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• Malignant melanoma of the ciliary body and choroid of the right eye developed in a 49-year-old man with right nevus of Ota. Initially the tumor appeared cystic on indirect ophthalmoscopic and ultrasonographic examination, but, with further growth, the cystic component was no longer detectable. The enucleated eye showed a malignant melanoma with multilocular cavities containing mucoproteinaceous material and no necrosis.

THE tendency for malignant melanomas of the iris to be quite vascular is well documented,1-4 but the fact that the angiomatous component may overshadow the melanomatous component has not been adequately stressed in the literature. This may be so marked that the melanoma may be overlooked on both clinical and histological examination. Trujillo,5 in 1952, described a case of hemangioma of the iris which may possibly have been a missed melanoma, since he states in the histologic examination that a band of pigmented cells was observed at the base of the angiomatous tumor. In 1963, one of us (W.H.S.)6 submitted a report to this journal of an iris hemangioma, which was subsequently reviewed by Andrew P. Ferry, MD, who observed the presence of spindle-shaped melanoma cells at the base of the lesion at one end of the tissue (oral communication, 1964). A subsequent reexamination, by Dr. Ferry,

Ocular nematodiasis due to Toxocara canis occurred in a girl 6 years of age who had no history of contact with kittens or puppies, no history of an illness suggesting visceral larva migrans, and no eosinophilia. The left-eye inflammation was observed for over a year and changed very little. It was characterized by a heavy cellular anterior vitreous-body exudate, a large gray mass of exudate in the lower region of the ciliary body, ora serrata, and peripheral retina, and macular and optic-disk edema. Previous surgery had been done for a patent ductus arteriosus. Following the surgery, the patient had cyanosis, and she died about 18 months later of pulmonary hypertension. The eyes were obtained at autopsy, and the right eye was found to be normal. Examination of the left eye showed a larva morphologically identical with T canis within the lower peripheral retinal tissues.

Intraocular extension of a primary epibulbar malignant melanoma is very rare. Such a case is described in this report. The possibility that prior local surgical excision aided the intraocular extension is discussed.

A letter to the editor is presented expressing disappointment about the failure of "Forbes" magazine to cover insurance firm United States Fidelity & Guaranty Co. in the May 15, 1972 issue.

This single volume textbook and atlas represents the combined efforts of four distinguished French ophthalmic pathologists. The work was sponsored by the French Society of Ophthalmology with partial financial assistance for the color plates by a French proprietary laboratory. No one volume can be all-inclusive and this book is clearly not intended to embody the entire field of ophthalmic pathology. It is organized as a series of chapters of varying format and length, beginning with the eyelids and proceeding in a generally posterior direction to the orbit. There are no introductory chapters on general pathology, embryology, inflammation, or neoplasia; instead, the authors cover these situations as individual entities. Each chapter begins with a short section on the anatomy of the tissue under discussion. In general, little or no physiology is presented. Particular praise should be given to the chapter on the retina, which is excellent. The sections discussing retinoblastoma and

• A 14-year-old native of Ethiopia with previously treated onchocerciasis moved to California where he was examined for evidence of persisting nematode infestation. Skin and conjunctival biopsy specimens initially disclosed no abnormalities. Subsequently, conjunctival nodules developed, and a biopsy specimen of one of these revealed microfilariae of Onchocerca volvulus lying adjacent to a necrotic eosinophilic granulomatous inflammatory nodule. To our knowledge, nodules of this type have not heretofore been reported to be a notable feature of ocular onchocerciasis. This type of inflammation has a relationship to degenerating microfilaria in onchocerciasis and in other nematode infestation.

• The high incidence of malignant neoplasms in renal transplant recipients and other immunosuppressed patients is well recognized. A large proportion of these neoplasms are skin cancers. The frequent occurrence of other ocular complications, such as cataract, elevated intraocular pressure, hypertensive retinopathy, cytomegalovirus retinitis, and herpetic keratitis in patients after kidney transplant. has also been described. This report pre sents the clinical and histopathologic features of eyelid involvement by keratoacanthoma and squamous cell carcinoma in two patients after renal transplantation and alerts ophthalmologists to the potential for this association.

TO THE EDITOR. —In May 1978, Schwartz et al1 documented the ocular effects of a posttraumatic phycomycotic infection on the anterior segment of the left eye of a 26-year-old man. We now wish to report follow-up clinical data and histologic evidence of localized persistence of the infection in the anterior segment and donor cornea two years later.The patient initially manifested a Rhizopus (phycomycosis) infection of the anterior segment of his left eye two months following a perforating injury with a soil-contaminated screwdriver. After intensive but unsuccessful antifungal medical therapy, a combined 10-mm penetrating keratoplasty and planned extracapsular cataract extraction was performed (Jan 7, 1977), which included the removal of an organized anterior chamber cast and portions of necrotic iris. Postoperatively, the patient received a seven-day course of intravenous amphotericin B and topical natamycin drops, and was discharged from the hospital on Jan 25, 1977, with a clinically quiet

Benign nodular fasciitis has only recently become widely accepted as a clinical entity distinct from the soft tissue neoplasms it may resemble. Two large series reported in 1961 and 1962 attest to the benignity of the disease.1,2 In none of the total of 135 cases reported in these studies was the lesion located in the eye. However, the wide range of distribution suggested to Hutter et al1 that it might occur wherever there is fascia. The lesion most often appears as an isolated, rapidly growing, hard mass showing many alarming histologic features suggestive of sarcoma, which may result in a grave error in diagnosis by uninitiated clinicians and pathologists. Our case is presented to illustrate the salient clinical and histologic features of nodular fasciitis arising in Tenon's fascia. (A series of ten cases with ocular involvement has been compiled at the Armed Forces Institute of Pathology by Ramon

The von Hippel-Lindau syndrome is one of the hereditary phakomatoses. It is characterized by hamartomatous lesions which occur in the cerebellum, retina, and other organs. Lindau reported that 25% of patients with angiomatosis retinae have associated intracranial lesions. The per cent of patients with primary central nervous system lesions that also show associated retinal changes is not known.This is a report of a fatal case with typical cerebellar involvement in which a small unsuspected retinal lesion was found at autopsy. REPORT OF CASE The patient, a 53-year-old white male, was one of a large family in which 22 other members exhibited von Hippel-Lindau syndrome or some other form of vascular hamartomatous abnormality. He was admitted to the University of California Hospital on Jan 29, 1961, with the chief complaint of headaches, but there were no eye symptoms. On physical examination, he was found to have signs of a midline

A review of the literature reveals only one case report of an angioma of the iris with histologic confirmation.1 The present report concerns a histologically proven cavernous hemangioma of the iris which clinically simulated an iris melanoma. REPORT OF CASE HISTORY. —A 48-year-old white male became aware of a tumor in the left iris three days before examination. At that time his young daughter noted that his eye had "two pupils." During the previous two weeks, there were short episodes of painless "cloudy vision" in this eye.Examination showed a localized tumor in the midstroma of the nasal iris of the left eye. It measured 2×3 mm and produced some distortion of the pupil (Fig 1). The angle was not invaded by the tumor, but on gonioscopic examination (Fig 2) the tumor was observed to have a multiloculated appearance with strands of white tissue surrounding dark-red material resembling blood.

This edifying little volume is designed as an introduction for the clinician to the realm of ocular electron microscopy and molecular biology. It achieves its purpose admirably and, in some respects, surpasses its original aim. The task is by no means simple. Due to limitations of space, the editor and each of the contributors has had to walk a fine line between the abstruse and the obvious, providing information that will simultaneously whet the appetite of the clinician reader for more definitive discussion while still embodying the subject matter.The book is divided into three parts. The first, which deals with the basic and specialized techniques of transmission and scanning electron microscopy, sets the stage for the second part, which wonderfully condenses current information regarding the structure and function of the cell into one short chapter on cellular molecular biology. The reader comes away with a grasp of the

In the second edition of this combined illustrated text and stereoscopic atlas of ocular diseases, the authors have expanded the chapters on the lens and glaucoma as well as the section of the chapter on fundus diseases pertaining to retinal detachment. In addition, there is a new chapter on the optic nerve. Many of the stereoscopic reels from the first edition have been incorporated as black and white illustrations in appropriate chapters, and the authors have added 50 new color stereoscopic photographs. Of particular historical interest are several reproduced original line drawings and photomicrographs taken from older literature that serve to remind us of our ophthalmologic heritage and to contrast with recent illustrations of these conditions.The reader should be aware that the book is not intended as a comprehensive text of ophthalmic pathology but rather an "illustrated overview" of the field. As such, it provides an illustrated introductory text

IN REPLY. —Dr Drews is correct in pointing out that the article by McCannel describes several suture techniques. The procedure performed by the surgeon in the case that we reported was the one described for iridodialysis repair and not the procedure for repositioning a dislocated intraocular lens. The inclusion of the suture advocated by Dr Alpar for fixation of intraocular lenses was an error on our part.Neither the text nor the diagrams in McCannel's article are clear about the type of flap to be used. In the case reported, the surgeon used a fornixbased flap. The surgeon is certain that the leak occurred along the inferior suture and states that when the suture was removed "the leak closed spontaneously, the pressure rose into the glaucomatous range, and the appearance of a membrane on the posterior cornea developed." We have interpreted the surgeon's statement and the clinical, as well as

In the centennial issue of the Archives (96:2202-2203,1978), David Cogan, MD, discussed the limited life of eponymic designations of diseases that memorialize those whose initial observations have subsequently been redefined, categorized, or substantially modified. Descriptive terminology also came under Dr Cogan's fire, since many entities initially stated to be unique have subsequently been found to lack specificity or to relate to secondary anatomic changes rather than primary physical chemical causes. Because of subsequent discoveries such as these, periodic "spring cleaning" of obsolescent names seems in order. But care must be taken with a new or substitute name to insure that it, too, does not imply causation before the basis of the disease is fully established.In this issue (see p 2104), Eagle et al propose that proliferation of the corneal endothelium in varying pattern, rate, and extent is the common underlying cause of three clinical entities currently designated as essential

THE APPLICATION of recent advances in laboratory methods to the study of individual intraocular structures has greatly enhanced our ability to evaluate their function in health and disease. Nowhere is this more apparent than in the investigation of the retinal pigment epithelium where the utilization of light and electron microscopy coupled with histochemistry and autoradiography has recently revealed unsuspected functions. Long associated with the storage of vitamin A and its conversion to a form that can be utilized by the photoreceptors for the synthesis of rhodopsin, the retinal pigment epithelium has now been found to play an important role in the phagocytosis and digestion of the rod outer segment discs as well as other retinal substances. In addition, the ability of the pigment epithelium to produce and excrete a portion of the mucoprotein which surrounds the outer segments of the photoreceptors is now generally accepted. The ultrastructural pathways for the

TO THE EDITOR. —It has recently come to our attention that the conjunctival melanin depositions that we described in the March, 1963, issue of the Archives of Ophthalmology (pp 317-321) had been examined histologically for the first time in 1938 by Dr. G. Biette of Florence, Italy and published in the Bollettino D'Oculistica in February of 1938.We incorrectly stated that the first histopathologic report of this entity was presented by Marchesani and Ullerich in 1951.

As a result of impressive progress made in basic studies of normal and malignant cells, investigators now appear to be on the threshold of discovering the fundamental causes of several forms of human cancer. Biochemists, virologists, immunologists, and electron microscopists have opened pathways that may have a great impact on the successful management of the cancer patient.In recent years, increasing evidence has accumulated that suggests that viruses play a role in the cause of many types of human cancers. Fulfilling Koch's postulates in relation to the causation of human cancer by a virus is notoriously difficult. Evidence to date consists of the demonstration of virus-like particles in tumor cells, the presence of an apparently virus-related enzyme in certain human cancers; the demonstration of common tumor-specific antigens and antibodies against particular forms of human cancer; and an analogy to experimental and spontaneous animal malignant tumors. Of the cancers studied in