Biomedical subjects
Publications and source records attributed to M S Ramsey.
PURPOSE: To report the singular case of a patient who developed three noncontiguous uveal melanomas over a 30-year period. METHOD: Case report. RESULT: Systemic evaluation of a 50-year-old man with an iris melanoma and bilateral choroidal melanomas disclosed no evidence of metastases or other primary neoplastic disease. CONCLUSION: Although rare, the possibility of bilateral and multifocal uveal melanoma should be recognized.
We describe two young men in whom severe anterior uveitis developed following relatively minor corneal trauma. Investigation revealed ankylosing spondylitis in both cases; neither had previously experienced uveitis. We are unaware of any previous reports implicating minor ocular trauma in precipitating a first episode of uveitis associated with ankylosing spondylitis. The possibility of occult ankylosing spondylitis should be considered in cases of disproportionately large anterior chamber reactions to minor ocular trauma.
Four cases of unsuspected uveal melanoma diagnosed after cataract extraction were found in a review of the records of enucleation specimens processed at our centre between 1974 and 1988. Similarities among the four cases included disparity in loss of visual acuity, unilateral angle-closure glaucoma, asymmetric cataract formation, inability to view the fundus and rapid flattening of the anterior chamber, with difficult closure at the time of surgery. Uveal melanoma should be suspected in any cataract patient presenting with one or more of these atypical clinical findings, and complete investigation, including A-scan and B-scan ultrasonography, is indicated.
An 81-year-old man presented with a globoid caruncular mass of recent onset involving the left medial canthus. Pathological examination of the mass after its complete excision showed a roughly spherical subepithelial tissue deposit of amyloid, surrounded and sparsely infiltrated by plasma cells. The amyloid showed permanganate-resistant congophilia consistent with immunamyloid, and since most of the plasma cells stained positive for lambda light chains on immunohistochemical cytoplasmic staining, with no demonstrable heavy chains, the lesion was regarded as an extramedullary amyloid-producing plasmacytoma. Its solitary appearance in our patient, who has remained disease free, probably predicts the favourable prognosis generally associated with such lesions.
To identify the main causes of presenile cataract formation, we reviewed the charts of 287 consecutive patients (341 eyes) aged 20 to 49 years who underwent cataract extraction at the Halifax Infirmary Hospital between 1976 and 1985. No cause for cataract formation could be determined in 34% of the patients. The leading identifiable causes were trauma (37% of cases), associated ocular disease (24%), associated systemic disease (14%) and use of medications (9%). There was no difference in sex or use of alcohol or tobacco between the patients with idiopathic cataracts and those in whom cataracts were associated with organic disease.
To determine the rates of and reasons for removal of intraocular lenses (IOLs) during the first 6 years of implant surgery at Halifax Infirmary Hospital, we reviewed the medical records of all patients who underwent primary cataract extraction with IOL implantation and subsequent removal of the IOL between 1980 and 1985. Among 2482 patients 21 cases of secondary explanation (0.8%) were identified. Of the 21 IOLs 20 were anterior chamber lenses and 1 was a posterior chamber lens. The most frequent causes of IOL removal were suspected bacterial endophthalmitis, excessive lens movement due to poor fit and traumatic dislocation of the lens.
To determine the incidence of systemic illnesses in patients presenting for cataract surgery, the hospital charts of 846 consecutive patients who had cataract surgery in 1983 were reviewed. Previously undiagnosed illnesses were found in 35.1% of the patients. The high rate could not be attributed to the fact that a large number of the patients were from rural areas and thus may have had less access to medical care. The incidence rate of diabetes mellitus, 3.5%, appeared higher than would be expected on the basis of recent age-matched population surveys. Recommendations are made for preoperative assessment of cataract patients.
In a previous paper we reported an elevated incidence of systemic illnesses in a population of 846 cataract patients. The charts were reviewed to determine the prevalence of systemic illnesses and of drug allergy. Elevated rates of hypertension (46.0%), diabetes mellitus (15.8%), glaucoma (11.0%) and drug allergy (30.6%) were found. Recommendations are made for preoperative assessment of cataract patients.
Although opinions vary to some extent, the general consensus is that the pseudoexfoliative component is an abnormal basement membrane material with amyloid-like characteristics; this is synthesized at a variety of ocular and extraocular sites. The resultant material is found to accumulate within, and in some instances to replace, the normal basement membranes of the producing cells. Also, some of the material detaches and, through aqueous humour dispersal, becomes deposited on a variety of surfaces throughout the anterior segment of the eye.
Developing photoreceptor-like cells in retinoblastoma tumour fleurettes were found to contain apical tight junctions, mitochondrial-filled inner segment regions with cilia, and basally located synaptic ribbons and vesicles. Synaptic contract appeared to be established with adjacent neuronal-like elements. We suggest that photoreceptor differentiation in retinoblastoma tumours follows a sequence similar to normal human photoreceptor embryogenesis.
The lens from a patient with homocystinuria was examined by scanning and transmission electron microscopy. A fringe of zonular remnants was found attached to the anterior lens capsule, and was observed to be composed of masses of short filaments in disarray, together with occasional bundles of normal-appearing zonular filaments. Although a pericapsular membrane (zonular lamella) was not observed, the remainder of the lens capsule and epithelium appeared unremarkable. The lens fringe of white zonular remnants may be characteristic, if not pathognomic, for homocystinuria.
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