Biomedical subjects
Publications and source records attributed to J R Wolter.
A monolayer of proliferating lens epithelium on the anterior surface of an intraocular lens was found cytologically and confirmed histologically in a postmortem examination of one eye of a 57-year-old man. The man had had extracapsular cataract surgery five years earlier. This pathological finding confirms observations with specular microscopy.
Intraocular accumulation of inflammatory neutrophils is an important feature of experimental phacoanaphylactic endophthalmitis (EPE). Increasing evidence suggests that localization of neutrophils to the site of inflammation requires the participation of neutrophil and endothelial adhesion molecules. These studies were undertaken to determine if blocking of adhesion molecules on neutrophils (CD18) or endothelium (ELAM-1) could attenuate EPE in Lewis rats. Treatment of experimental animals with anti-CD18 or anti-ELAM-1 significantly suppressed intraocular neutrophil accumulation, retinal hemorrhage, and vasculitis, and attenuated retinal edema formation by 48% and 70%, respectively. These observations demonstrate that antibodies directed against adhesion molecules on the neutrophil (CD18) or the vascular endothelial cell (ELAM-1) exhibit potent anti-inflammatory effects, resulting in a striking amelioration of injury in EPE in rats.
Hematopoietic islands of erythroblastic precursor cells with mitotic activity were found pathologically in the distorted iris of a 35-year-old diabetic male. The eye had been enucleated for absolute hemorrhagic glaucoma occurring secondary to central vein occlusion and complicating previous vitrectomy, repair of retinal detachment and extracapsular cataract extraction.
Ocular tissues frequently form a special kind of reactive fibrosis with distinct cellular strands that anchors prominent surface irregularities of lens implants--haptics, manipulation holes, or borders--to adjacent ocular structures and helps fixate the implant in the eye. The strands originate in reactive proliferation of chemotactically attracted sessile macrophages on the surface of lens implants. They are cellular in their early stages and may undergo secondary fibrosis or hyalinization. The formation of these strands is called "fixation fibrosis." An initial description of the pathology of this complicated process is presented.
Spontaneous breaks in proteinaceous membranes on the surface of intraocular lenses are demonstrated with pathological and clinical methods. These breaks appear to be the result of traction and can be a horseshoe or radial-traction type. The breaks are repaired by the natural process of protein film deposition on the newly exposed area.
The cytopathology of a lipogranuloma of external origin is reported in the eyelid of a 32-year-old man excised 1 year following regional exposure to an explosion of hydraulic oil under high pressure. The foreign lipids were still present in chronic lipogranulomas with intercellular lipid-filled cysts surrounded by macrophages and giant cells containing intracellular lipid-filled vacuoles. These indicate efforts in storage and very slow digestion. Secondary fibrosis in the region of the lipogranuloma was an important associated process. In view of the widespread technical use of hydraulic oily fluids under high pressure, it is recommended that these fluids be biodegradable.
An eye with clinically successful anterior chamberlens implantation following cataract surgery was removed at autopsy after death in accordance with the wishes of a grateful patient. It was offered for corneal transplantation, and rejected for this purpose. The eye was examined pathologically. In addition to diffuse loss of corneal endothelium, a diffuse uveitis, and a reactive membrane with macrophages on the implant, a special granulomatous surface-cyclitis associated with reactive shrinkage of the vitreous, a peripheral break of the retina, and an early stage of pseudophakic macular edema were also found.
"Minimal" orbital exenteration, obtained by excision of a lid tumor (that had recurred after local incision), removal of the conjunctival sac, enucleation, and tenonectomy were used to treat intraepithelial sebaceous epithelioma with pagetoid spread to conjunctiva and cornea in an 80-year-old man.
Invasion of the subendothelial plane of the cornea by granulocytes (polymorphonuclear leukocytes) in acute keratouveitis is shown to progressively cause separation of the endothelial layer from Descemet's membrane, interruption of the cell layer's continuity, and damage of endothelial cells. This disease mechanism is described in a case that allows for the demonstration of several representative stages of this neutrophil-mediated inflammatory process.
The eye of a 3-year-old boy was directly exposed to the explosion of an M-80 firecracker which he had been holding in his hand. The cornea and lens were ruptured. Although not evident on an initial CT scan, pathologic examination revealed a paperboard foreign body lodged in the vitreous. This paperboard, rather than the burnt powder, was likely the central focus of the subacute endophthalmitis that developed.
Xeroderma pigmentosum is an autosomal recessive, precancerous dermatosis caused by defective repair of ultraviolet-damaged DNA. Characterized clinically by progressive cutaneous pigmentary alterations and tumorigenesis, it serves as a model for ultraviolet carcinogenesis. We describe the clinical and histopathologic findings in a 31-year-old woman with xeroderma pigmentosum and a massive iris melanoma of the left eye. Histologic examination following enucleation revealed diffuse iris replacement by spindle and epithelioid cells with extension into the trabecular meshwork. Evidence of direct extraocular extension was absent, and a metastatic evaluation showed no abnormalities. To our knowledge, this is the first reported case of xeroderma pigmentosum complicated by melanoma of the iris. It provides further evidence suggesting a role for sunlight exposure in the pathogenesis of uveal melanoma.
The deposition of fibrin on the intraocular lens (IOL) in two cases of failed implantation is reported. In one case the network of fibrin fibers was isolated on the surface of an IOL that also showed a clear reactive protein film populated by macrophages and giant cells. In the other case the fibrin network was closely related to sessile macrophages on the implant surface. The presence of fibrin on IOLs indicates an acute phase of increased regional vascular permeability and is clinically important.
A choroidal melanoma was clinically suspected in one eye of an 84-year-old farmer. At the time of the first examination the patient refused the studies necessary for a certain diagnosis as well as any treatment. Later, when the eye suddenly became blind and painful, it was enucleated. Pathological study revealed necrosis of all ocular contents, but the presence of a choroidal melanoma could still be verified histologically. The ciliary artery supplying the region of the melanoma was involved with giant cell arteritis. General examination of the patient gave support to a diagnosis of temporal arteritis, and steroid treatment resulted in general improvement.
The extension of a malignant choroidal melanoma of an epithelioid cell type all through the subretinal space exhibiting a change of its solid state with its own stroma and blood supply in the choroid into a fluid growth phase resembling a tissue culture in the subretinal space is demonstrated in this case. This fluid state is represented by free-floating malignant melanoma cells living without their own stroma or direct blood supply in subretinal exudate. The transitional interface between the solid and fluid neoplastic states of this choroidal melanoma is demonstrated. The development of the fluid state indicates a potential of choroidal melanomas for isolation and survival of its cells without stroma and is related to the process of regional seeding and metastatic dispersion.
Two cases with a history of recurrent subretinal hemorrhaging are reported. Multinucleated giant cells of macrophage origin were demonstrated on Bruch's membrane in a few stages of their functions of phagocytosis of old blood and storage of blood remnants. Their classification as foreign-body giant cells fails to recognize the important purification, disposal and storage functions of these cells in situations with extensive intraocular hemorrhage, exudation or necrosis.
A foldable silicone posterior chamber intraocular lens implant caused irritation and glaucoma postoperatively in the eye of a diabetic patient who subsequently was treated with steroids and a laser capsulotomy. Because the lens implant was loose in the capsular bag and caused considerable glare, it was removed about 4 months after placement. Pathologic study revealed the entire surface of the implant to be covered by a continuous and firmly adherent protein membrane with excrescences and of irregular thickness. Sessile macrophages found on the membrane were not firmly attached.
Most small scleral wound leaks at the limbus are treated successfully with suturing, patching, bandage lenses, or cyanoacrylate adhesive, but occasionally a wound leak may continue and a fistula may develop. Although rare, most such fistulas are usually associated with cataract surgery or trauma. Failure of a scleral fistula to close may be due to epithelialization or chronic necrosis of the lumen. In three cases, persistent fistulas of the limbal sclera were excised with a trephine, and a peripheral graft using corneal donor tissue was used to seal the circular defect. This resulted in permanent wound closure and provided a tissue diagnosis of epithelial downgrowth (2 cases) and chronic scleral necrosis (1 case).
An early stage in the formation of a reactive membrane on the exposed surface of a glass foreign body in the anterior chamber is demonstrated. It is emphasized that the formation of reactive membranes on the surface of foreign bodies in the anterior segment of the eye give the cytologic impression of different stages of successful adaptation.