William C. Lloyd

Corneal pathology in microphthalmia with linear skin defects syndrome.

PURPOSE To describe the histopathology of the cornea in microphthalmia with linear streaks (MLS) syndrome. METHODS Two patients with MLS syndrome underwent penetrating keratoplasty. This study describes the histopathology and investigates immunophenotype of the corneal extracellular matrix by using keratan sulfate and collagen type III antibodies. RESULTS Clinical examination revealed bilateral sclerocornea and characteristic skin changes. By light microscopy, central corneal stroma in both patients showed vascularization and irregular thick collagen lamellae typical of sclerocornea. In addition, corneal thinning, anterior synechiae, and the absence of the Descemet membrane were noted, which was suggestive of Peters anomaly. Diffuse and intense anti-keratan sulfate staining and minimal anti-collagen type III stromal staining were seen in both corneal buttons. CONCLUSIONS The cornea in MLS may clinically resemble sclerocornea. Histologic features resemble those previously described in sclerocornea and also seen in anterior segment dysgeneses. Keratan sulfate and collagen type III labeling suggests that the corneal extracellular matrix resembled cornea and not sclera.Objective:To examine characteristics of circumcised and uncircumcised Latino and black men who have sex with men (MSM) in the United States and assess the association between circumcision and HIV infection. Methods:Using respondent-driven sampling, 1154 black MSM and 1091 Latino MSM were recruited from New York City, Philadelphia, and Los Angeles. A 45-minute computer-assisted interview and a rapid oral fluid HIV antibody test (OraSure Technologies, Bethlehem, PA) were administered to participants. Results:Circumcision prevalence was higher among black MSM than among Latino MSM (74% vs. 33%; P < 0.0001). Circumcised MSM in both racial/ethnic groups were more likely than uncircumcised MSM to be born in the United States or to have a US-born parent. Circumcision status was not associated with prevalent HIV infection among Latino MSM, black MSM, black bisexual men, or black or Latino men who reported being HIV-negative based on their last HIV test. Further, circumcision was not associated with a reduced likelihood of HIV infection among men who had engaged in unprotected insertive and not unprotected receptive anal sex. Conclusions:In these cross-sectional data, there was no evidence that being circumcised was protective against HIV infection among black MSM or Latino MSM.

Treatment Protocol for Orbital Inflammatory Disease

Forty-five consecutive patients suspected of having orbital inflammatory disease (OID) were treated according to a protocol that provided specific dosages of steroids and a formula of dose reduction. Nonresponsive cases were managed with intravenous dexamethasone and, when brought under control, were switched to oral therapy. The cases that continued to be unresponsive or escaped from control were biopsied. If the frozen section was read as inflammatory, intralesional steroid was injected. For resistant or recurrent cases, 1000-3000 rads of orbital irradiation were delivered in fractionated doses. For extreme cases, radiotherapy was combined with steroids and chemotherapy (cyclophosphamide). Twenty-nine patients improved with steroids alone, four with additional intralesional steroid injections, six with radiotherapy, and two required both radiotherapy and chemotherapy.

Surgical Repair of Medial Wall Fractures

We treated ten patients with medial wall fractures, five of whom had concomitant floor fractures. The most consistent preoperative findings were restriction in abduction with retraction of the globe and limitation in adduction. A direct medial canthal surgical approach provided adequate exposure for removing incarcerated tissue as well as covering the defect with a thin silicone implant. There were no surgical complications or evidence of implant migration, the longest follow-up being two years. Of the ten patients, six had satisfactory results with full or nearly full ductions, one was orthophoric in the primary position but still had significant restriction in abduction, and three had persistent diplopia in the primary position.

Malignant Melanoma of the Lacrimal Sac

A 79-year-old man with a bloody ocular discharge and a mass above the medial canthal tendon was found to have a malignant melanoma of the lacrimal sac. Because he refused radical surgery, he was treated with radiotherapy and chemotherapy. Within a year the tumor had spread to his palate and cervical nodes. Because of the uncommon occurrence of melanoma in the lacrimal area and the fact that the microscopic appearance may resemble other malignancies, special stains are necessary for identification to implement the appropriate therapy.

A Simple Method of Instant Close-up Photography

In the ophthalmic examination, photographs document both normal and pathologic findings in patients. Thus, they constitute an invaluable part of the medical record. High-quality external photographs, produced quickly and inexpensively, are particularly helpful as a surgeons reference in blepharoplasty, blepharoptosis correction, and other oculoplastic procedures. Instant-camera photography is also useful in the evaluation of ocular motility and neuro-ophthalmic disorders.