was performed preoperatively with subsequent corneal transplantation of the left eye. The corneal button was submitted for histopathologic examination. RESULTS: Preoperative UBM proved helpful in assessing the status of the cornea as well as the anterior chamber and its structures. Findings on histopathologic examination correlated well with the results on UBM and confirmed the diagnosis of sclerocornea. CONCLUSION: We recommend the use of UBM in assessing opacified corneas to assist in obtaining a diagnosis, to highlight potential associated structural anomalies, and to help guide decisions regarding surgical management.

Cornea↗
PubMed1998

Diffuse ocular metastases as an initial sign of metastatic lung cancer.

A 68-year-old man with lung carcinoma and no systemic metastasis presented with a blind, painful right eye. Examination showed no perception of light in the affected eye, elevated intraocular pressure, marked epibulbar hyperemia, and a white placoid mass in the conjunctiva nasally. Although a cataract precluded a clear view of the fundus, ultrasonography disclosed a total retinal detachment and a diffuse thickening of the choroid. Metastatic carcinoma was suspected clinically and the eye was enucleated because of severe, intractable pain. Pathologic examination demonstrated extensively necrotic metastatic adenocarcinoma involving the conjunctiva, peripheral cornea, sclera, iris, ciliary body, choroid, optic nerve, subarachnoid space, and orbit. Metastatic disease usually affects a singular ocular tissue, and it is highly unusual for such widespread ocular involvement to be the first sign of systemic metastasis from a primary neoplasm.

Adenocarcinoma↗
PubMed1997

Bilateral Candida parapsilosis endophthalmitis.

We describe a patient with bilateral, delayed endophthalmitis who underwent bilateral pars plana vitrectomy, total capsulectomy, intraocular lens exchange, intravitreal injection of amphotericin B, and oral fluconazole therapy. The long-term inflammation resolved, and vitreous cultures from both eyes yielded Candida parapsilosis. Histopathologic examination revealed sequestered yeast forms in the capsular bags.

Aged↗
PubMed1997

Histopathologic study of eyes after iodine I 125 episcleral plaque irradiation for uveal melanoma.

OBJECTIVES: To describe the histopathologic findings attributable to irradiation in eyes with uveal malignant melanoma treated with iodine I 125 brachytherapy and to compare these findings with those reviewed in a previous study that compared histopathologic findings in eyes enucleated after proton beam teletherapy with those seen in eyes in a nonirradiated control group. METHODS: The slides from 22 eyes with uveal melanoma that had undergone enucleation after the administration of 125I brachytherapy were studied. The histopathologic features of the tumor and the retina were graded. Results were compared with findings from a previously reported group of 47 proton beam-treated eyes and its control group. RESULTS: Patient age, time between irradiation and enucleation, and ciliary body involvement were similar for the 125I brachytherapy-treated group and the proton beam-treated group and its control group. This allows comparison of the histopathologic findings. Comparing the 125I brachytherapy- and proton beam-treated groups, most histopathologic features were similar with nominally statistically significant differences only for cell type, number of mitotic figures, and fibrous metaplasia of the retinal pigment epithelium adjacent to the tumor. CONCLUSIONS: Irradiation of uveal melanoma induces changes in the tumor and in the surrounding retina. Brachytherapy and charged particle therapy are the 2 principal methods of irradiation. This study demonstrates that similar changes are produced by 125I plaque irradiation and proton beam irradiation.

Adult↗
PubMed1997

Melanogenic neuroectodermal tumor of the retina (primary malignant melanoma of the retina).

A 35-month-old girl with leukocoria was clinically diagnosed with unilateral sporadic retinoblastoma. Macroscopic examination of her enucleated eye disclosed a white retinal tumor that appeared to be a retinoblastoma. Histopathologic examination, however, revealed that the tumor was composed of poorly differentiated neuroblastic cells, larger spindle-shaped cells, and anaplastic epithelioid cells, which is inconsistent with retinoblastoma. Immunohistochemical testing disclosed that the tumor cells were immunoreactive for melanoma-specific antigen HMB-45, while electron microscopy showed premelanosomes in the tumor cells, both of which are consistent with melanogenesis. To our knowledge, such an ocular tumor has not been reported previously.

Antigens, Neoplasm↗
PubMed1997

Adenoid cystic carcinoma developing in the nasal orbit.

PURPOSE: To describe the clinical, imaging, and histopathologic findings of an adenoid cystic carcinoma that occurred in the medial orbit. METHODS: A 26-year-old man developed a painless soft tissue mass in the nasal aspect of the left orbit. Computed tomography was done, and incisional biopsy performed elsewhere disclosed adenoid cystic carcinoma. Orbital exenteration was performed. RESULTS: Computed tomography showed a 1.5cm mass in the antronasal region of the orbit without bone erosion. Histopathology disclosed adenoid cystic carcinoma. CONCLUSIONS: Although orbital adenoid cystic carcinoma usually originates superotemporally in the main lacrimal gland, it can develop in the nasal orbit, possibly from ectopic lacrimal gland tissue. Adenoid cystic carcinoma should be included in the differential diagnosis of tumors of the nasal orbit.

Adult↗
PubMed1997

Conjunctival metastasis as the initial manifestation of lung cancer.

PURPOSE: To report a case of conjunctival metastasis as the initial manifestation of lung cancer. METHOD: A 55-year-old man without known systemic disease developed a conjunctival mass in his right eye. He underwent excision of the tumor and systemic evaluation. RESULTS: Histopathologically, the mass was a metastatic squamous cell carcinoma. Further evaluation disclosed a primary bronchogenic carcinoma with metastasis to ribs and brain. The primary and secondary tumors were treated with chemotherapy and irradiation. CONCLUSIONS: Conjunctival metastasis may be the initial manifestation of lung cancer. It should be considered in the differential diagnosis of a deep conjunctival mass.

Brain Neoplasms↗