Seymour Brownstein

The Prevalence of Macular Drusen in Postmortem Eyes

In a histologic study of 46 eyes from 23 consecutive autopsy cases (mean age, 67 years; range, 36 to 94 years) with no previously documented ocular disease, drusen were identified in the macula of 87% (40 of 46 eyes), with hard drusen in 83% (38 of 46 eyes) and soft drusen in 39% (18 of 46 eyes). Soft drusen were found without hard drusen in two maculas. In 14 of the 16 eyes that contained both hard and soft drusen, the hard drusen outnumbered the soft drusen. The number of macular drusen in the right eye generally approximated that in the left eye for both hard drusen (r = 0.959; P less than .001) and soft drusen (r = 0.754; P less than .001). There was no correlation (t = 0.538; P greater than .05) between the number of hard drusen and increasing age. However, there was a significant correlation (t = 2.54; P less than .02) between the number of soft drusen and increasing age.

The Role of Cryotheraphy in the Management of Conjunctival Melanoma

Abstract Fifteen patients with melanocytic proliferative disease of the conjunctiva were treated in part by cryotherapy. In all cases nodules of invasive malignant melanoma were removed surgically if they were present, and cryotherapy was delivered to the base of surgical excision, as well as to surrounding areas of flat pigmentation consisting of intraepithelial melanocytic proliferation. Four patients with focal nodules of invasive malignant melanoma surrounded by minimal to moderate amounts of intraepithelial flat pigmentation appeared to have complete arrest of their disease from six months to 21h years of follow-up. Five patients with preinvasive disease (intraepithelial atypical melanocytic hyperplasia) have had follow-ups of three months to two years (median of 11h years); two patients appear to have had complete arrest of their disease; and three others with very extensive disease have persistent pigmentation and will require additional cryotherapy. With the exceptions of one patient who experienced severe corneal complications leading to a profound loss in vision, and another with progressive bilateral senile macular degeneration, the others have maintained the same vision after operation that they had before cryotherapy. Three patients in this group experienced mild ptosis, two loss of cilia due to eyelid margin involvement, two reversible iritis, and one mild symblepharon formation from forniceal disease. The patient with corneal scarring also developed a cataract. Six patients had widespread flat pigmentation of the conjunctiva associated with one or more nodules of invasive malignant melanoma. Three patients appeared to have complete arrest of their disease, and three others have had evidence of persistent melanocytic activity, with follow-ups of three months to three years (median of one year). The preoperative and postoperative visual acuities have been the same. More severe symblepharon formation was encountered in these patients because of forniceal surgery (four patients), mild ptosis was encountered in one and severe ptosis in three; these patients were more apt to have pupillary and precorneal tear film abnormalities from damage to the ciliary body and accessory lacrimal glands respectively (three patients each). Recurrences in both the preinvasive diffuse and widespread malignant melanoma groups were frequently due to incompletely treated intraepithelial disease, as well as to the impossibility of treating all areas in one cryotherapy session, so that healing usually involved the migration of atypical melanocytes from untreated areas to treated ones. None of the patients has developed deeply invasive disease such as two-thirds of them had at the time they presented, and none of the patients has experienced regional or distant metastases. By adding cryotherapy to the removal of invasive nodules, none of the patients required exenteration.

Lacrimal Drainage System Inflammatory Masses from Retained Silicone Tubing

In two cases studied we found inflammatory masses of the lacrimal system associated with retained silicone material. We saw the first patient two years after a failed dacryocystorhinostomy. A mass of the superior punctum mimicking a lacrimal sac or canalicular neoplasm consisted of chronic granulomatous inflammation centered around retained silicone tubing. In the second patient, a foreign body giant cell inflammatory reaction occurred in the lacrimal sac in which there were retained knots of silicone tubing. We believed the inflammation in these patients to be caused by the knots and the cut ends of the silicone tubing present in the lacrimal drainage system.

Inverted Papilloma of the Conjunctiva

We encountered inverted papilloma of the conjunctiva in three cases. To the best of our knowledge, this tumor, which typically involves the nose, paranasal sinuses, and lacrimal sac, has not been described previously in the conjunctiva. Two of the tumors occurred as purely inverted lesions of the inner canthal region )caruncle and plica) and the third as a mixed inverted-exophytic papilloma over the tarsus. Melanotic pigmentation in one of the lesions was clinically confused with malignant melanoma. Because of the high incidence of recurrence of these tumors in the sinuses and lacrimal sac, and their unknown biologic behavior in the conjunctiva, inverted papillomas should be removed completely and the patients carefully observed.

Cryptophthalmos Syndrome with Bilateral Renal Agenesis

We conducted a postmortem study of an infant with the abortive form of the cryptophthalmos syndrome. He had syndactyly and anal atresia and also showed features of Potters (renal nonfunction) syndrome, including bilateral renal agenesis, pulmonary hypoplasia, and the typical facies. Histopathologic examination of both globes disclosed that the superior eyelid folds were partially replaced by skin that fused with the superior third of each cornea; there were also anomalies of the superior canaliculi and scarring of the corneas. We found no specific abnormality of the intraocular contents.

Fibrous histiocytoma of the corneoscleral limbus and conjunctiva.

An 11-year-old boy and a 28-year-old woman each had a painless, slowly enlarging, elevated, yellow lesion of the inferior corneoscleral limbus and adjacent cornea and conjunctiva of the left eye. Histopathologic examination of both lesions disclosed involvement of the conjunctival substantia propria and the adjacent limbal and peripheral corneal stroma by a nonencapsulated, dense infiltrate composed of elongated fibrocytic cells, plump histiocytic cells occasionally with a vacuolated cytoplasm, some multinucleated giant cells, and scattered lymphocytes. The diagnosis in each case was fibrous histiocytoma. Both patients were otherwise in good health with no dermatologic, systemic, or other ocular abnormalities.

S-Antigen Immunoreactivity in Trilateral Retinoblastoma

Using monoclonal antibody MAbA9-C6, which identifies an antigenic determinant of S-antigen retained in fixed tissue sections, we investigated S-antigen immunoreactivity in the ocular and brain tumors of four cases of trilateral retinoblastoma. In the eye, S-antigen immunoreactivity was present in all retinoblastomas examined, as well as one retinocytoma characterized by benign appearing cells including fleurettes. S-antigen immunoreactivity was focally present in two of the four brain tumors examined. Additionally, two intraocular medulloepitheliomas, one of which contained well-defined rosettes, and 16 primary intracranial tumors, including seven pineal gland tumors and nine other lesions, some of which histopathologically may resemble retinoblastoma, were examined. S-antigen immunoreactivity was observed in two pineal gland tumors but not the remaining nine primary intracranial neoplasms or the two intraocular medulloepitheliomas. Our results further substantiate the immunologic relationship between the retina and the pineal gland, and tumors originating in these tissues.

Carbon Dioxide Laser Treatment of the Conjunctiva and the Cornea

Carbon dioxide (CO2) laser treatment was applied to the cornea and conjunctiva of 16 eyes from eight young pigs at power levels of 2.5 to 20.0 W, an exposure time of 0.1 seconds and different numbers of overlapping burns. Four animals were euthanatized at 30 minutes, one at 36 hours and three from 18 to 21 days after the treatment. Nitrous oxide (N2O) cryotherapy also was applied in a double freeze-thaw fashion to three of the eyes to compare the effects of the CO2 laser and cryotherapy at each of the time intervals. Epithelial destruction was achieved with CO2 laser power levels of 5.0 W and one or more superimposed burns. At 5.0 W, Bowmans membrane was destroyed while the conjunctival substantia propria protected the underlying sclera. The anterior chamber reaction was minimal and appeared to be less intense than with cryotherapy after 36 hours. At high energy levels (20.0 W), corneal and scleral perforation occurred. Furthermore, we have treated five human patients with the CO2 laser for bulbar conjunctival epithelial proliferative disorders. Minimal scarring occurred and local control of the disease was obtained in four patients. The CO2 laser may offer advantages over other modalities of treatment for bulbar conjunctival epithelial disorders. Its use is not recommended for lesions of the cornea and forniceal or palpebral conjunctiva.

Pseudomonas Aeruginosa Scleritis

In two patients Pseudomonas aeruginosa scleral infection led to ocular perforation. In one patient, a scleral abscess was identified anteriorly. A scleral perforation occurred at a more posterior focus, but the eye was salvaged with minimal residual visual function. In the other patient, perforation at the corneoscleral limbus occurred after initial corneal improvement with antibiotic therapy; histopathologic examination of the enucleated globe disclosed an abscess extending from the corneoscleral limbus to the equator superiorly.

Fungal Invasion of Seven Hydrophilic Contact Lenses

In six patients we reviewed the clinical, microbiologic, and histopathologic findings of seven hydrophilic contact lenses that had been infiltrated by fungi. Three patients had visual blurring or irritation and redness while wearing a contaminated lens; of these, two were unaware of any lens deposits. Three of the lenses from two patients were spares kept in storage for six months and one year, respectively. One contaminated lens had been torn and was kept in a case while a loaner lens was worn. Culture of this lens grew Cladosporium species. The contact lens case from one patient grew Penicillium species. Gross pathologic inspection disclosed multiple brown deposits in five lenses, multiple gray infiltrates in one lens, and a white infiltrate in one lens. Light microscopic examination disclosed partial-thickness (three lenses) or full-thickness (four lenses) invasion of the lens matrix by fungi, which contained granular, brown pigment in six lenses.