Donor eye program.
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Biomedical subjects
Publications and source records attributed to R Y Foos.
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A 39-year-old woman had a large benign intracranial schwannoma of the Gasserian ganglion. Thirty-two years previously, she had an embryonal rhabdomyosarcoma of the orbit. She had been treated by enucleation, local excision, and low-dose supplemental irradiation (1,400 rads). This is the longest survival of which we are aware following any treatment modality in such tumors. No correlation between the two tumors has been established.
The incidence and morphologic features of coronal adenomas, benign epithelial tumors of the ciliary processes, were studied in 500 autopsy cases. Macroscopically, coronal adenomas are white, globular, often cystic in appearance, of limited growth potential, and found only on the ciliary processes. Microscopically, they contain convoluted sheets or tubes of nonpigmented epithelium, between which are found varying amounts of amorphous eosinophilic, PAS-positive, extracellular material. Coronal adenomas were present in 153 (31%) of 500 cases, were bilateral in 23 (15%), and were thus present in 176 (18%) of the 1,000 eyes examined. Two clinically important complications of coronal adenomas were found, sectoral cataracts and misdiagnosis as iris tumor.
A 59-year-old man developed painless visual loss in his left eye over a one-year period, with rapid progression to blindness over three months. Ocular examination of the left eye revealed proptosis, marked optic disk pallor, dilated retinal veins, and congeries of vessels at the disk margin (opticociliary veins). His right eye was unremarkable. Fluorescein angiography and histopathologic examination confirmed the presence of opticociliary veins communicating between branches of the central retinal vein and the adjacent choroidal vasculature. Primary orbital optic nerve meningioma associated with opticociliary veins was diagnosed.
Four patients had extensive unilateral myelinated nerve fibers associated with ipsilateral myopia, amblyopia, and strabismus. Their profound visual impairment, exotropia, and the early age onset of symptoms indicated that the amblyopia may have been organically caused. Prognosis is poor for even partial correction but good results have been obtained with intense therapy that includes full correction of the refractive error in each eye and extraocular muscle surgery if cosmetically necessary. In patients with axial myopia, images of a similar size will be produced by placing a lens of the correct power at the spectacle plane. In younger patients, a contact lens should not be used to correct the refractive error because it creates an undesirable anisometropia. Younger patients who have parafoveal fixation and no strabismus respond best to amblyopia therapy.
A case of metastatic tapioca melanoma of the iris in a 12-year-old girl is reported. The patient had heterochromia, a red painful eye, and was treated for iritis with secondary glaucoma. In the course of 5 months iris lesions with the clinical appearance of tapioca pudding developed, and biopsy disclosed a melanoma. The eye was immediately enucleated, and pathological examination showed a melanoma with predominantly epithelioid-type cells which had infiltrated the angle, the posterior chamber, and the surgical wounds. Conjunctival extension was noted 10 months after enucleation, and regional lymph node metastases were found 4 months later. Previously reported cases are reviewed and compared with the present case.
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Holes of the peripheral retina, defined as full-thickness breaks of trophic origin with no associated flap or free operculum, were found in 136 (2.4%) eyes from 2,800 autopsied subjects. Primary retinal holes (those with no indication of a proximal causative lesion and with no lattice degeneration in either eye) occurred in only eight of the 5,600 eyes studied; all were unilateral, single, less than 0.25 disk diameter in size, within the basal zone, and in eyes from elderly subjects. Secondary holes were found in 128 (2.3%) of eyes and of these, lattice degeneration was the most common cause (103). Other lesions complicated by hole formation included zonular traction tufts (10), chorioretinitis (9), meridional folds (3), and pavingstone degeneration (2). Retinal holes in surgically aphakic eyes did not differ qualitatively or quantitatively from those in age-matched phakic eyes.
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Previous studies have attributed changes in the retinal surface over or adjacent to large superficial retinal vessels to a variety of conditions, the most common being 'anomalous vitreoretinal attachments.' The fundamental nature of the lesions and their pathogenesis, however, has remained controversial. The present study was undertaken to categorize the ultrastructural alterations of the vitreoretinal juncture over retinal vessels in the posterior fundus of man, and to clarify the relationship of these fundamental changes to clinically significant lesions in this region. Results show no difference in vitreoretinal, or more specifically vitreolaminar attachments over vessels when compared with adjacent regions. The cause of the more significant anomalies, notably surface breaks and their sequelae, is apparently multifactorial and related to a sequence of events. Initially three events predispose to or cause small surface breaks: developmental thinning of the inner limiting lamina; subsurface retinal degeneration; and transmigrating macrophages. These small surface breaks, when complicated by vitreous incarceration or by simple epiretinal membrane formation, can during posterior vitreous detachment cause peeling of the retinal surface, and the resulting large surface breaks may in turn provoke more complex proliferative lesions of the vitreoretinal juncture.
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This report reviews current knowledge of the ultrastructural features of the vitreoretinal juncture in its normal state, in eyes with posterior vitreous detachment (PVD), and in eyes with epiretinal membranes (ERM's) and then presents new concepts concerning the interrelationship of ERM's and the vitreous. Results show no vitreous residues on retinal surface following uncomplicated rhegmatogenous (senescent) PVD. In eyes that develop ERM's before vitreous detachment, however, a layer of vitreous may be entrapped beneath the ERM and on adjacent membrane-free retina when PVD ocurs. ERM's may be a cause as well as an effect of PVD.
Four cases of incisional complications following pars plana vitrectomy are presented. In each instance, excessive fibrosis occurred at the wound site. In one patient, the disorder was mild and did not lead to clinical difficulties during his lifetime, however, in the three severe cases the eyes were lost secondary to intraocular organization and phthisis bulbi. Possible contributing factors include diabetes mellitus, excessive trauma and necrosis at the wound site, postoperative inflammation, and vitreous involvement in the wound. Since no treatment is known, atraumatic management of the incision using microsurgical techniques is strongly recommended.
Macroscopic and light microscopic features of regional ischemic infarcts of retina in autopsy eyes are described. Lesions were found throughout life span, most patients having significant primary or secondary vascular disease (younger had systemic hypertension, rheumatic heart disease, vasculitis or sickle hemoglobinopathy; most older patients had arteriosclerosis). Diabetes mellitus and infarction of other organs (including brain) also were common. Topographically almost all lesions were found in posterior fundus; most were temporal and involved anatomical macula. Microscopically there was destruction of inner retinal layers with preservation of outermost cells of inner nuclear layer; occasionally ganglion cell layer was relatively spared.
Healing of mechanically-induced, minimal wounds of vitreoretinal juncture in non-vascularized retina of rabbits was studied with electron microscopy at 1 and 3 days, and 1, 2, 6 and 10 weeks. Neuroectodermal scar was formed by two processes, each having a specific anatomical relationship to wound. Accessory gliocytosis, in which accessory glia adjacent to wound become phagocytic and proliferate; following this their progeny migrate to wound and progressively differentiate into fibrous astrocytes to fill in the wound proper. Plexiform gliosis, in which the Müller cell side branches proliferate to form a layer about the perimeter of wound. The retinal inner limiting lamina did not regenerate. The significance of these findings in relation to epiretinal membrane formation in man is discussed.
The ultrastructural features of vitreoretinal relations in the posterior fundus of enucleated eyes were studied. Vitreous detachment occurs at the anatomical vitreoretinal juncture, between the inner limiting lamina of the retina and the vitreous cortex, the surface of the lamina becoming smooth and without vitreous residues.
A pathologic analysis of 19 cases of acute retrolental fibroplasia in autopsy eyes from paranatal infants is presented. The clinical profile of these subjects showed no clear-cut maternal factors. Infant factors included systemic congenital anomalies (14 cases); ocular congenital anomalies (1); birth weight--less than 1500 grams (12), more than 2000 grams (4); neonatal complications--"respiratory distress" (8), "apneic spells" (7), Erythroblastosis fetalis (3); oxygen therapy of varying amounts (14); periodic elevations of arterial oxygen (7); and varying survival times (intrauterine death, one case; less then 48 extrauterine hours, 9 cases). Considering all cases, the lesions showed a progressive pattern--beginning with proliferation of primitive vascular mesenchyme in vanguard of advancing vasculature (four cases), formation of intraretinal band of endothelial cells in rear guard (10 cases), and finally, extraretinal neovascularization from rear guard zone (five cases).
For a rabbit model of hematogenous endophthalmitis caused by Candida, 80 New Zealand white rabbits were given intravenous injections of 10-5 Candida albicans. Two weeks after infection 88 percent of infected rabbits had ocular lesions with clinical appearance identical to that of human lesions. Cultures of the chorioretina and kidneys averaged 10-4.3 and 10-3.9 organisms per g of tissue, respectively, three days after infection and remained positive for 38 days. Ninety-five percent of rabbits with positive cultures of the chorioretina had positive cultures from other organs. The ocular lesions were focal chorioretinitis characterized by a combination of granulomatous and acute suppurative reactions. Hematogenous endophthalmitis caused by Candida in the rabbit is a useful model for study of the pathogenesis and treatment of the disease in humans.