Kathleen A. Lamping

Long-term Evaluation of Initial Filtration Surgery

In a long-term study of 252 eyes that had initial glaucoma filtration surgery, there was an overall success rate of 85%. Rigid criteria for success included an intraocular pressure equal to or less than 19 mmHg, no further visual field loss or disc damage, and no glaucomatous etiology for a decrease in visual acuity. The success rate was evaluated over an extended postoperative period with a range of 2 to 14 years and a mean follow-up of five years (61 months). Full thickness procedures had a higher success rate for a greater length of time, 88% (6 years) than did trabeculectomy, 76% (4 years). If an eye was considered successful at two years, the probability of success at five years was 94.5% for full thickness procedures and only 82% for trabeculectomies. Choroidal effusion associated with hypotony and shallow anterior chamber was the most frequent postoperative complication. There was no difference in the incidence between full thickness procedures and trabeculectomies. Cataract extraction was indicated more often following full thickness procedures, 34%, than trabeculectomies, 21%. However, the performance of a choroidal tap or subsequent cataract extraction did not appear to influence the success of the filtration operation. Bleb leaks and bleb infection occurred only after full thickness operations and were associated with a high 5/8 (62%) rate of bleb failure and loss of glaucoma control. Full thickness filtering operations appeared to insure a lower pressure from a longer period of time than does trabeculectomy.

The Dysplastic Nevus Syndrome: A Pedigree with Primary Malignant Melanomas of the Choroid and Skin

Intraocular and cutaneous melanomas developed in a family with features of the dysplastic nevus syndrome. (The proband had a choroidal melanoma, his son had a cutaneous melanoma, and his grandchildren have mildly atypical melanocytic lesions clinically.) The syndrome is characterized by clinically and histologically atypical nevi, which may serve as cutaneous markers to identify persons at high risk for melanomas, both of the skin and the eye. Although it has been proposed recently that the association of intraocular melanoma with cutaneous melanoma and the dysplastic nevus syndrome may be coincidental, statistical analysis suggests that the occurrence of the two forms of melanoma in the same patient and in different members of the same family is not explained by chance alone. Therefore, until the relationship between intraocular and cutaneous melanomas is more fully elucidated, recognition of the dysplastic nevus syndrome is important, and the skin of patients suspected of having intraocular melanomas should be examined routinely for evidence of atypical melanocytic lesions.

Melanotic Neuroectodermal Tumor of Infancy: (Retinal Anlage Tumor)

Six cases of the melanotic neuroectodermal tumor of infancy, including light and electron microscopic findings, are presented. The tumor, now believed to originate from neural crest, is usually cured by wide excision; however, malignant cases have been reported. Histopathologically, this lesion resembles neural retina and retinal pigment epithelium. It may involve the orbit but most frequently occurs in the maxilla. One case presented involved the orbit, another the anterior fontanelle, and four presented in the maxilla.

The Harrower collection and its place in the history of ophthalmic pathology

A set of ophthalmic pathology slides made in 1882 by Dr. David Harrower, a Massachusetts physician who studied at Moorfields Eye Hospital, and Mr. W. Jennings Milles, the curator of Moorfields, are reviewed. They are of historical significance, as they were made at a time when microscopic examination of ocular tissues was first being introduced, and they represent one of the earliest examples of the use of celloidin for embedding ocular tissue. The slides are well preserved and contain cases demonstrating a wide spectrum of ocular pathology. The Harrower collection is possibly the oldest existing slide collection of ophthalmic histopathology.