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Malignant melanoma is a malignant neoplasm composed of cells that produce melanin, a naturally occurring pigment found in the iris and choroid of the eye. Malignant melanoma of the uvea (the pigmented vascular tunic of the eye beneath the sclera that includes the iris, ciliary body, and choroid) can be assessed by study of cell nuclei and their features. Specific areas called nucleolar organizer regions are part of the nucleus of the cell and are responsible for the formation of the nucleolus (small dense structures composed of ribonucleic acid); these areas are essential in the production of ribosomal protein. One method used to evaluate the malignancy of various tumors is a silver staining of the nucleolar organizer regions. A study was undertaken to determine the effectiveness of this silver staining method in assessing the malignant potential of a variety of tumors of the eye. The tissue specimens studied included 126 ciliochoroidal melanomas, three nevi in eyes with melanoma, and one eye with a nevus. The results indicated that malignant lesions had higher average silver-stained nucleolar organizer region counts than did the benign nevi. Silver-stained nucleolar organizer regions correlated with cell division and tumor size. Silver staining of nucleolar organizer regions may be useful in assessing malignancy of uveal melanomas. (Consumer Summary produced by Reliance Medical Information, Inc.)

We compared survival experiences for three groups with uveal melanoma: (1) 120 patients treated by proton beam irradiation from 1975 to 1981; (2) 235 patients treated by enucleation from 1953 to 1973 (enucleation group 1); and (3) 161 patients treated by enucleation from 1975 to 1981 (enucleation group 2). The following variables were predictive of melanoma-related deaths. Treatment: rate ratio (ratio of the rate of death for one category of the variable relative to the rate of death for another category) of 6.32 (95% confidence interval 1.70 to 23.51) for enucleation group 1 vs proton beam, 3.06 (0.81 to 11.54) for enucleation group 2 vs proton beam, and 2.07 (1.05 to 4.07) for enucleation group 1 vs enucleation group 2. Size: rate ratio of 3.61 (1.51 to 8.64) for large (16+ mm) vs small (<11 mm) tumors. Location: rate ratio of 3.19 (1.56 to 6.53) for tumors anterior vs posterior to the equator. When death from all causes was evaluated as the outcome, the estimated rate ratios were similar. When melanoma metastasis was evaluated as the outcome, the estimated rate ratios were reduced in magnitude.

Ultrastructural studies of six vitreous biopsy specimens obtained during cataract surgery on patients with retinitis pigmentosa showed four types of cells. These were ocular pigment epithelium, uveal melanocytes, retinal astrocytes, and macrophage-like cells. The fibrous astrocytes displayed plump cell bodies, large nuclei, and numerous intracytoplasmic filaments. The pigment epithelial cells and uveal melanocytes were round to cuboidal and were heavily pigmented. Macrophage-like cells demonstrated round cell bodies, inclusions of glycogen, and long processes extending from the cell membrane. Also identified in the vitreous material were loose pigment granules. In contrast, vitreous from the control group showed occasional macrophages and loose pigment. These findings explained the clinical observation of material within the vitreous of patients with retinitis pigmentosa.

In 104 patients undergoing biopsies for temporal arteritis, lymphocyte characterization identified both T4 helper/inducer and T8 cytotoxic/suppressor lymphocytes in approximately equal numbers. B lymphocytes were absent. Deposition of IgM and IgG was observed in three of 16 positive biopsy specimens. Antinuclear antibodies were present in ten of 16 biopsy-proven cases of temporal arteritis compared with 19 of 55 in the control group with negative biopsy specimens. Anti-smooth-muscle, anti-DNA, and antimitochondrial antibodies were not useful in distinguishing between the two groups.

We examined the effects of commercially prepared gentamicin, a wide-spectrum topical antibiotic, on the healing of epithelial defects of the rabbit cornea. Abrasions were created by: (1) removing the corneal epithelium and 3 mm of the conjunctival epithelium (Group 1); and (2) producing the same initial trauma and subsequently removing the central 8 mm of epithelium 28 days after initial healing (Group 2). The complete healing of the large corneal and conjunctival epithelial defects was not delayed when gentamicin solution was used four times a day (Group 1). When the healed epithelium was reinjured while transdifferentiating from conjunctival to corneal epithelium (day 28, Group 2), treatment with the gentamicin solution and its vehicle, both containing benzalkonium chloride, delayed epithelial healing significantly compared with treatment with saline (P < .01).

A study of the uveas of white patients with known cutaneous melanoma and white control subjects showed that patients with cutaneous melanoma had a significantly higher frequency of iris nevi (101 of 197 patients, 51%) than control subjects (58 of 147 subjects, 39%). The frequency of choroidal nevi was also higher in the group with cutaneous melanoma but the number (eight of 197 patients compared with two of 147 control subjects) involved was too small for statistical significance to be assessed. Patients with cutaneous melanoma, particularly women, had more skin nevi than did control subjects.

We evaluated three cases of Pseudomonas aeruginosacorneoscleritis, one associated with the use of contaminated eyedrops; another in an elderly, debilitated patient; and the third in a patient who had previously undergone penetrating keratoplasty. In the first two cases, control of the infection was achieved by intensive antibiotic therapy alone. The third case required evisceration of the eye following spontaneous perforation at the site of scleral involvement. Histopathologic findings showed persistence of the organism in the sclera despite intensive antibiotic therapy for six days.

Using intraocular Greene melanoma in a hamster model, we studied the effect of pre-enucleation irradiation on the development of melanoma metastases. One group (No. = 111) was treated with 1,210 to 1,600 rads of cobaltous chloride Co 60 gamma irradiation before enucleation and the second group (No. = 100) received no irradiation. The groups did not differ with respect to presence of metastases in the 106 days after tumor implantation (χ2= 3.05; P = .08). However, Kaplan-Meier survival curves gave a longer time to melanoma-related death in the irradiated animals compared with the controls (log rank test, P = .0008).

We examined the effect of liver damage induced by carbon tetrachloride on the incidence of hepatic metastasis in the Greene hamster melanoma. Nine of 17 animals with liver damage had melanoma growth in the liver after the intraportal vein injection of tumor cells, whereas tumor growth occurred in four of 27 control animals (P < .01). These results suggest that, in this model, liver damage predisposes to metastatic involvement by melanoma.

Forty-one human conjunctival papillomas were histopathologically examined for koilocytosis and papillomavirus common antigen with a peroxidase-antiperoxidase technique immunospecific for genus-specific papillomavirus antigen. Koilocytotic cells, typically found in other papillomavirus-induced tumors, were present in 24 of the 41 specimens. Two of the 41 specimens were positive for viral antigen. The positive reactions were intranuclear within the superficial layers of the epithelium.

We studied the clinical and histopathologic ocular findings in four related males with a newly recognized syndrome consisting of microphthalmos, microencephaly, mental retardation, agenesis of the corpus callosum, hypospadius, and cryptorchidism with X-linked recessive inheritance. The ocular abnormalities include microphthalmos, corneal pannus and hypoplasia, cataracts, uveal hypoplasia, retinal dysplasia, optic nerve hypoplasia, and congenital blepharoptosis. In case 4, a female twin who died in utero (at 15 weeks’ gestation) showed none of the ocular abnormalities.

We successfully treated a patient with uveal effusion syndrome and abnormal sclera with a partial-thickness sclerectomy. Part of the sclera was immediately cultured, and the excised sclera and the cultured cells were examined by electron microscopy. The sclera demonstrated increased glycosaminoglycan-like deposits between the scleral fibers. The cultured scleral cells showed large intracellular glycogen-like deposits, which were not seen in cells cultured from two control scleras. These findings may be the result of a metabolic defect, which causes a thick, impermeable sclera in some cases of uveal effusion.

In the first well-documented case of bilateral retinoblastoma to be cured by X-irradiation of the nonenucleated eye, a basal cell carcinoma and then a squamous cell carcinoma of the eyelids developed 60 years after the original treatment. The patient, a 66-year-old man, had been treated by Verhoeff between 1917 and 1919. These new tumors may have been examples of second primary tumors, found in about 0.5% to 2.5% of patients with bilateral retinoblastoma, or they may have been coincidental. Because of the 60-year period between the patient's original treatment and the development of these tumors, it seems unlikely that they were the result of the irradiation.

We performed experiments to determine the potential usefulness of nuclear magnetic resonance spectra in the diagnosis and follow-up of ocular melanoma. High-resolution phosphorus 31 nuclear magnetic resonance spectra at 109.3 MHz were obtained for human uveal melanoma, Greene hamster melanoma, and normal human diploid fibroblast cells. Phosphate metabolites were identified and their concentrations were shown to vary among the different cell lines. Uveal melanoma cells contain unusually high concentrations of the phospholipid metabolite phosphorylcholine and the phosphodiesters glycerol 3-phosphoryl choline and glycerol 3-phosphoryl ethanolamine. Baseline data are thus provided for studies of the effect of various treatment modalities on uveal melanoma. These initial results suggest that the data provided by high-resolution phosphorus 31 nuclear magnetic resonance spectra can provide useful diagnostic and follow-up data with respect to ocular melanoma.

Two histologically proven conjunctival papillomas (one from a 33-month-old boy and the other from a 28-year-old woman) were examined for the presence of papillomavirus by DNA molecular hybridization. The first case, a recurrent tumor known to be positive for papillomavirus structural antigen, demonstrated human papillomavirus DNA sequences that cross-hybridized to a human papillomavirus type 11 DNA probe. The second case, an initial tumor, which was negative for papillomavirus structural antigen, demonstrated no viral DNA sequences by hybridization.

We studied two children who died of suspected familial erythrophagic lymphohistiocytosis. The first child, a 7-year-old boy, had fever, diffuse pulmonary infiltrates, bilateral choroidal effusions, diabetes insipidus, and marked meningitis with increased cerebrospinal fluid protein. Ocular histologic studies disclosed diffuse choroidal infiltrates consisting of atypical mononuclear cells with foamy cytoplasm. Similar histologic changes were seen in the lungs, liver, brain, and kidneys. The second child, the 5-year-old male cousin of Patient 1, had fever, hepatosplenomegaly, pulmonary infiltrates, and cerebrospinal fluid pleocytosis. Histologic changes were similar to those in the first case, but viral particles of the herpes simplex virus group were noted in brain tissue as well. The findings of virus particles in this histiocytic proliferative disease suggested a defect in the inflammatory response in these patients.

We examined 223 consecutive patients with vitiligo for ocular disease and 154 consecutive patients with uveitis for vitiligo to better determine the nature of the relationship between vitiligo and ocular disease. Of the 129 patients whose uveitis had an unknown cause, seven (5.4%) had cutaneous depigmentation, poliosis, or early graying of hair. The incidence is 0.5% in the general population (P<.02). None of the 25 patients whose uveitis had a known cause had vitiligo. Eleven (4.8%) of 223 patients with vitiligo had uveitis at the time of the study or had had it within the previous two years. Of 27 patients in whom vitiligo was associated with cutaneous melanoma, five (18.5%) had had uveitis within the previous two years. In three of these five, the uveitis began within one month of the appearance of cutaneous changes. Evidence of old chorioretinal scars were present in 69 of 223 patients with vitiligo (30.9%) but in only two of 148 control patients (P<.001). Sixty of 223 patients with vitiligo (26.9%) had evidence of hypopigmentation or atrophy of the retinal pigment epithelium, or both, not related to old chorioretinitis or macular degeneration but only six of 148 controls did (P<.001).

Peripheral iridectomy was performed in pigmented rabbits after the application of bipolar microcautery to the iris surface. At low doses of cautery, no increase in post-operative inflammation or complications was noted clinically or pathologically in control eyes. High doses of cautery resulted in an increased incidence of postoperative inflammation, corneal opacity, hyphema, iris prolapse, lens changes, and poor wound healing.