Bruce L. Johnson

Corneal Toxicity with Systemic Cytarabine

Three patients with leukemia developed corneal toxicity while receiving high doses (3 g/m2) of systemic cytarabine. Symptoms began five to seven days after initiation of treatment with high doses of systemic cytarabine and consisted of ocular pain, tearing, foreign-body sensation, photophobia, and blurred vision. All three patients developed bilateral conjunctival hyperemia and fine corneal epithelial opacities and refractile microcysts that were more numerous in the central than in the peripheral cornea. The symptoms disappeared without treatment in approximately one week. The corneal changes we observed with high doses of systemic cytarabine resembled descriptions of corneal toxicity from topical cytarabine and were probably secondary to inhibition of DNA synthesis in the corneal epithelium.

Orbital Fine-Needle Aspiration Biopsy

Fine-needle aspiration was used as a primary orbital diagnostic technique in 156 patients. A 20-mm syringe, a 22-gauge, 3.75-cm needle, and a plastic pistol grip were used. Local anesthetic was not necessary. When the needle is in the lesion, small to-and-fro movements with a minimum of angulation are helpful. The aspirate is spread on slides fixed with alcohol. Positive cytologic identification was made in 125 of 156 cases. Commonly identified lesions included metastatic carcinoma, inflammatory lesions, and lymphoid lesions. Small posterior apical lesions are difficult to aspirate, but are often the most rewarding diagnostically. Fine-needle aspiration was not successful in tumors of fibrous consistency, in those located in the orbital apex, or in lymphocytic lesions with specimens inadequate for diagnosis.

Rosai-Dorfman disease presenting with multiple orbital and intracranial masses

Abstract Rosai-Dorfman disease is an idiopathic histocytic proliferative disorder typically characterized by painless cervical adenopathy, fever, and weight loss. Extranodal manifestations are responsible for presentation in approximately 25% of patients. Orbital involvement has been described in about 10% of patients. There have been only 16 reported cases of Rosai-Dorfman disease presenting with an intracranial mass. We report an unusual case of a patient presenting with bilateral orbital tumors as well as multiple intracranial masses. Clinical, magnetic resonance imaging, and histopathological features are discussed.

Neuroretinitis Associated with Herpes Simplex Encephalitis in an Adult

A 48-year-old man who died of herpes simplex encephalitis had a bilateral papillitis at autopsy. Intranuclear inclusion bodies were especially numerous within the ganglion cells and inner nuclear layer of the macula and consisted of typical virions by electron microscopy. Contiguous spread from the brain to the eyes may have occurred via the optic nerves. Clinically, the disk and retinal changes were misinterpreted as being caused by papilledema. Papillitis should be included in the differential diagnosis of disk swelling in adults with suspected Herpesvirus hominis infection of the central nervous system.

Microsurgical Removal of a Primary Intraorbital Meningioma

A 48-year-old woman with a primary intraorbital meningioma associated with the optic nerve sheath underwent a microsurgical removal of the tumor through a lateral orbitotomy. Visual recovery was essentially complete.

CT-Guided Fine Needle Aspiration Biopsy of Orbital Optic Nerve, Tumors

Biopsies were done for seven patients who had blinding optic nerve tumors or inflammations, using the fine needle aspiration technique guided by the CT scan. Cytologic material was recovered in this manner in all cases, which allowed the rendering of diagnoses. This allowed for therapeutic planning with minimal therapeutic invasion.

A Light and Electron Microscopic Study of Recurrent Granular Dystrophy of The Cornea

Light and electron microscopic studies in three cases of recurrent granular dystrophy with corneal epithelial involvement showed intracellular rod and trapezoidal crystalline granules characteristic of granular dystrophy. Small intraepithelial cytoplasmic granules were rimmed by 15-nm particles, while larger deposits were often membrane-bound. The granules were closely associated with tonofilaments. There were ultrastructural similarities to keratohyaline. Extracellular granules were often intermixed with cytoplasmic organelles of disintegrated squamous epithelial cells. There was no evidence of a subepithelial pannus. These findings suggest an epithelial origin of the granular dystrophic deposits in these recurrent cases.

Orbital fine needle aspiration biopsy with B-scan guidance.

In three patients we used B-scan ultrasonography to guide the placement of an aspirating needle, which allowed rapid and accurate cytologic diagnosis of retrobulbar orbital neoplasms. This technique spares the patient the greater costs, inconvenience, and morbidity of more invasive procedures.

Keratoglobus and Blue Sclera

Five patients from two families had similar features including keratoglobus, blue scleras, hyperextensibility of the hand, wrist, and ankle joints, sensorineural conduction hearing alterations, and mottling of the teeth. Keratoglobus had been observed in all patients at, or shortly after, birth. Corneal perforations developed in seven of the ten eyes after minimal trauma. Repair of these perforations was complicated by the extremely thin corneas and six eyes had to be either enucleated or eviscerated. Histopathological examination of two of the enucleated eyes showed the corneal stromas of both eyes to be estremely thin, Bowmans membrane was absent, and Descemets membrane was unusually thick. This condition has an autosomal-recessive inheritance pattern.

The role of the crystalline lens epithelium in postpseudophakos membrane formation.

Pupillary membranes were experimentally produced in rabbits and correlated with biopsy specimens from human eyes which had undergone extracapsular cataract extraction. These fibrous membranes were derived from proliferation of lens epithelial cells. Wider anterior capsulectomies or barrier devices attached to intraocular lenses may reduce opacification of intact posterior capsules.