Metastatic gastric carcinoma to the optic nerve.
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Biomedical subjects
Publications and source records attributed to V T Curtin.
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A 63-year-old man with a history of cutaneous melanoma and a 3-month history of visual loss in his right eye presented with marked pigmentation of the anterior-segment structures, including trabecular meshwork, iris, and lens surface, with pigment dispersion in the aqueous and anterior vitreous in the right eye. Clinical examination and echography showed no evidence of an intraocular tumor although metastatic melanoma was suspected. Pathologic examination revealed numerous heavily pigmented melanoma cells throughout the anterior segment of the eye, mainly concentrated in the anterior vitreous near the ciliary body. No discrete tumor was found on multiple sections through the globe.
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A 37-year-old male laboratory technician who sustained a cutaneous penetrating wound from a rhesus monkey developed a progressive ascending encephalomyelitis due to culture-proven herpes B virus (Herpesvirus simiae) infection. He died 6 weeks after his injury despite acyclovir and ganciclovir treatment that was initiated after central nervous system symptoms developed. Histopathological examination of the patient's left eye revealed a multifocal necrotizing retinitis associated with a vitritis, optic neuritis, and prominent panuveitis. Herpes-type virus was identified in the involved retina by electron microscopy. Postmortem vitreous cultures taken from both eyes and retinal cultures taken from the right eye were positive for herpes B virus. Herpes B virus produces infection and destruction of retinal tissues similar to other herpesviruses. To our knowledge, this case represents the first histopathologic demonstration of herpes B virus infection in a human eye.
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We studied two blind eyes enucleated during the active phase of the acute retinal necrosis syndrome. Both eyes showed similar histopathologic findings of necrotizing retinitis, retinal arteritis, and optic neuropathy. A virus morphologically consistent with a herpes group virus was found on electron microscopy and immunocytopathologic stains showed this virus to be varicella zoster in both cases. Varicella zoster virus was cultured from the vitreous of one of the eyes. We conclude that varicella zoster virus retinal infection is a cause of the acute retinal necrosis syndrome.
Four cases of the simultaneous occurrence of bilateral diffuse melanocytic uveal tumors were studied by us. In each case, the patient had an associated systemic malignant neoplasm diagnosed by biopsy or at autopsy. There was no evidence of metastatic melanoma in any patient. Clinically, the patients experienced rapid loss of vision, and cataracts were usually present. Multiple pigmented and nonpigmented placoid iridic and choroidal nodules, as well as serous retinal detachment, frequently were noted. Histopathologically, the uveal tracts of both eyes were diffusely infiltrated by preponderantly benign-appearing nevoid or spindle-shaped cells. Areas of necrosis within the tumors and scleral involvement were commonly seen. We believe this constellation of findings constitutes a new syndrome in which there is a bilateral, diffuse proliferation of melanocytic cells throughout the uvea in association with a systemic malignant neoplasm.
To our knowledge, this is the first published description of the clinical and pathologic features of combined ocular infection with both cytomegalovirus and Cryptococcus. Infection occurred in a patient treated by immunosuppression and corticosteroid therapy. This article emphasizes that ocular findings may be the first sign of disseminated opportunistic infection and that clinical manifestations may be sufficient to allow accurate diagnosis of opportunistic retinitis.
53 cases of choroidal and ciliary body melanomas have been followed for a minimum of 5 years. 26 patients had enucleation after an initial period of observation, mainly because of growth. Survival rates of these patients compared to other series treated by initial enucleation are unaffected. Small melanomas which did not grow did not cause death in this series. The results of this series thus far indicate that patient survival is not jeopardized by initial observation and that useful vision is preserved for many patients.
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38 retinal detachment cases in which intravitreal gas was injected were compared to 156 cases without intravitreal gas injection to determine if intraocular gas had deleterious effects upon the visual and surgical results. No differences were found in either group. Intraocular gas enhances the technical aspects in retinal detachment surgery.
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