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Two patients with incompletely excised invasive papillary squamous cell carcinoma of the corneoscleral limbal conjunctiva had subtle clinical signs suggesting incomplete transmural extension or localized intraocular tumor invasion. We attempted a wide en bloc resection procedure in each case. Histopathologic examination disclosed that the surgical margins were involved with tumor cells and the eyes were subsequently enucleated. The enucleated eyes disclosed more extensive microscopic intraocular involvement than had been anticipated.

Although specific data on patients will be useful only after a 5- to 10-year follow up, radiotherapy of choroidal malignant melanoma with 125iodine has several advantages over the other radioactive sources that are presently being used. The low gamma energy of 125iodine allows for construction of metal eye plaques that can attenuate the radiation preferentially so that the tumor is treated while the rest of the eye receives minimal irradiation. This ability to direct the radiation is not possible with high energy sources such as 60cobalt. The ability to control the dose rate as well as the total dose is yet another advantage. Exact positioning of the 125iodine seeds in a plaque allows for an even distribution of the radiation throughout the tumor. Six patients have been treated. We are enthusiastic, but consider this an experimental procedure until our follow-up is complete.

• Two thirds of 60 patients followed up after enucleation for uveal melanoma with extrascleral extension eventually died of metastatic disease. Large intraocular tumor size, more malignant cell types, optic nerve invasion, and surgical transection or nonencapsulation of the extraocular tumor margin were found to be significantly correlated with development of metastases. Advanced age at enucleation and large intraocular tumor size were significantly associated with early metastatic death. Recurrence of tumor in the orbit was identified in 10% of the patients and was significantly correlated with large intraocular tumor size and optic nerve invasion. Early exenteration, performed in seven cases, did not improve prognosis. Application of Bayesian methods produced a multifactorial model for prediction of metastatic disease within 13 years after enucleation.

Report of a 71-year-old woman with acute closed-angle glaucoma. Echography shows an intraocular tumor of the choroid, and the histological diagnosis is necrotic malignant melanoma of the choroid. The clinical, echographical and histological findings are discussed.

These various intraocular disorders, which, either in their primary manifestations or after the fundus picture has become obscured by secondary developments, may suggest the existence of intraocular malignancy, are discussed seriatim from the point of view of differential diagnosis and as to their literary history. Some personal cases are reported, historically significant illustrations from the literature are reproduced, and the monograph is supplemented by ample bibliographies under the respective heads. (In addition to the text illustrations, see the colored frontispiece, containing a drawing of the author's case of Hippel's disease and a drawing of a large choroidal tuberculoma.)

A 42-year-old woman developed a ciliary body mass which indented the lens equator and produced a dense focal cataract in the right eye. The clinical diagnosis was malignant melanoma of the ciliary body, and the lesion was removed by a large iridocyclectomy. Histopathologic examination revealed an acquired adenoma of the non-pigmented ciliary epithelium. The clinical and histopathologic features of this rare intraocular tumor are discussed with emphasis upon its differentiation from malignant melanoma.

The case of intraocular tumor here reported is of especial interest because its course was followed five years before its removal, and it illustrates the unreliability of intraocular tension, in differentiating intraocular tumor from simple detachment of the retina. Read before the American Ophthalmological Society, June, 1920.

The difficulty of determining whether a detached retina hides an intraocular tumor makes every symptom bearing on the subject important. Two cases are reported in which deep ocular pain was present and an intraocular tumor found when the eye was enucleated. Read before the American Ophthalmological Society, June, 1923.

INTRODUCTIONChoroidal melanoma is the most common primary malignant intraocular tumor in adults. And its metastatic spread has been considered to be hematogenous with the liver being the most common site, and a solitary pulmonary metastasis without hepatic involvement is quite rare.PRESENTATION OF CASEWe report the case of a 61-year-old woman with a solitary pulmonary metastasis from choroidal melanoma, which had been originally treated with enucleation 13 years ago. Video-assisted thoracoscopic surgery (VATS) right upper lobectomy was performed for the right upper lobe tumor, which was histopathologically confirmed to be metastatic choroidal melanoma.DISCUSSIONOur case is quite unusual in 2 points; firstly, a solitary pulmonary metastasis without hepatic involvement is rare. Secondly, this mode of metastasis with an exceptionally long disease-free period (13 years) is also rare.CONCLUSIONA pulmonary metastasis from choroidal melanoma is described with reference to relevant literature.

A 24-year-old male was referred for evaluation and treatment of a choroidal tumor located 1 1/2 disc diameters from the optic disc of the right eye. The tumor had doubled in size over a 29-month period of observation, and measured 8 × 8 × 5 mm. The intraocular tumor was removed by internal eye wall resection, and the pathology specimen revealed the tumor to be a meningothelial meningioma.

Lymphocyte cytotoxicity using 51Cr releasing assay was investigated in 10 F344 rats bearing intraocular tumor derived from human adenovirus 12 (Ad 12)-induced retinoblastoma -like cell line (EXP-5). Lymphocytes obtained from tumor bored animal (1 X 10(6)/well) incubated with 51Cr-labelled EXP-5 cells (1 X 10(5)/well) for 24 hours, and counted by beta-scintillation counter. The cytotoxic activity of lymphocytes of transplanted animals was higher in 3 out of 10 subjected rats (24-30%) than in 10 rats of control (3-5%). The results support the view that the correspond animal model in its resemblance and suggested that the rats with retinal tumor have concomitant cell-mediated immunity in the early stage of tumor bearing.

• We have developed and used a thermoradiotherapy (TRT) plaque to treat choroidal melanoma (Greene strain) in rabbits. A dual-therapy scleral plaque delivers localized hyperthermia (4.8-gigahertz microwave) and ionizing radiation (iodine I 125). Transscleral treatment involves placement of a TRT plaque on bare sclera at the base of an intraocular tumor. Therapeutic doses of ionizing and hyperthermic radiation are then simultaneously delivered to the intraocular tumor. Sparing of normal ocular structures outside the treatment area after the combined therapy has been noted on clinical, gross, and histologic examinations. Our study suggests that the TRT plaque described satisfies the requirements for dual-modality treatment of choroidal melanoma.

Retinoblastoma in a 26-year-old woman is reported clinicopathologically, and the difficulties in this clinical diagnosis are presented. Clinical and morphologic findings of this case suggest that rare embryonal retinal cells can persist and be subject to late malignant transformation.

Fourteen patients with retinoblastoma treated with chemotherapy in our hospital were surveyed to study the effects of chemotherapy on retinoblastoma. These patients were compared with those registered in 1980 and 1981 in Japan. In unilateral retinoblastoma limited to the eyeball, there was no significant difference in outcome between the chemotherapy and non-chemotherapy groups. In bilateral retinoblastoma, however, patients treated with chemotherapy within one month after the start of conservative therapy showed a better outcome than those whose chemotherapy was started more than one month after conservative therapy was begun.

Three cases of uveal melanoma with scleral or extraocular extension as detected by standardized echography and confirmed histopathologically are reported. Two patients had scleral and orbital extension: one patient had a huge intraocular tumor and small orbital nodule, while the other had a small intraocular tumor with massive orbital involvement. In the third patient, early scleral extension (less than 25% of its thickness) was detected echographically. The early detection of scleral or extraocular extension, which are known poor prognostic factors, should be routinely attempted with standardized echography even in a small, apparently stable uveal melanoma.

Leukokoria, a white pupillary reflex, is an important clinical sign in ophthalmology since it is the most common presenting sign of retinoblastoma, a highly malignant pediatric intraocular tumor. Numerous simulating conditions need to be distinguished from retinoblastoma in order to insure prompt recognition and appropriate treatment of all conditions. The majority of cases can be diagnosed through careful clinical examination and correlation with pertinent historical data. Unfortunately, in approximately 20% of cases a secure diagnosis cannot be established through standard clinical techniques, and in these patients ancillary diagnostic testing is extremely valuable.

The authors present the results of a transmission electron-microscopic study performed on a tissue sample obtained by an intraocular fine-needle aspiration biopsy in a case of retinoma. The ultrastructural study showed that the tumor was composed mainly of granular osmiophilic material which contained some tumor cells. These cells showed peculiar ultrastructural characteristics, which demonstrated their neural character, and appeared in different degenerative stages. Apparently, this is the first case in whom ultrastructural techniques have been applied to study an intraocular tumor sample obtained by intraocular fine-needle aspiration biopsy, and the first case of retinoma studied by such a diagnostic approach.

A patient had Ewing's sarcoma of the rib which metastasized to the choroid. Clinically, he showed a solid retinal detachment and recurrent episodes of anterior nongranulomatous uveitis. The uveitis responded to steroid therapy. While metastasis of Ewing's tumor to the orbit is well known, no previous cases of Ewing's tumor in the choroid were found, and the extreme rarity of intraocular tumor metastasis in childhood is discussed.

The possibility that malignant melanoma may be transmitted in a hereditary manner is not often considered. However, Falls 1 lists malignant melanoma of the choroid under those eye conditions which may show a dominant hereditary transmission. The following is an example of choroidal malignant melanoma occurring in two successive generations. Report of Cases Case 1. —A 45-year-old white female was admitted to the hospital on May 19, 1953, with a diagnosis of retinal detachment and intraocular tumor, right eye. For three months prior to admission the patient noted a "scum" over right eye. One week prior to admission there was loss of all but light perception in the eye. On examination, the vision in the right eye was limited to light perception. There was a massive retinal detachment with a solid mass behind it. Examination of the patient for metastatic disease revealed no metastases. The family history contained no evidence

The anatomical identification of a white intraocular tumor in an adult can occasionally be very difficult. Accurate recognition of the nature of the lesion is, of course, important from the standpoint of prognosis, but such cases also have academic interest as a diagnostic challenge especially to the pathologist. Some of the differential diagnostic features that may be presented under such circumstances are shown in an illustrative case. As our title indicates, one of the chief considerations suggested by that case is the possible occurrence of retinoblastoma in adult life. Report of Case A 46-year-old man noticed gradual diminution of vision in the right eye beginning about November, 1956. By July, 1957, there was no vision in that eye, but the patient did not seek medical attention until the eye became painful in 1958. He was first seen on the service of Dr. Michael J. Buonaguro at the Brooklyn Eye and

Recognition of the malignant intraocular tumor in the earliest possible stage of its growth is of obvious importance. Diagnosis by ophthalmoscopy is not difficult in the initial stage, before the development of subretinal transudation and retinal detachment. Such an extremely early stage is practically never seen, except in some rare instances in which the tumor is near enough to the macula to create a serious disturbance of the central vision. Once transudation and retinal detachment have occurred, and especially if the tumor is located in the posterior half of the eyeball, diagnosis becomes extremely difficult and is seldom more than presumptive. Consequently, the addition of any pathognomonic feature to the present meager knowledge of this clinical picture, even though it is limited to half of the cases, should be of distinct value. The present paper reports such a feature, viz., detachment of the pars ciliaris retinae, which I observed in

Judged by its literature, the causation of glaucoma is unsettled. No effort to harmonize undoubted facts has met with general support. Whether glaucoma is a deformity or a disease, remains an open question. Thus Priestly Smith and his followers claim that glaucoma is a deformity of the eyeball, that an engorgement of the blood vessels in the posterior chamber pushes forward the lens and crowds the ciliary body and iris into the anterior angle, effectually blocking the outlet from the eye for the intraocular secretion. From the resultant intraocular tension he deduces the phenomena of primary glaucoma. The failure of this view to account for glaucomatous attacks in the young, in persons having no iris, in cases of intraocular tumor or dislocated lens, etc., has prevented its universal acceptance. Of those holding that glaucoma is a disease, part affirm that it is purely local; and part that it is the