Irene Pecorella

Osteo-odonto-keratoprosthesis: Description of Surgical Technique with Results in 85 Patients

Osteo-odonto-keratoprosthesis is a technique designed for patients with severe corneal opacification who would be at high risk of graft rejection should donor tissue transplantation be performed. Because of the isolation of the prosthetic implant from the tissues that the technique provides, the authors are of the opinion that it is the only viable option in such patients. The visual outcome and complications of the procedure in a series of 85 cases are presented.

Strampelli's osteo-odonto-keratoprosthesis. Clinical and histological long-term features of three prostheses.

The histological features are reported of osteo-odonto-acrylic laminae removed from three patients who for differing underlying causes received Strampellis osteo-odonto-keratoprostheses (OOK) 20, 16, and 12 years previously. It appears that preservation of the alveolar-dental ligament plays a definitive role in the maintenance of the prosthesis. If this tissue undergoes necrosis as a consequence of an inflammatory disease the implanted material is eventually lost. However when no such event occurs the OOK is well preserved and well tolerated even 20 years after implantation.

Inflammatory Pseudotumour of the Liver — Evidence for Malignant Transformation

A case of inflammatory pseudotumour of the liver is reported, and evidence is presented for its subsequent evolution into malignant non-Hodgkins lymphoma. Such postulated malignant transformation challenges the assumption that hepatic inflammatory tumours are entirely benign lesions.

Are most intraocular leiomyomas really melanocytic lesions

BACKGROUND Intraocular smooth muscle tumors have long been a subject of controversy. The advent of immunohistochemistry with antibodies against HMB-45, S-100, smooth muscle actin, desmin, and vimentin has helped greatly in the distinction between smooth muscle tumors and melanocytic lesions. METHODS Twenty-seven archival tissue blocks from patients who had had intraocular leiomyomas or leiomyosarcomas diagnosed were located and fresh sections cut and stained for the above markers. The cases constituted 24 iris lesions and 3 ciliary body lesions. RESULTS All 24 iris tumors were reclassified as iris melanocytic lesions. Two of the three ciliary body leiomyomas retained their classification, and the third was reclassified as a spindle B-cell melanoma. CONCLUSION The authors suggest that intraocular leiomyomas are much rarer than previously suggested and that many of the cases previously reported in the literature are open to question.

Preoperative and postoperative size and movements of the lens capsular bag: ultrasound biomicroscopy analysis.

PURPOSE: To evaluate capsular bag size and accommodative movement before and after cataract surgery using ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS‐OCT). SETTING: Ophthalmology Unit, Fabia Mater Clinic, Rome, Italy. DESIGN: Cohort study. METHODS: Eyes having cataract surgery and monofocal intraocular lens (IOL) implantation were studied using UBM. The following parameters were measured preoperatively and 1, 2, and 12 months postoperatively: anterior chamber depth (ACD) (also by AS‐OCT), capsular bag thickness, capsular bag diameter, ciliary ring diameter, sulcus‐to‐sulcus (STS) diameter, ciliary process–capsular bag distance, ciliary apex–capsular bag plane, and IOL tilting. The preoperative and postoperative capsular bag volumes were calculated at 12 months. The results were compared with the changes during accommodation. RESULTS: The study comprised 24 eyes. With the exception of the ciliary apex–capsular bag plane, which appeared to be unmodified postoperatively, all measured parameters showed significant variation after IOL implantation. Only the ACD did not change significantly during accommodation. CONCLUSIONS: After cataract surgery, the capsular bag stretched horizontally and with reduced vertical diameter as a result of adaptation to the implanted IOL. The capsular bag–IOL complex filled all available space, compressing the zonular fibers and almost abolishing the space between the ciliary apex and the capsular bag. There was anterior chamber deepening and a decrease in the ciliary ring diameter and STS diameter. In the absence of zonular fiber tension, the shape of the ciliary processes may be modified. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Psychophysical and Electrophysiological Testing in Ocular Hypertension

Purpose. The purpose of this study was to compare psychophysical and electrophysiological testings in early optic nerve dysfunction in a group of clinically asymptomatic subjects with suspect ocular hypertension (OHT). Methods. Forty eyes of 40 patients with suspect OHT and asymmetrical horizontal cup/disc ratio (0.2/0.4), 22 eyes of 22 patients with open-angle glaucoma (OAG), and 40 eyes of 40 healthy controls were evaluated by using frequency-doubling technology perimetry (FDT), contrast sensitivity (CS), pattern electroretinography (PERG), and pattern visual-evoked potentials (VEP). The VEP were elicited by checkerboard stimuli with large (VEP 120), medium (VEP 45), and small (VEP 15) checks; then the values of the amplitude (A) and latency (L) of P100 peaks were studied. Receiver operator characteristic (ROC) curves were calculated to determine the sensitivity, specificity, and optimal cutoff points of abnormal values. A logistic regression analysis was performed to determine which tests were providing the most useful information. In addition, Kruskal-Wallis test was performed to test the differences between the control group and the OHT group. Results. VEP P100 peak latency (VEP L15 and VEP L45) and amplitude (VEP A120), PERG N95 peak amplitude, CS at medium spatial frequencies (CS 4SF), and FDT pattern standard deviation (PSD) yielded the greatest sensitivity (85.0 to 60.0%) and specificity (80.0 to 60.0%) ratio, displaying the largest ROC curve areas; whereas PERG N95 peak latency ROC curve had the smallest areas. Kruskal-Wallis test showed that most diagnostic tests were able to differentiate the OHT group from the control group. Stepwise logistic regression analysis identified VEP L15 (p < 0.001), CS 4SF (p = 0.023), FDT PSD (p = 0.032), and VEP A120 (p = 0.072) as tests that could be useful to distinguish controls from OHT. Conclusions. Our data confirm that psychophysical and electrophysiological tests are useful for early detection of patients at risk of developing OAG.

Co-occurrence of Psoriatic Arthritis with Collagenous Colitis: Clinicopathologic findings of a Case

Abstract A 58-year-old man developed psoriatic arthritis and, after 6 months, persistent watery diarrhoea. Biopsies from the colorectal mucosa showed thickened subepithelial collagen consistent with collagenous colitis. There also was an inflammatory cell infiltration (mainly lymphocytes and monocytes) in the chorion. These findings and the parallel course of articular and bowel complaints suggest a clinicopathologic correlation between arthritis and colic involvement.

Postmortem histological survey of the ocular lesions in a British population of AIDS patients.

AIMS To study ocular pathology and systemic correlations in a series of 73 postmortem eyes from British patients who died from AIDS before the introduction of a HAART regimen. METHODS The eyes were studied with conventional histology, special histochemical stainings, and immunohistochemistry. RESULTS 72.6% of the cases showed chronic uveal inflammation, caused by opportunistic agents in 37.7% of them (cytomegalovirus (CMV) in 30.1%,C neoformans in 5.6%, and Gram positive bacteria in 1.8%). Cytoid bodies were noted in 10/73 eyes, three linked to CMV retinitis. Six retinal haemorrhages, four of which were secondary to CMV, were found. 14 specimens (19.1%) showed foci of calcification, and a further 11 (15%) calcium oxalate deposits. In no cases were the calcific deposits suspected clinically. Six eyes (8.2%) did not show any abnormality. CONCLUSIONS CMV retinitis is the most common (28.7%, 21/73) ocular infection in this series and may occur either during or in the absence of systemic dissemination. Conversely, ocular cryptococcosis appears to be an epiphenomenon of systemic and CNS disease. No other opportunistic ocular infections were present in this series. Interesting findings were the presence of intraocular precipitates of calcium oxalate and calcium phosphate or carbonate in a significant number of cases (15% and 19%, respectively), and the high prevalence of idiopathic uveal inflammation (43.8%).

Calcium oxalate microdeposition in failing kidney grafts

Forty allograft nephrectomies (28 males and 12 females, mean age of 33.2 years), performed between 1986 and 1999, were selected. Twenty patients had been grafted from cadaveric donors; of the remaining cases, 15 had received a kidney from a living related donor. Except for six patients who received steroid-azathioprine immunosuppression, all recipients were treated with cyclosporine A and low doses of steroids. None had primary or acquired hyperoxaluria as the cause of original end-stage renal disease, and none had a history of kidney stones or urinary infection. Kidney failure occurred after a time period ranging from 2 days to 11 years posttransplant and was secondary to acute rejection in 17 cases, chronic rejection in 15, ischemic necrosis in five, acute or chronic pielonephritis in two, and allergic microangiopathy in one. No blood chemistry evaluations for oxalemia were performed. Clinical data are summarized in Table 1. Multiple sections cut from formalin-fixed, paraffin-embedded blocks and stained with haematoxylin-eosin (H&E) were examined using partially crossed polarizing screens. The presence of calcium oxalate crystals in different segments of the nephron or in the interstitium was recorded. Birefringent deposits with characteristic green iridescence, presenting as large plate-like or diamondshaped crystals, or any shape, provided that the crystals displaced tissue structures, were studied. Confirmation of the crystal nature was obtained using Yasue’s method, a histochemical stain considered to be specific for calcium oxalate, while usual stains for calcium (alizarin red and von Kossa’s method) were negative. Silver nitrate–rubeanic acid with 5% acetic acid pretreatment (Yasue’s method) stains only calcium oxalate, since calcium phosphate and calcium carbonate are dissolved with the acetic acid. A thyroid with multiple deposits of calcium oxalate and hydroxyapatite crystals was used as a positive control for the histochemical stains.

Ocular, cerebral and systemic interrelationships of cytomegalovirus infection in a postmortem study of AIDS patients

Purpose Eighty-six post-mortems of AIDS patients were reviewed microscopically and the presence of cytomegalovirus (CMV) infection in the viscera, brain and eye was recorded.Methods Immunohistochemical stains and in situ hybridisation with a CMV probe were performed.Results and conclusion CMV infection was observed in 63% of the cases. Visceral, cerebral and ocular involvement were overall 49%, 33% and 29%, respectively. The visceral form with no concomitant ocular and/or cerebral infection was the main cause of death (31%) in the 54 CMV-infected patients. Although CMV retinitis occurred mostly (20%) as a component of systemic disease, in 13% of the CMV-infected patients the eyes only were involved, while there were no cases with CMV limited to the brain. In the absence of systemic involvement, 9% of the cases showed concomitant ocular and cerebral infection, but because we failed to observe CMV optic neuritis without ocular involvement, retrograde viral spread from the brain through the optic nerve appears to be an infrequent mechanism of CMV retinitis.