[Uveal effusion syndrome. Physiopathology].
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We evaluated 16 patients with malignant melanomas of the choroid (11) or the ciliary body (5) by magnetic resonance imaging (MRI), using a 0.5 T magnet and a surface coil. The tumor was seen in all cases, hyperintense in T1-weighted images, and hypointense in T2-weighted sequences (80%). These images reflected the short T1 and T2 relaxation times caused by the presence of melanin in those tumors. This non-invasive method was superior to computed tomography (70%), and sometimes superior to fundoscopy (2 cases), angiofluorography (3 cases) or echography (1 case). MRI also proved valuable for differentiating uveal melanoma from associated subretinal effusion.
Three patients (a 51-year-old man, an 8-year-old boy, and a 70-year-old man) developed shallowing of the anterior chamber and uveal effusion after blunt ocular injuries. After treatment with antibiotics (all three patients), corticosteroids (one patient), a mydriatic-cycloplegic solution (two patients), and antiglaucoma drugs (one patient), the shallowing and uveal effusion resolved. Because resolution occurred within two weeks in all three cases, surgical intervention was unnecessary. Both hypotony, which is common after nonpenetrating ocular injuries, and shallowing of the anterior chamber, which is rare, may result from localized uveal effusion that is clinically undetectable.
The authors report the experience of applying immunocytochemistry in routine cytological examination and its contribution for diagnosis during a period of 3 yr in Veterans General Hospital-Taipei, Taiwan. From August 1991 to July 1994, the cytology laboratory received 5,762 non-gynecologic specimens with urine excluded. Immunocytochemistry was performed selectively in problematic cases. A total of 215 stainings including 124 epithelial markers, 50 lymphoma/leukemia markers, 22 neuroglial and choroid plexus markers, seven mesenchymal markers, six melanoma markers, and six others was performed on 145 specimens consisting of 89 effusions, 28 fine-needle aspirations, 11 cerebrospinal fluids, and 17 other specimens. Effusions were by far the most frequent specimens for immunocytochemistry and the epithelial markers were the most frequently used antibodies. The immunocytochemical results were essential in 41 specimens (28%), confirmatory in 37 (26%), and non-contributory in 67 (46%). Essential and confirmatory results occurred in 49% of effusions (44/89), 71% of fine-needle aspirations (20/28), 55% of cerebrospinal fluids (6/11), and 47% of other specimens (8/17). It is concluded that immunocytochemistry is proved to be a good aid for the final diagnosis of daily cytologic practices in which the fine-needle aspiration specimens are benefitted best.
We report the case of a patient with a dural carotid-cavernous fistula. The examination showed a proptosis, a chemosis, an increased intraocular pressure and a choroidal detachment. The diagnosis was confirmed by arteriography. The treatment consisted of the embolisation of the feeders originating from the external carotid artery. The ocular improvement was only partial, but choroidal detachment regressed.
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PURPOSE: To describe the case of a 16-year-old patient with nanophthalmic uveal effusion associated with renal failure that was treated with scleral window surgery and topical administration of mitomycin C (MMC). METHODS: Case report. RESULTS: Total uveal effusion was restored in the nanophthalmic eyes. Partial-thickness scleral flap with deep sclerostomy was performed and topical MMC was administered to one quadrant of the equatorial sclera. The subretinal fluid resorbed gradually. CONCLUSIONS: Topical MMC might relieve the blocked transscleral outflow of intraocular fluid in the small area of a sclerostomy in young patients with nanophthalmos or in patients with renal failure in whom uveal effusion occurs repeatedly.
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Posterior scleral trephination at the pars plana ciliaris in a dependent site, with normal conjunctiva covering the opening, proved a reliable method for evacuating subchoroidal effusion in cases of flat anterior chamber. The method was also successful in cases occurring after retinal detachment surgery and after retinal detachment surgery and after expulsive hemorrhage. Unlike linear sclerotomy, drainage of the subchoroidal effusion continues for several days after the trephination.
PURPOSE: To evaluate the results and complications of cataract surgery in patients with nanophthalmos. SETTING: University hospital practice. METHODS: The records of consecutive patients with nanophthalmos who had cataract surgery from 1978 through 2002 were reviewed for ocular diagnoses, corneal diameter, keratometry, axial length, retinal-choroidal-scleral thickness determined by echography, ocular surgeries, visual acuity, and complications. RESULTS: Eight patients (6 women, 2 men) with a mean age of 59 years were reviewed. Four patients were not previously diagnosed with nanophthalmos; increased retinal-choroidal-scleral thickness (mean 2.41 mm) confirmed the diagnosis. Twelve eyes had cataract extraction with posterior chamber intraocular lens (IOL) implantation, 11 by phacoemulsification and 1 by extracapsular cataract extraction, and 4 eyes had lamellar scleral resections. Additional surgeries included glaucoma laser treatment (8 eyes), cyclocryotherapy (2 eyes), trabeculectomy with scleral resection (1 eye), trabeculectomy combined with phacoemulsification (1 eye), and neodymium:YAG laser capsulotomy (4 eyes). No eye lost vision; however, complications included severe iritis, broken IOL haptic with vitreous loss, posterior capsule opacity, choroidal hemorrhage, phthisis, and aqueous misdirection. CONCLUSIONS: Results indicate that echography should be used to assess retinal-choroidal-scleral thickness in eyes that are hyperopic and at risk for narrow-angle glaucoma. Thickening may confirm the diagnosis of nanophthalmos and allow careful preoperative assessment and appropriate operative procedures in these high-risk eyes. With advances in cataract, glaucoma, and uveal effusion treatments, surgical results in patients with nanophthalmos are improving.
Verification of the position of an episcleral iodine-125 gold plaque in relation to underlying choroidal melanoma is essential during early radiation therapy to ensure accurate plaque placement and thus optimum dose delivery. The authors used magnetic resonance (MR) imaging to examine 15 patients with choroidal melanoma after plaque placement to assess tumor coverage. The relationship of the plaque to the tumor was well defined in all cases, including two tumors anterior to the ora serrata. MR imaging measurements of the plaques were within 1 mm of the actual plaque sizes, while tumor measurements were within 2 mm of the preoperative ultrasound estimations of tumor dimensions. Tumors as small as 3 mm thick were readily visualized with MR imaging. Associated subretinal effusion was demonstrated in seven cases.
A 51-year-old man complaining of cough, hemoptysis, and decreased visual acuity was admitted to our hospital. Chest radiography revealed a left hilar mass and pleural effusion in the left hemithorax. In his ophtalmological examination, there was total retinal detachment in the left eye. Ultrasonographic examination and orbital magnetic resonance imaging (MRI) were reported as choroidal metastasis. A computed tomography (CT) confirmed the mass in the left hilum and multiple mass lesions consistent with metastasis in the liver and in the body of 12th thoracic vertebra. Bronchoscopic biopsies revealed large cell carcinoma with basaloid features. He died after 4 months with rapid progression of the disease in spite of combined chemotherapy. Although primary lung cancer with concurrent eye metastasis is an uncommon entity, it should always be kept in mind for patients with ocular symptoms.
OBJECTIVE: To determine the pathogenesis of transient high myopia after blunt eye trauma. DESIGN: Two observational case reports and literature review. METHODS: Refraction was measured in two patients with an autorefractometer in the acute and convalescent stages after a blunt eye injury. The anterior chamber angle, the ciliary body, and the choroid were examined by ultrasound biomicroscopy (UBM) in the acute and convalescent stages. In one patient, the anterior chamber depth, lens thickness, and axial length were measured by A-scan ultrasonography in the acute and convalescent stages. MAIN OUTCOME MEASURES: Comparison of the refraction, anterior chamber depth, lens thickness, axial length, and the UBM-determined appearance of the choroid and ciliary body during the acute stage with the values during the convalescent stages. RESULTS: The first patient showed a myopic shift of -9.75 diopters (D) and an anterior chamber shallowing of 0.94 mm measured 3 days after trauma by an air bag inflation compared with the measurements at the convalescent phase. UBM showed an annular ciliochoroidal effusion with ciliary body edema, anterior rotation of the ciliary processes, and disappearance of the ciliary sulcus. Eleven days after the injury, these UBM findings normalized, and the myopia decreased to -0.75 D, 27 days after trauma. The second patient had a myopic shift of -8.9 D compared with the convalescent phase, immediately after blunt trauma by a firework. Seven days after the injury, UBM revealed a partial cyclodialysis in addition to findings similar to those in the first patient. Ten days after injury, a myopic shift (-4.75 D), anterior chamber shallowing (by 1.1 mm), and thickening of the crystalline lens (by 0.27 mm) were observed compared with the convalescent phase. Associated UBM findings confirmed the anterior shift of the lens-iris diaphragm. Seventeen days after trauma, the UBM findings, including the cyclodialysis, were normalized, and the myopia had decreased to -1.0 D. CONCLUSIONS: Transient high myopia after blunt trauma is caused by anatomic changes in the ciliary body and crystalline lens. The anterior shift of the lens-iris diaphragm caused by ciliochoroidal effusion with ciliary body edema and thickening of the crystalline lens from blunt eye trauma are involved in traumatic high myopia.
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This paper relates the case of a 54-year-old woman with spontaneous annular detachment of the chorioretina in the right eye. Through examination and evolution confirm that it is an "uveal effusion", most probably in relation with choroïdal circulatory troubles and an affection of the pigment epithelium.