Joseph B. Michelson

Fetal antigens in retinoblastoma

Plasma carcinoembryonic antigen (CEA) and alpha fetoprotein (AFP) levels were studied in five patients with retinoblastoma. CEA and AFP were found elevated in four of five patients prior to therapy. Following enucleation and/or radiation therapy, the elevated values were significantly lowered. This preliminary study suggests that CEA and AFP levels may be of value in the diagnosis of retinoblastoma, and that serial CEA levels may be useful in evaluation of retinoblastoma patients after treatment.

Cea family syndrome—Abnormal carcino embryonic antigen (CEA) levels in asymptomatic retinoblastoma family members

Plasma carcinoembryonic antigen (CEA) levels were studied in all available members of 17 families in which a presumed sporadic retinoblastoma had occurred. In 9 of the 17 families, close relatives of the patient had elevated CEA levels in the absence of demonstrable disease; this we have termed the “CEA family syndrome.” In two families (Nos. 8 and 17) one or both parents and all of the siblings had elevated CEA levels. To our knowledge, this is the first report of abnormal CEA levels in unaffected family members of patients with nonadenocarcinoma‐type malignancies. As follow‐up studies of such families become available, detection of the “CEA family syndrome” may prove to be a useful means of locating individuals with inherited premalignant or malignant conditions and may provide a stimulus for additional clinical examination of asymptomatic individuals considered at risk for developing malignancies.

Melting corneas with collapsing nose

A 31-year-old white woman with relapsing polychondritis presented with profound, diffuse episcleritis, marked conjunctival chemosis, and corneal-limbal inflammation and melting, which was refractory to corticosteroid treatment. With the initiation of chlorambucil the inflammation subsided, leaving an almost normal slit-lamp picture. The associated findings of nasal cartilage and pinna cartilage inflammation helped to establish the diagnosis of relapsing polychondritis in this patient.

Subretinal Neovascular Membrane and Disciform Scar in Behçet's Disease

A 33-year-old woman with a three-year history of aphthous ulceration of the mouth, vaginal ulceration, and erythema nodosum, also had a subretinal neovascular membrane in the left eye. She showed antibodies to guinea pig lip epithelium by indirect immunofluorescence. Thus, Behçets disease must also be considered in the differential diagnosis of subretinal neovascular membrane in young patients, especially when antibodies to oral mucosa can be shown.

Antibodies to Oral Mucosa in Patients with Ocular Behcet's Disease

A method is reported for the identification of cytoplasmic antibodies in patients with Behcets disease and uveitis. The assay appears positive in at least 80% of patients in an American population with definite or probable Behcets disease and 60% of patients from a Turkish population with definite Behcets disease, with a false-positive rate of 6.5% among non-Behcets ocular inflammatory disorders with vasculitis. When refined, this test may prove useful to the ophthalmologist in selecting out those patients with Behcets disease from the larger group of patients with uveitis for whom no systemic etiology is identified.

Nonocular manifestations of parenteral drug abuse

The nonocular manifestations of parenteral drug abuse are presented to familiarize the ophthalmologist with this ever growing, medical and psychosocial problem. The ophthalmologist, like other primary care physicians, may be the first professional to encounter these patients whose substance abuse may lead to a wider spectrum of physical and psychiatric illness. The variety, history, and manifestations of abused substances are discussed.

Iridocyclitis masquerade syndrome

A 52-year-old man presented with blurred vision and a red, painful eye. There was a marked anterior uveitis associated with a solid white lesion on the iris. The differential diagnosis and appropriate diagnostic workup are discussed. The diagnosis of adenocarcinoma of the lung with metastasis to the iris was made.

Retroviruses and Their Play-pals

A 28-year-old man with a previous history of Neissena infection presented with diminished vision, disc swelling, and panuveitis. Serologic tests revealed positive titers for both HIV and syphilis. Current epidemiology and treatment of such cases are discussed.

Subretinal fluid examination of LDH, PGI, and CEA in a case of metastatic bronchogenic carcinoma of the choroid

A 58‐year‐old white male with a history of bronchogenic carcinoma presented with a total retinal detachment overlying a choroidal metastasis. His main tumor burden had been extirpated by pneumonectomy followed by radiation therapy four months prior to admission. With the development of a painful, glaucomatous eye, unresponsive to conventional therapy, enucleation was performed. Histologic examination of the enucleated globe revealed a metastatic tumor to the choroid, consistent with primary bronchogenic carcinoma. Aqueous humor and plasma examination revealed elevated ratios (Aqueous humor:Plasma) of lactate dehydrogenase (LDH) and phosphoglucose isomerase (PGI). Furthermore, subretinal fluid examination demonstrated concentrations of LDH and PGI higher than aqueous humor. While the level of carcinoembryonic antigen (CEA) in the plasma was normal (<2.5 ng/ml) following pneumonectomy, it was 121 ng/ml in the subretinal fluid. This would suggest that a choroidal lesion alone, in the absence of a clinically detectable primary tumor, is insufficient to elevate the plasma CEA.

Acute psychiatric decompensation with sudden loss of vision.

Abstract A 60-year-old woman with Vogt-Koyanagi-Harada syndrome was referred with a four-month history of psychiatric decompensation, acute bilateral visual loss, headaches, intraocular inflammation, and exudative retinal detachment unresponsive to argon laser photocoagulation. She was treated successfully with subtenons and systemic steroids, pars plana vitrectomy, and chlorambucil with improvement of visual acuity to 20 40 in her left eye and resolution of the psychiatric disorder.