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Computerized image processing was used to analyze color fundus photographs of 11 patients (22 eyes) with macular drusen who were followed for more than 2 years (mean follow-up, 4.7 years). Significant changes over time (more than +/- 20% of baseline area) were measured in the surface area of macular drusen in 18 of 22 (82%) eyes. An increase in the drusen area was associated significantly with eyes with mostly hard drusen and an initially smaller drusen area; but a decrease was associated with eyes with mostly soft drusen and an initially larger drusen area (P less than 0.01). The mean absolute rate of change in the drusen area was more than twice as great in eyes with mostly soft drusen compared with those with mostly hard drusen (P less than 0.05). All eye pairs studied showed a concomitant increase or decrease in the drusen area.

Although diabetic retinopathy has been thoroughly studied, little attention has been given to the corneal changes of diabetic patients. Pathophysiologic and clinical findings may be related to the ultrastructural changes found in these corneas.To investigate the ultrastructural corneal changes of diabetic patients.Transmission electron microscopic ultrathin sections were prepared from corneas of 16 noninsulin-dependent diabetic patients (mean age, 65 years; range, 40-82 years) who suffered from the disease for a mean period of 22 years (range, 10-30 years). We used 16 corneas from healthy age-matched donors as normal controls.In addition to the epithelial changes that include accumulation of glycogen granules, occasional focal epithelial cell degeneration, and irregular thickening and multilamination of the epithelial basement membrane, unusual 120-nm wide-spaced collagen fibril bundles were observed scattered among both Descemet's membrane and stromal matrix.The aggregates of wide-spaced collagen fibrils, which have not been described in other basement membranes of diabetic patients, may reflect an excessive glycosylation rate.

Ofloxacin is a broad spectrum fluoroquinolone antibiotic with good ocular penetration. We investigated the potential for retinal toxicity associated with increased intraocular penetration following intensive topical, oral, and combined topical and oral administration. We confirmed ofloxacin concentrations in aqueous and vitreous following these forms of administration. Rabbits received either topical, oral, or a combination of oral and topical ofloxacin. Topical administration consisted of one drop of ofloxacin 0.3% drops given every thirty minutes for a total of eight doses. Oral ofloxacin was administered at a dose of 10 mg (4 mg/kg for average weight 2.5 kg rabbit) every 12 hours for a total of three doses. Six rabbits were followed longitudinally for 4 weeks for evidence of retinal toxicity by indirect ophthalmoscopy and serial ERGs. Electron and light microscopic histopathologic examination of the retina were performed 4 weeks following drug administration. To verify intraocular penetration, ten rabbits received identical dosing schedules followed by HPLC measurement of aqueous and vitreous drug concentrations at 1, 4, 8, 12, and 24 hours following dose completion. No evidence of retinal toxicity was detected by indirect ophthalmoscopy, electroretinography, or histopathological examination. Vitreous ofloxacin levels were highest after combined oral and topical administration, peaking at 0.892 microgram/ml 8 hours following dosage completion. The peak vitreous level following oral administration was 0.230 microgram/ml and 0.026 microgram/ml following topical administration. Peak aqueous humor levels were achieved one hour following drug administration and were 11.400 micrograms/ml after topical, 0.206 microgram/ml after oral, and 8.180 micrograms/ml after combined administration. Our study suggests that intensive topical and oral ofloxacin administration does not cause retinal toxicity in rabbits, despite achieving effective aqueous and vitreous humor antimicrobial concentrations.

A 56-year-old woman presented with orbital signs and symptoms suggestive of lacrimal gland tumor. An excised biopsy specimen was obtained and showed glandular tissue, which could be confused with lacrimal gland acini. Closer microscopic examination and immunohistochemical studies revealed a metastatic tumor of thyroid gland origin. Initially, there was no identifiable nodule in the thyroid, but 3 months later a thyroid nodule was found by ultrasound and radioisotope scan. The histopathologic appearance of the thyroid nodule was similar to that found in the orbit. This case demonstrates the usefulness of immunohistochemistry in establishing a diagnosis when the microscopic appearance is inconclusive.

BACKGROUND Diabetes mellitus causes ultrastructural changes in various basement membranes. These changes include increase in collagen biosynthesis rate and production of altered collagen. PURPOSE To evaluate the ultrastructural changes in the corneas of streptozotocin- induced diabetic rats, focusing on Descemet's membrane. METHODS Sprague-Dawley rats were sacrificed at different intervals after induction of diabetes mellitus by streptozotocin. Ten animals were sacrificed 1, 2, 3, 4, 6, 8, and 12 months after the injection of streptozotocin. Five untreated rats of the same age were used as normal controls and were sacrificed at the same intervals. Ultrathin sections were obtained from the corneas and were examined by transmission electron microscopy. RESULTS Unusual 120-nm-spaced collagen fibril bundles were found in Descemet's membrane of the diabetic rats as early as the second month following the induction of diabetes. Their concentration and size increased gradually over the follow-up period of 12 months. CONCLUSIONS Changes in the morphologic features of the collagen within Descemet's membrane may occur in diabetic-induced rats. The appearance of wide-spaced collagen fibrils in Decemet's membrane may represent alteration in collagen biosynthesis by the endothelial cells in diabetes or altered assembly of collagen due to increased glycosylation of normal formed collagen.

Purpose/Methods Computed tomographic scan disclosed a well-defined mass in the right lacrimal fossa of a 5 7-year-old woman. We excised and examined the mass. Results/Conclusions The mass was a combination of a small benign mixed cell tumor and a large ductal cyst of the lacrimal gland. It is possible that a cyst in the lacrimal duct may mask an underlying neoplasm of the lacrimal gland.

This book was published with the intention of giving practicing ophthalmologists and those in training a comprehensive review of vitreoretinal surgery and the management of vitreoretinal diseases. The book opens with excellent chapters on surgical anatomic landmarks and preoperative evaluation of patients. The authors discuss in detail the instrumentation, equipment, and various vitreous substitutes used in this type of surgery. They proceed to describe the techniques for anesthesia and akinesia and methods for preparation of sclerotomy sites. This is followed by a comprehensive description of complete vitrectomy, membrane peeling, internal drainage, endolaser, retinotomies, retinectomies, bimanual surgery, and the use of vitreous substitutes. The authors provide valuable hints on how to overcome impaired visualization of the posterior segment. A special chapter is devoted to the complications of cataract surgery, such as vitreous loss and dislocated lenses. Various methods for handling tractional and rhegmatogenous retinal detachments are described, including the use of

Goodpasture's syndrome is a rapidly progressive disease characterized by the onset of pulmonary hemorrhage with glomerulonephritis, leading to pulmonary and renal failure. The hallmark of this disease is linear deposition of antibasement membrane IgG in the basement membranes of the kidney and lung. In two cases of nonrhegmatogenous retinal detachment in patients with Goodpasture's syndrome, the first patient demonstrated multiple ischemic areas in the choroid on fluorescein angiography. Histopathologic and immunologic studies of the eyes in the second patient demonstrated macular edema and elevation of the retina in association with choroidal infarction and linear deposition of IgG in Burch's membrane and the basement membranes of the choroidal vessels.

The effect of photodynamic inactivation on corneal epithelial, stromal and endothelial cells was investigated in tissue cultures. In contrast to reports regarding in vivo studies, the in vitro treatment caused significant degeneration and growth inhibition of stromal corneal cells and less marked changes of epithelial corneal cells in tissue cultures. Stationary endothelial cells appeared least effected. The neutral red was seen in the intracytoplasmic granules and in time localized mostly in the perinuclear area, and to a lesser extent within the nucleus. The in vitro study of actively growing corneal cells appears to be a sensitive indicator of cell damage following photoinactivation.

Drusen are yellowish deposits at the level of the retinal pigment epithelium and are frequently associated with age-related maculopathy (ARM). Drusen often change in size and number over time and may be followed by atrophic or exudative macular degeneration. A quantitative method to measure the development of drusen is needed for controlled studies of the natural history, prognosis, and treatment of ARM. An objective method is described using computer image analysis of fundus photographs for the detection and measurement of drusen. This technique enables us to measure both the area of drusen in the macula and the changes in the drusen pattern over time. Evaluation of repeated photographs showed reproducibility of 6.1%, whereas the reproducibility of processing photographic duplicates was 2.3%. Digitization with a high-quality linear array solid state camera did not change reproducibility significantly.

A review of currently-available diagnostic coding systems revealed that most are either too abbreviated or too detailed. We have compiled a simplified diagnostic coding sheet based on the International Coding and Diagnosis (ICD-9), which is both complete and easy to use in a general practice. The information is transferred to a computer, which uses the relevant (ICD-9) diagnoses as database and can be retrieved later for display of patients' problems or analysis of clinical data.

We report a 22-year-old Hispanic man with familial congenital nystagmus, iris transillumination, and pigmentary retinal anomalies with subretinal fatty exudates similar to those seen in Coats' disease. Direct treatment of the telangiectatic vessels with cryotherapy caused a subretinal hemorrhage. We therefore recommend surrounding the area of abnormal vessels (posterior to vessels and between vessels and ora serrata) with cryotherapy to reverse the formation of the vascular anomalies.

Two patients are described in whom black hypopyon and black keratic precipitates occurred as a result of intraocular melanoma. In one instance the hypopyon was due to a clinically unsuspected primary choroidal melanoma in an eye with opaque media; in the second case the tumor was metastatic to the uvea from a cutaneous melanoma. Histological examination showed the hypopyon to be composed of pigment-laden macrophages and neoplastic melanoma cells.

A case of advanced pigmentary retinal degeneration is described. Posterior subcapsular cataract and a remnant of the anterior hyaloid system on the posterior lens surface were found. Extensive dispersion of pigment and organization of the vitreous base were present. Gliosis was seen in the retina, and no photoreceptors were evident. The retinal blood vessel walls were extensively hyalinized, with cell debris and deposition of basement-membrane-like material, which may have originated from perivascular pigment-laden cells of pigment epithelial origin. The pigment epithelium showed extensive proliferation in clumps. Pigmented retinal pigment epithelium (RPE) cells without lipofuscin, migrating nonpigmented RPE cells, and macrophages with large lysosomal bodies could be identified in each clump. An abundance of extracellular basement-membrane-like material or mucopolysaccharide was seen in the retina and adjacent to the RPE. This material probably originated from the abnormal RPE. Abnormalities of the large and small choroidal vessels are present.

A white infant was born with acute disseminated histiocytosis X. Clinical ocular examination at birth revealed thickening of the irides with a nodular lesion of the right iris and a focal linear discoloration of the left iris. The pupils showed minimal dilatation following instillation of mydriatics. The child died at 7 days of age; histopathologic examination revealed massive infiltration of histiocytes in the iris, choroid, and meninges of the optic nerve. This pattern of ocular involvement is rare in acute disseminated histiocytosis X. There was involvement by similar cells of the skin, visceral organs, and brain. This association of anterior uveal involvement with severe though clinically unrecognized visceral involvement has been described previously, but not emphasized. Recognition of the ocular involvement may be helpful in the diagnosis, and contribute to the early institution of therapy.

Histopathologic examination of six, adult human eyes revealed "rosette-like" structures in the retina which appear to have developed after maturation of the retina. These structures resemble dysplastic rosettes which are generally interpreted as a sign of maldevelopment of the retina (retinal dysplasia). The underlying lesions in the eyes of these patients were ocular ischemia, sickle-cell retinopathy, diabetic retinopathy, central retinal vein occlusion, and trauma. It is suggested that a distinction should be made between these degenerative-regressive changes and dysplastic rosettes which represent an abortive attempt of regeneration by germinal cells.

Long-term clinicopathologic observations of the Refojo (MAI) implant in rabbits confirm its suitability as a scleral buckling material in retinal detachment. It produces an adequate and durable scleral buckling effect. It proves to be nontoxic and well tolerated by ocular and periocular tissues. The implant stimulates the formation of a permanent fibrous capsule that stabilizes and isolates the implant from the episcleral vasculature.

Presentation of Case A 79-year-old man was admitted to the hospital because of fever, abdominal pain, and an inflamed right eye. The patient felt well until six days earlier, when he ate a huge tur...

A new classification scheme for neovascularization of the iris (NVI) is presented. This system designates the location of the new vessels by a letter and the number of quadrants involved by a numeral. The presence of elevated intraocular pressure (IOP) is denoted by a "+" sign. It was found to be a reliable method in the evaluation of the clinical course and results of treatment in patients with NVI.

A rare metastatic choroidal tumor from primary mediastinal choriocarcinoma in a male is described. This tumor secreted gonadotrophins and showed the histopathologic characteristics of cytotrophoblast and syncytiotrophoblast cells. Early metastatic disease resulted in rapid death; the development of the choroidal metastatic lesion was diagnosed at autopsy.

On examining 54 globes that harbored choroidal malignant melanomas, we found 28 tumors to be composed of spindle cells; 24, of mixed cells; and two, of epitheloid cells. In 80% of the tumors studied, pigment-laden cells had accumulated away from the tumor region and at the periphery of the subretinal space. The number of cells increased in proportion to the extent of retinal detachment, a finding that related directly to the size of the tumor.

Three patients suffered blunt trauma that caused rupture of the site of cataract incision three to 12 years after surgery. Epithelial cells were noted in the old cataract would of a 79-year-old white man. The second patient, a 25-year-old black women, had bilateral ocular toxoplasmosis and loss of vitreous humor at the time of lens extraction. The third patient, a 63-year-old white woman, had open-angle glaucoma treated previously with filtering procedures and cyclocryotherapy. The ultimate outcome was poor in each case.

Xeroderma pigmentosum occurred in three siblings of a black family in Haiti. One affected child developed a fungating mass that obscured the cornea and limbus. The lesion recurred after two excisional biopsies, and enucleation was performed. Microscopical examination of the biopsy lesion and the involved area of the enucleated globe showed similar findings: exuberant granulation tissue, inflammation, acanthosis, and dysplasia of the epithelium. An important additional feature was the presence of atypical cells with notable pleomorphism at the base of the corneal lesion. Scalp nodules excised from two of the children were infiltrative squamous cell carcinoma. The fungating corneal lesion demonstrated in this report differs greatly from the pterygium-like growths, pannus-like infiltrates, hyperkeratotic changes, and carcinomatous processes previously described, which arise from the ocular tissues of patients with xeroderma pigmentosum.

The effect of photodynamic inactivation on experimental herpes simplex keratitis in rabbits was investigated using neutral red as a photosensitizing dye followed by exposure to light at 425 nm. Combined dye application and light exposure early in the disease (two days following infection) reduced to a minimal extent the severity and duration of the acute epithelial infection. The effect on well-established keratitis (three days postinfection) was negligible as evaluated by clinical grading, viral recovery, and histopathological study. In initial experiments, it was found that the dye and light did not have any observable deleterious effect on intact corneas or cause any noticeable delay in healing of injured corneas. Further, when light or dye were utilized alone, neither changed the severity or duration of the keratitis. In vitro treatment of the virus with light and dye destroys its ability to produce experimental keratitis.

Numerous and diverse clinical entities are associated with iris neovascularization, but the most frequently encountered are diabetes mellitus and central retinal vein occlusion. The prevalence of iris neovascularization is between 1–10% among all diabetic patients and over 40% in patients with proliferative retinopathy (1–3). The incidence of iris neovascularization among patients with central retinal vein occlusion is about 15% (4), but is only 1 to 2% in patients with central retinal artery occlusion (5). The clinical presentation, histologic pathology, and theories of pathogenesis of this disorder have been reviewed (6–14).

Nevus-like structures were observed at the base of experimental choroidal tumors. These neoplasms were obtained by injecting Greene transmissible hamster melanoma cells into the choroid of Syrian hamsters and murine neuroblastoma cells into the choroid of A/J strain mice. Cells from both tumors, when injected intraocularly or systemically, give rise to lesions composed predominantly of epithelioid or round cells. The choroidal tumors in both species, however, generally showed a zone of flattened cells adjacent to the sclera, composed of relatively benign-appearing, smaller, and more delicate cells—and in the case of the melanoma, usually more densely pigmented cells—than the main portion of the tumor. The cells in this area appeared similar to the "nevus cells" that have long been described beneath and adjacent to primary malignant melanomas of the uvea.