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Objectives: To study the prevalence and associations of asteroid hyalosis (AH) in a series of autopsy eyes., Methods: Retrospective review of the University of California at Los Angeles (UCLA) autopsy eye database from 1965 to 2000 yielded 10,801 patients. The patients' medical histories were reviewed for evidence of diabetes mellitus, hypertension, hyperlipidemia, alcohol abuse, hypercalcemia, hypothyroidism, and chronic renal failure. Autopsy records were searched for evidence of optic atrophy, macular degeneration, posterior vitreous detachment, atherosclerosis, and chronic renal failure. Asteroid hyalosis was diagnosed by examination of the autopsy eyes. Univariate and multivariate statistical methods were used to analyze our data., Results: The prevalence of AH was 1.96% in this autopsy population. By chi(2) analysis, AH was significantly correlated with age (P<.001), male sex (P = .006), age-related macular degeneration (P = .02), hypertension (P = .03), atherosclerosis (P<.001), and posterior vitreous attachment (P<.001). After adjusting for age in a multivariate logistic regression analysis, statistical significance was found only for posterior vitreous attachment (P = .002) and male sex (P = .046). No statistically significant association was found with diabetes mellitus or alcohol abuse by univariate or multivariate analysis. Analysis of the odds ratio showed a strong age effect that increased from 5.0 (95% confidence interval, 2.2-11.3) in age group 41 to 50 years, compared with 25.4 (95% Wald confidence interval, 8.2-77.9) in the age group of patients older than 90 years., Conclusions: A unique epidemiological autopsy cohort study of AH and its systemic associations yielded a higher prevalence of AH than previous studies. Asteroid hyalosis was strongly correlated with age and inversely correlated with posterior vitreous detachment. Unlike some previous reports, we found no statistically significant correlation between AH and diabetes mellitus.

The pathology of pars plana incisions of four patients is described: three with light microscopy and one with light and electron microscopy. Two eyes were removed because of choroidal melanoma, immediately and 8 days after vitrectomy and transvitreous retinal biopsy. Considerable disruption of tissues surrounding the pars plana incisions was observed. Vitreous was incarcerated in the wounds, which healed with granulation tissue. One eye was examined 4 months after vitrectomy for diabetic retinopathy and a failed pars plana filtering operation. It contained fibrovascular ingrowth from all the incisions, infiltrating the vitreous base with granulation tissue and causing vitreous haemorrhage and retinal detachment. One eye was removed 1 year after vitrectomy for anterior hyaloidal fibrovascular proliferation and early phthisis. The wound had fibrous ingrowth histologically and evidence of active fibroplasia.

This study describes the involvement of anterior chamber (AC) angle structures in patients with disseminated histoplasmosis. The postmortem eyes from three patients (aged 33, 41, and 42 years, respectively) with disseminated histoplasmosis, two of whom had acquired immunodeficiency syndrome, were examined by light microscopy using hematoxylin-eosin, periodic acid-Schiff (PAS), and Gomori's methenamide silver (GMS) stains. Electron microscopy studies of the choroid were performed in one eye. Significant numbers of budding yeast forms of Histoplasma capsulatum measuring 2-5 microns in diameter were observed within the trabecular meshwork, Schlemm's canal and in the deep intrascleral plexuses. All eyes showed massive involvement of the choroidal vasculature, including the choriocapillaris. The organisms were observed freely as well as in small clusters within the cytoplasm of circulating monocytes. The vessels of the limbal conjunctiva (two eyes) and ciliary body (three eyes) contained many Histoplasma organisms. In one eye, several budding yeast were noted in an iris vessel and in occasional histiocytes within the ciliary muscle. Blood smears containing Histoplasma organisms were observed in two cases. None of the patients had an ophthalmologic examination prior to death. Involvement of the intravascular structures of the eye as well as the AC angle was observed in three patients with disseminated histoplasmosis. The fungus most likely reached the AC angle structures by direct hematogenous dissemination or via the aqueous humor by migration from vessels in the ciliary body and iris. An abnormal retrograde blood flow into the AC angle structures may have also played an important role. We suggested that the intraocular pressure be monitored in cases of suspected disseminated histoplasmosis to detect functional alterations indicative of a blockage in the outflow channels.

Purpose: We evaluated the sensitivity of the polymerase chain reaction as a technique to directly screen potential donor corneas for human immunodeficiency virus type 1 (HIV-1) proviral DNA., Methods: DNA from the central 8.0-mm cornea, limbal cornea, aqueous humor, and retina from 22 eyes of 11 cadavers seropositive for HIV was extracted and amplified by polymerase chain reaction using primers specific for the gag and env regions of the HIV-1 genome. The identity of amplification products was confirmed by Southern blot hybridization., Results: Viral DNA was detected in four (18.2%) of 22 central corneas, one (4.5%) of 22 limbal corneas, one (6.3%) of 16 aqueous humor samples, and seven (31.8%) of 22 retinas. No correlation was noted between the presence of HIV-1 proviral DNA in samples from the central cornea and from the other tissues tested from the same eye., Conclusions: Within the limits of our assay, processing and analysis of limbal cornea, aqueous humor, and retina by polymerase chain reaction may not reliably ascertain the presence of HIV-1 in the central, transplantable cornea.

Background: Coccidioidomycosis has reached epidemic proportions in the southwest region of the United States. Despite the greater numbers of cases, isolated anterior segment ocular coccidioidomycosis in the absence of systemic infection continues to be rare, although its incidence may be increasing., Methods: Two patients without clinical evidence of systemic disease and one patient with previously treated pulmonary coccidioidomycosis had granulomatous iridocyclitis and iris nodules that were unresponsive to corticosteroid therapy. All three patients underwent iris biopsy, anterior chamber tap, and washout for histopathologic diagnosis of anterior segment disease, and all subsequently received systemic antifungal therapy. Two patients also received multiple intraocular injections of amphotericin B., Results: Papanicolaou and hematoxylin-eosin-stained preparations of anterior chamber tap and biopsies of the iris in each of these patients showed fibrinopurulent or granulomatous inflammatory exudate with intact and disrupted Coccidioides spherules. Despite aggressive systemic and intraocular therapy, one patient required enucleation for a blind, painful eye. The other two patients continue to have limited visual acuity but with at least partial resolution of the intraocular lesions., Conclusions: Ocular coccidioidomycosis without clinical evidence of systemic involvement is rare. Isolated anterior segment disease is also uncommon; however, because of the current epidemic in the southwest region of the United States, ocular coccidioidomycosis should be considered in any patient who traveled through or lived in endemic areas and who has a granulomatous iridocyclitis associated with iris mass that is unresponsive to corticosteroid therapy.

We measured vertical and horizontal diameters of the optic disk and retrobulbar optic nerve in eyes from 95 patients on whom autopsies were performed at the UCLA Medical Center over a 20-year period. Ages at death ranged from 4.8 months' gestation to 21.9 years. Optic disk surface area and nerve cross-sectional area were calculated for each subject by using the formula for an ellipse. Approximately 50% of the growth of the optic disk and nerve occurs by 20 weeks' gestation, and 75% by birth; 95% of the growth occurs before the age of 1 year. All optic disk and nerve measurements correlate strongly (correlations > .67; P < .0001) with subject height and globe anteroposterior diameter. We applied our results to the current understanding of optic disk and nerve development, and compared them to previous clinical and pathologic studies of optic nerve dimensions in adults and older children.

Background: Vogt-Koyanagi-Harada (VKH) syndrome is a form of chronic panuveitis that often has a poor long-term visual outcome. To the authors' knowledge, there have been only two previous reports describing immunocytologic findings in the eyes of patients with VKH syndrome, all studied in relatively late stages of the disease., Methods: The authors performed immunocytologic studies on the enucleated eyes of a patient with active VKH syndrome, using monoclonal antibodies to mononuclear subsets, major histocompatibility antigens, and viral and treponemal agents, to better understand the pathophysiologic mechanisms underlying the disease. Emulsified chorioretinal tissue also was processed for viral isolation in tissue culture and for Treponema pallidum by rabbit inoculation studies., Results: The dense uveal infiltrates in active VKH syndrome are composed predominantly of T lymphocytes and HLA-DR+ macrophages. Scattered T cells and plasma cells were present in the retina. In addition, nondendritic-appearing CD1 (Leu-6) positive cells were localized in the choroid, in close proximity to choroidal melanocytes. No microbial agents were identified., Conclusion: Whereas the etiology of the VKH syndrome remains an enigma, the authors' immunocytologic findings are consistent with a T-cell-mediated disorder. In demonstrating CD1 (Leu-6) positive cells in the infiltrates, the authors propose a potential role for these cells in the etiology of VKH syndrome.

Mycobacterium fortuitum keratitis is an indolent infection of traumatized corneas in humans. To study this disorder in an animal model, 10(4) M fortuitum organisms (10 microliters) were inoculated into the stroma of both corneas of 16 New Zealand albino rabbits. Eight of the rabbits were also given bilateral subconjunctival injections of methylprednisolone acetate (20 mg in 0.5 ml) at the time of inoculation. Two corticosteroid-treated and two untreated rabbits were selected each week after inoculation for histopathological examination and quantitative cultures. Corneal lesions in corticosteroid-treated eyes were characterized clinically by indolent ulcerations and satellite lesions that slowly enlarged; on histopathologic examination at each week, acute inflammation and microorganisms were consistently present. Corneal lesions in untreated eyes were characterized clinically by small infiltrates that progressed little over time; at weeks 1 and 2, light microscopic examination showed intrastromal granulomatous and/or mixed acute and chronic inflammation with focal intrastromal necrosis, but at weeks 3 and 4 there was no evidence of active disease. Organisms could not be identified microscopically in corneas of any untreated rabbits. Mean values for quantitative cultures of corneas were higher in corticosteroid-treated rabbits after week 1, although standard deviations were large. These results suggest that M fortuitum keratitis in rabbits is made worse by corticosteroid use. Clinical and histopathologic changes were compared with human disease and found to be similar in corticosteroid-treated rabbits.

Recently, the pars plana route of injection has been used to administer drugs for the treatment of severe intraocular infections. We observed a complication of this method in a patient with AIDS and cytomegalovirus (CMV) retinopathy.

To further characterize the nature of retinal periphlebitis and retinitis in multiple sclerosis, immunoperoxidase studies were performed on retinal tissue from multiple sclerosis patients at autopsy. Antibodies against myelin basic protein stained the optic nerve but not the retina. Both normal and multiple sclerosis retinas showed staining of Müller cells with Leu-7 (a monoclonal antibody that cross-reacts with myelin associated glycoprotein and natural killer cells). Nerve fiber bundles of the optic nerve in cases with multiple sclerosis and controls also showed staining with Leu-7 antibody. Tissue-bound IgG was demonstrated on retinal ganglion cells in six of seven multiple sclerosis cases but not in controls.

We studied by electron microscopy three coronal adenomas discovered incidentally in eyes removed surgically. Tumor cells displayed prominent intercellular interdigitations with numerous desmosomes, mitochondria, abundant rough endoplasmic reticulum, and nuclei with membrane infoldings and a granular chromatin pattern. In these characteristics, the tumor cells were identical to nonpigmented ciliary epithelium of the ciliary processes. These growths contained abundant extracellular material, which showed a dimorphic pattern of complex reduplicated basal lamina and granular areas without structure. Immunohistochemical studies on formalin-fixed, paraffin-embedded coronal adenomas demonstrated type IV collagen and laminin in the extracellular material. These findings confirm that coronal adenomas develop from nonpigmented ciliary epithelium and that the extracellular material of these tumors contains components normally present in basement membranes.

A light microscopic study was done to investigate retinal changes in healthy and immunosuppressed mice after intraocular inoculation of murine cytomegalovirus (MCMV). A 0.01-ml inoculum containing 10(5) plaque-forming units of MCMV was placed behind the lens in 138 4-week-old Swiss Webster mice. Ninety-eight mice were immunosuppressed with 0.2 mg/g of cyclophosphamide given intraperitoneally at the time of inoculation and 0.1 mg/g of cyclophosphamide every 5 days thereafter. Selected eyes were examined on postinoculation days 5, 10, 15, and 16-20. Evidence of viral infection was most prominent in uveal tissue. Uveal infection developed whether or not animals received cyclophosphamide, but retinal necrosis developed only in immunosuppressed mice. Focal retinal necrosis, primarily involving the outer retinal layers and retinal pigment epithelium, was first observed in an eye examined on day 10. Retinopathy from MCMV was present in three of five eyes (60%) examined on day 15, and in six of 16 eyes (37.5%) examined between days 16-20. Retinal disease was characterized by full-thickness retinal necrosis, scattered cytomegalic cells, intranuclear and intracytoplasmic viral inclusions, and acute and chronic inflammation. These results indicate that MCMV can produce a necrotizing retinopathy in mice and that immunosuppression facilitates infection. Although ocular MCMV infection in immunosuppressed adult mice is a potential model for study of human CMV retinopathy, many differences exist between human CMV and MCMV and between the ocular diseases they produce.

Conjunctival pigmented lesions, including ten compound nevi, three subepithelial nevi, two acquired melanoses, and six melanomas, were examined histologically and immunohistochemically to determine the specificity of mouse monoclonal HMB-45 antibody for these lesions. Eleven of 13 nevi, two of two acquired melanoses, and six of six melanomas stained with this antibody. Conjunctival melanomas showed intense and diffuse cytoplasmic staining; compound nevi and subepithelial nevi showed less intense but diffuse reaction. There was strong staining in melanocytic cells at the junction of the epithelium and substantia propria in compound nevi and acquired melanoses. Unlike skin nevi, conjunctival nevi show HMB-45 reactivity in their stromal components. Immunoreactivity to HMB-45 does not distinguish benign from atypical or malignant melanocytic lesions of the conjunctiva.

Bilateral white crystalline opacities of the central corneas were found at autopsy in the eyes of a 17-day-old girl with Turner's Syndrome. Corticosteroid therapy had not been used. Histopathologic and electron microscopic evaluation revealed clusters of gram-negative rods between relatively intact stromal lamellae. Inflammation was mild and restricted to the limbus and peripheral cornea. This case represents an unusual presentation of an infectious crystalline keratopathy.

A 17-year-old boy presented with persistent swelling and ptosis of the eyelid after blunt injury. Histologic examination revealed a clinically unsuspected traumatic neuroma. Ptosis and the traumatic neuroma persisted despite two eyelid operations. Traumatic neuroma is rare after blunt trauma; it has not been previously reported in the eyelid. It is important to identify this lesion because complete excision may help to prevent recurrence.

A gross, light, and electron microscopic study of the eyes from 35 consecutive autopsy cases of the acquired immune deficiency syndrome revealed cotton-wool spots (71% of cases), retinal hemorrhage in areas without cytomegalovirus infection (40%), cytomegalovirus retinitis (34%) with associated retinal detachment, Roth's spots (23%), retinal microaneurysms (20%), papilledema (14%), conjunctival Kaposi's sarcoma (9%), cryptococcal chorioretinitis (6%), Mycobacterium avium-intracellulare in retina and in choroidal granulomas (6%), ischemic maculopathy (6%), bilateral keratitis (3%), and herpes simplex retinitis (3%). Ocular infection with candida or toxoplasmosis were not found in this autopsy series. Immunocytologic studies demonstrated deposition of immunoglobulins in arteriolar walls, consistent with immune complex mediated disease. Ultrastructural studies showed a vasculopathy in the areas near cotton-wool spots. A mechanism is proposed linking the deposition of immune complexes with subsequent small vessel lesions, ischemia, cotton-wool spots and later spread of cytomegalovirus to retina via damaged vascular endothelium.

A 7-year-old boy with acute lymphocytic leukemia developed iris infiltration, blood-streaked hypopyon, and high intraocular pressure. A diagnostic anterior chamber paracentesis was performed, which provided a cytologic diagnosis. The aspirate was studied by both the millipore filter technique with Papanicolaou stain and a dried smear using the Wright's stain. Wright's stain provided more distinct cellular details. Irradiation of the anterior segment resulted in clearing of leukemic iris infiltration, hypopyon, and glaucoma.

Ocular pathology in a case of neonatal adrenoleukodystrophy (ALD) showed marked degeneration of photoreceptor cells throughout the retina including the macula. Macroscopically visible white opacities in the cortical vitreous of the posterior fundus were shown immunohistochemically and ultrastructurally to be macrophages containing bileaflet inclusions, a finding previously unreported. Additional findings included extensive loss of the retinal nerve fiber and ganglion cell layers, optic nerve degeneration, and bileaflet inclusions in retinal pigment epithelial cells and macrophages of the retina and optic nerve. Focal retinal pigmentary changes were observed that histologically were different from retinitis pigmentosa.

Seventeen months after penetrating keratoplasty for pseudophakic bullous keratopathy, a patient developed severe pain and a peripheral corneal ulcer that had the characteristic clinical appearance of a Mooren's ulcer. We performed a 10-mm penetrating keratoplasty that extended from the superior margin of the previously placed graft to the inferior corneoscleral limbus to encompass the ulcerated cornea. Histopathologic examination of tissue removed at surgery disclosed that the peripheral corneal ulcer extended nearly through the entire stromal thickness and that the donor corneal stroma adjacent to the ulcer was infiltrated with lymphocytes, plasma cells, and neutrophils. The conjunctiva adjacent to the peripheral corneal ulcer was packed with plasma cells and also showed some lymphocytes and neutrophils.

The acquired immune deficiency syndrome (AIDS) is a recently described disorder of cellular immunity in homosexuals, intravenous drug abusers, and Haitians. Manifestations include Kaposi's sarcoma, Pneumocystis carinii pneumonia, and other opportunistic infections. Ophthalmic and autopsy examinations of 30 patients at UCLA revealed frequent ocular abnormalities. Findings included cotton-wool spots (16 patients), cytomegalovirus retinitis (eight patients), conjunctivitis and keratitis (four patients), conjunctival Kaposi's sarcoma (three patients), Mycobacterium avium intracellulare choroidal granulomas (one patient), and retinal periphlebitis (one patient). We feel that the presence of cotton-wool spots in patients with this syndrome indicates a poor prognosis. Immunologic and electronmicroscopic studies of cotton-wool spots revealed no infectious agents or immunoglobulin deposition. Cytomegalovirus retinitis always was associated with a fatal outcome. The retinitis was characterized by an acute inflammatory reaction in 50% of patients. Ophthalmologists should be aware of the syndrome and its ocular manifestations.

Twenty-two fine needle (30 gauge) aspirations were performed in eyes enucleated for the clinical diagnosis of melanoma. Cytologic preparations were evaluated for adequacy of material, and needle tracts were evaluated for tumor implantation. A scleral marking method was used to identify all needle tracts. The number of tumor cells in tracts of direct transscleral aspirates was compared to those in tracts of indirect aspirates that traversed the anterior chamber or vitreous. Cellular material obtained with 30-gauge needles was sufficient for the diagnosis of malignant melanoma in all but one case. While 14 of 21 (67%) of all fine needle aspiration tracts and eight of 15 (53%) of indirect tracts contained tumor cells, the number of tumor cells was less than that associated with tumor growth in experimental models. Indirect aspirate tracts contained significantly fewer cells than tracts of direct aspirates (P less than .001).

Three premature infants with no family history of eye disease showed bilateral cystoid maculopathy on post-mortem examination. These macular lesions are indistinguishable macroscopically from the macular lesions of sex-linked juvenile retinoschisis. Cystoid change was observed at various vertical retinal levels. The oldest child had a schisis cavity within the nerve fibre layer. All cases had reduced numbers of retinal ganglion cells and central nervous system (CNS) abnormalities. The authors believe these are the first reported cases of a cystoid macular lesion present at birth and the first description of the pathological features of a cystoid macular lesion in infants.

Pathologic changes in chorioretinal juncture (pigment epithelium, drusen, Bruch's membrane, and choriocapillaris) were studied in the peripheral fundus of eyes removed at autopsy and surgically enucleated eyes by gross, light microscopic, and electron microscopic methods. Vascularization of Bruch's membrane (VBM) occurred in 430 (43%) of eyes at autopsy, was age related, and was most common in the ora zone and temporal sectors; a significant correlation was found with systemic oligemic conditions. Vascularization of Bruch's membrane occurs in the inner collagenous layer of the membrane, which always demonstrates collagenous thickening and often shows intrusion of interstitial-type cells; the vessels emanate from adjacent pars plana. While many degenerative changes of the pigment epithelium accompany VBM, only direct ophthalmoscopic visualization of linear-dendritic depigmentation of overlying pigment epithelium provides diagnostic evidence of vessels. Thus, VBM seems pathogenically related to the fact that the peripheral fundus is a vascular watershed and is selectively vulnerable to senile involutional changes.

This report analyzes 92 malignant melanoma cases from a series of 12,383 consecutive autopsies. There were 12 cases of primary ocular malignant melanoma, 76 cases of primary nonocular malignant melanoma, and 4 cases of unknown primary site. Subjects with malignant melanoma were characterized by age, sex, and race; metastatic disease patterns as well as survival periods were analyzed. In the 12 ocular malignant melanoma cases, tumor size, cell type, and survival were considered. Discussion is concerned with the distribution of primary tumor site, the location of metastatic lesions secondary to malignant melanoma, and survival in cases with primary ocular malignant melanoma.

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.

To clarify the nature of mulberry-like excresences of the optic disk, we histopathologically studied the eye of a 66-year-old woman with retinitis pigmentosa. Examination showed that the optic nerve excresences were ordinary drusen and not hamartomas. There was a marked predisposition to mineralization of other intraocular structures.

A 27-year-old woman with the syndrome characterized by ectrodactyly, ectodermal dysplasia, and cleft lip-palate had an absent lacrimal punctum in each eye, with signs and symptoms of nasolacrimal obstruction during childhood. Examination disclosed bilateral corneal vascularization and opacification, with diffuse superficial punctate staining of the ocular surface epithelium by fluorescein, an instantaneous tear film break-up time, and normal Schirmer tear measurements. A full-thickness biopsy specimen of the eyelid confirmed the absence of meibomian glands that had been suspected because of absent meibomian gland orifices and secretions. The total absence of meibomian gland secretions in this patient may be a primary feature of this case and may contribute to a lipid-deficient and unstable tear film with resultant desiccation and destruction of the ocular surface epithelium. Breakdown of the corneal epithelium in association with obstruction and infection of the nasolacrimal system may be a particularly disastrous combination for the cornea that resulted in the recurrent, severe bacterial corneal ulcers found in our patient.

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.

A quantitative study of synchysis senilis of vitreous and a statistical evaluation of its relationship to posterior vitreous detachment (PVD) was performed in eyes of 2,246 autopsied subjects (4,492 eyes); cases in which there was any cause for synchysis or PVD except senescence were excluded. Synchysis was graded 0 through 6 according to degree of destruction as judged by the technique of suspension-in-air; synchysis increased with age (P less than 0.00005). PVD was also age-related, becoming notable in the seventh decade (27%) and reached a zenith in the eighth (63%). When the rate of PVD for each grade of synchysis was plotted, there was a significant upturn between synchysis grades 3 (50% destruction) and 4 (67%) (P less than 0.00005); this trend was also evident when age was considered. These quantitative data reaffirm the role of synchysis in rhegmatogenous PVD and suggest that the vitreous of human eye can tolerate only a given degree of synchysis before some event, possibly related to vitreous instability, initiates PVD.

Cataract disrupts the crystalline lens, a transparent, elastic, avascular, biconvex structure composed of a capsule, lens epithelium, and lens fiber cells. Many factors contribute to the progression of lens opacity, but aging is most frequently associated with cataract. As aging-related cataract develops, many biochemical and biophysical changes occur, most notably a marked increase in the insolubilization of the crystallin and extensive oxidation damage to many of the lens constituents. Cataract management should include ophthalmologic history and examination, medical evaluation, optical correction, control of ocular and systemic disease that may contribute to cataract, discontinuation of cataractogenic drugs, and periodic reexamination. Surgery is indicated when cataract is associated with vision decrease interfering with activities important to the patient, intraocular inflammation or glaucoma, or interference with management of posterior segment disease. More than 600 000 cataract operations are done in the United States each year; in 1982 an estimated 496 000 cataract operations were combined with intraocular lens implantation.

The authors sought S-100 protein in sections cut from formalin- or glutaraldehyde-fixed, paraffin-embedded tumors from the eye and other sites by an immunoperoxidase technique, using rabbit antibovine S-100 protein antiserum, swine antirabbit serum, a peroxidase-antiperoxidase preparation, and amino-ethylcarbizole as developer. Tissue from 26 intraocular tumors was examined, the pathologic diagnosis being unknown to the investigators at that time that the tests were performed. Thirteen of 16 malignant melanomas of the choroid contained S-100 protein (81%), while only one of seven retinoblastomas contained S-100 protein (14%). One cutaneous malignant melanoma metastatic to the eye contained S-100 protein, while none of three metastatic nonmelanocytic, nonneural tumors contained the protein. These results are similar to our findings with nonocular tumors, in which 56 of 56 cutaneous melanomas contained S-100 protein (100%) and only 1 of 51 nonneural, nonmelanocytic tumors contained S-100 protein (2%). S-100 protein may be useful as a marker for ocular malignant melanoma.

We examined retinal tissue from eight human immunodeficiency virus type 1 (HIV-1) seropositive patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex for evidence of dual infection with HIV-1 and cytomegalovirus. Culture demonstrated simultaneous infection with HIV-1 and cytomegalovirus in two of 13 retinal specimens. This was confirmed by both immunofluorescence and immunohistochemical staining. Moreover, coinfection of individual cells with cytomegalovirus and HIV-1 was observed by immunohistochemical staining. Infection of retina with cytomegalovirus or HIV-1 alone occurred in one and six of the 13 retinal specimens, respectively. HIV-1 antigens were present on scattered cells in all layers of the retina and on retinal vascular endothelium. HIV-1 was isolated from retinal tissue derived from eyes both with and without gross ocular lesions. Cytomegalovirus antigens were found in all layers of the retina, but not on vascular endothelial cells. The atypically rapid clinical progression of retinitis in one of the patients with dual HIV-1 and cytomegalovirus infection suggests the possibility that interactions between these two viruses may influence retinal disease in patients with AIDS.

We studied the pathologic features of a rare case of coccidioidomycosis retinitis in a 12-year-old girl. At autopsy there were multiple small lesions throughout the vital organs. Ocular lesions were restricted to the posterior part of the fundus. Step-level serial sectioning including the optic axes of both eyes showed 29 discrete retinal and 22 choroidal granulomas. Topographic analysis demonstrated random distribution of lesions throughout the fundus. Retinal granulomas were centered within layers served by the retinal circulation. Choroidal lesions most often involved the middle vascular layer and in only two areas focally disrupted Bruch's membrane. The pigment epithelium was intact. Retinal granulomas were not topographically associated with choroidal lesions.

We utilized the leu series of monoclonal antibodies and an indirect immunoperoxidase technique to quantitate the cellular infiltrates in seven rejected human corneal allografts and compared them to nine identically processed corneas from patients with chronic herpetic stromal keratitis and to three control corneas. The cellular infiltrates in the rejected allografts were of mixed composition, comprised predominantly of leu-1 positive T-lymphocytes and leu-M3 positive macrophages. Both helper and cytotoxic-suppressor T-cells were identified in the stromal lesions. Statistically significant differences were noted in the absolute number of mononuclear cells and macrophages seen infiltrating the rejected corneal allografts compared to the herpetic corneas. We discuss the implications of these findings with regard to possible mechanisms underlying corneal allograft rejection in man.

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 clinicopathologic study of reticular degeneration of the pigment epithelium (RDPE) was done on 750 eyes of 396 consecutive autopsy cases and on 100 eyes of 50 consecutive patients with RDPE. The clinical, angiographic, macroscopic, and histopathologic characteristics of RDPE and its correlation with macular degenerative abnormalities in the autopsy and clinical eyes are presented. Reticular degeneration of the pigment epithelium and macular degeneration were found to be concomitant manifestations of the aging process, and RDPE may be a significant risk factor associated with age-related macular degeneration. Evaluation of the peripheral fundus is of value in assessing patients with macular degenerative abnormalities.

This article details the pathologic features of recently described clinical stages of vitreoretinopathy associated with premature birth in humans, beginning with a review of retinal angiogenesis in humans and then of the five stages of retinopathy of prematurity, with a description of paramount clinical feature in each stage and then corresponding pathologic changes. The article concludes with a consideration of arrested and reactivated retinopathy.

A localized pocket of missing vitreous invariably overlies lattice degeneration of the retina. Subjects with lattice also have a higher rate of rhegmatogenous retinal detachment, which is usually a complication of retinal tears. The latter are in turn a result of alterations in the central vitreous--that is, synchysis senilis leading to posterior vitreous detachment. In order to determine if there is either an association or a deleterious interaction between the local and central lesions of the vitreous in eyes with lattice, a comparison was made in autopsy eyes with and without lattice the degree of synchysis and rate of vitreous detachment. Results show no association between the local and central vitreous lesions, indicating that a higher rate of vitreous detachment is not the basis for the higher rate of retinal detachment in eyes with lattice. Also, there was no suggestion of deleterious interaction between the local and central vitreous lesions, either through vitreodonesis as a basis for precocious vitreous detachment, or through a greater degree of synchysis as a basis for interconnection of local and central lacunae (which could extend the localized retinal detachment in eyes with holes in lattice degeneration).