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A 29-year-old woman had a pigmented ciliary body mass that extended through the iris into the anterior chamber. On the basis of clinical findings and ancillary diagnostic studies, the clinical diagnosis was malignant melanoma of the ciliary body. The enucleated eye showed the tumor to be composed of cells identical to those of a melanocytoma of the optic disk.
Immunoregulation in the eye requires both an effective defense against exogenous pathogens and protection of the delicate anatomy of the eye against "innocent bystander destruction", which accompanies inflammatory reactions. We studied the role of uveal cells for local immunoregulation in the eye and investigated the effect of cultured Lewis rat ciliary body cells on antigen-specific 3[H]-thymidin incorporation in a T-helper-lymphocyte cell line (ThS) specific for the retinal-soluble antigen (SAg). Ciliary body cells inhibit the proliferation of ThS. This inhibition is not species-specific and is mediated by at least two mechanisms: a soluble inhibitor and a contact-requiring factor that is trypsin-sensitive, suggesting a protein molecule. After removal of these inhibitory components, ciliary body cells also exhibit the capacity to effectively present SAg to ThS. This dual effect of ciliary body cells on T-helper lymphocytes supports the concept of active local immunoregulation in the eye.
Biochemical studies of acidic lens protein degrading activity in the bovine ciliary body were performed. The activity showed two peaks, Fractions A and B, on Sephadex G-75 column chromatography. Fraction A contained cathepsin D and thiol proteinase activities and was inhibited by pepstatin and leupeptin. Fraction B contained thiol proteinase activity and was inhibited by leupeptin. The proportion of peptide released from the lens protein by Fractions A and B was higher than those from bovine serum albumin and casein. Lens protein may be a good assay substrate for cathepsin D and lysosomal thiol proteinase in the ciliary body.
PURPOSE: To investigate the efficacy of ciliary body endophotocoagulation during pars plana vitrectomy in eyes with medically uncontrolled glaucoma and concomitant vitreoretinal disorders. METHODS: The authors compared preoperative and postoperative intraocular pressure (IOP) and visual acuity in 21 eyes of 21 patients undergoing ciliary body endophotocoagulation with pars plana vitrectomy. RESULTS: Preoperative IOPs ranged from 22 to 59 mmHg (median, 46 mmHg). Visual acuity ranged from 20/200 to light perception (median, hand motions). Follow-up ranged from 3 to 18 months (median, 10 months). Postoperative IOPs ranged from 11 to 19 mmHg (median, 16 mmHg) at 6 weeks, 4 to 20 mmHg (median, 14 mmHg) at 3 months, 1 to 26 mmHg (median, 12 mmHg) at 6 months, and 0 to 48 mmHg (median, 12 mmHg) at 12 months. Postoperative visual acuity was statistically improved from preoperative visual acuity by 6 weeks. CONCLUSION: Ciliary body endophotocoagulation combined with pars plana vitrectomy can effectively treat concomitant glaucoma and vitreoretinal disorders.
OBJECTIVES: To describe and illustrate the ultrasound biomicroscopic findings in patients with one or more cystic lesions of the iris, ciliary body, or both. METHODS: Retrospective study of 263 ultrasound biomicroscopic studies performed at one institution during a 20-month period, May 1994 through December 1995. All studies were performed using the Humphrey ultrasound biomicroscope model 840. RESULTS: Thirty-nine of the 263 evaluated patients had one or more cystic lesions. Four different types of cysts were detected. Twenty-seven patients had one or more primary neuroepithelial cysts of the iris or ciliary body. These cysts were frequently multifocal and bilateral. All contained clear fluid and had a thin but highly reflective wall. Three patients had a stratified squamous epithelial implantation cyst. These cysts were all unifocal and unilateral. The intracavitary fluid contained multiple suspended particles (presumably desquamated epithelial cells), and the walls were relatively thick. Six patients had a neuroepithelial cyst associated with a solid tumor. Each of these cysts resembled the primary neuroepithelial cysts. Three patients had focal intratumoral cavitation. The cavity in each case contained clear fluid. The surrounding tumor tissue in each case appeared homogeneous. CONCLUSIONS: Ultrasound biomicroscopy appears to be a valuable clinical tool for evaluating and differentiating cystic lesions of the iris and ciliary body.
Thirty-four patients with medium (2) or large (32) uveal melanomas which involved the ciliary body (ciliary-choroidal, ciliary, and iris-ciliary) were treated with helium ion (29) or I-125 brachytherapy (5). Thirty-one of 34 eyes were retained after treatment. Most melanomas were too large for surgical removal with retention of the eye. Eyes containing very large tumours often had poor visual acuity after treatment.
Acquired tumours of the nonpigmented ciliary body epithelium are rare. We present herein a case of low-grade adenocarcinoma in order to stress the problems related to the clinical diagnosis. The tumour in our case was circumscribed, localised on the ciliary body, and nonpigmented. The height of the tumour, measured with ultrasound biomicroscopy, was 3.5 mm. The internal reflectivity of the tumor was homogeneous with low attenuation. The tumour was surgically excised with an uneventful iridocyclectomy. Both clinical presentation and preoperative examinations allowed to circumscribe the correct diagnosis which could be confirmed only with histology.
The authors studied the mitotic activity of 21 choroidal and ciliary body melanomas treated by external beam radiotherapy (2000 rad in 5 fractions over 5-7 days) before enucleation and 21 case-by-case matched nonirradiated uveal melanomas. The Wilcoxon signed ranks test and McNemar's fourfold table test were used to compare the mitotic activity of the irradiated and nonirradiated tumors. The results of these analyses suggest that pre-enucleation external beam radiotherapy substantially reduces the mitotic activity of posterior uveal melanomas (P less than 0.005). This information supports current efforts to mount a successful randomized clinical trial of pre-enucleation radiotherapy in high-risk patients with choroidal and ciliary body melanomas.
The differences between the drug penetration levels in the iris-ciliary bodies of sparfloxacin (SPFX) and cefmenoxime (CMX), which respectively have high and low affinity to melanin, were examined using pigmented and albino rabbit eyes. Each drug was mixed with a homogenate of the iris-ciliary bodies of pigmented and albino rabbit eye, respectively. All CMX was distributed in a water soluble protein of the above homogenate of both pigmented and albino eyes, while all SPFX was detected from the water soluble protein of the tissue homogenate of the albino eye. However, in homogenate of the pigmented eyes, 60% of the drug was detected from water soluble protein and 20% of that was detected from water non-soluble protein. In the in vivo study, each drug was topically administered to pigmented and albino rabbit eyes. The SPFX concentration in the iris-ciliary body was significantly higher in the pigmented than in the albino eyes. The results indicated that the intraocular dynamics of the drug which has a high affinity to melanin showed significant differences between pigmented and albino rabbit eyes. This should be considered in studies of ocular pharmacology as an important factor which influences intraocular drug dynamics.
BACKGROUND: When dissection of porcine eyes from a living body results in the cessation of aqueous humor production and blood flow, programmed cell death regulated by TPR53BP2 and BCL2 genes may occur in the pigmented epithelium (PE) and non-pigmented epithelium (NPE) of the ciliary body. Blood products are subjected to gamma irradiation in order to prevent cellular damage resulting from transfusion-associated graft-versus-host disease. We investigated whether gamma irradiation influenced BCL2 or TPR53BP2 genes as well as the morphology of the porcine ciliary body. METHODS: We irradiated the anterior segments of porcine eyes by using (60)Co gamma-rays (20 Gy). To study BCL2 and TPR53BP2 expression, the irradiated specimens were fixed in formalin and embedded in paraffin and then incubated with mouse monoclonal anti-human BCL2 or TPR53BP2 antibody. RESULTS: Following dissection, an imbalance in homeostasis began with positive BCL2 and TPR53BP2 expression in the edematous ciliary processes, and resulted in atrophy of the NPE. Increased BCL2 and TPR53BP2 expression were evident just after gamma irradiation. Decreased TPR53BP2 expression occurred after 8 h of incubation, and thereby suppressed apoptosis in the NPE; hence, the structure of the ciliary body that was incubated for 8 h after gamma irradiation was well preserved. CONCLUSIONS: Irradiation renders the ciliary body in enucleated porcine eyes less vulnerable to apoptosis, and thereby exerts a profound preservative effect.
Transepithelial potential difference and short-circuit current of the dog ciliary body were measured in vitro in an Ussing-type chamber using HEPES-buffered solution containing bicarbonate. Their values were -1.35 +/- 0.08 mV (mean +/- S.E.M., n = 52) and -23.6 +/- 1.7 microA/cm2, respectively. At 10(-4) M, ouabain reduced the short-circuit current upon to either side of the chamber. On the other hand, at 10(-5) M of furosemide to the aqueous side, the short-circuit current was reduced. However even at 10(-3) M, this drug had no effect when applied to the stromal side. Behavior of the dog ciliary body towards these two inhibitors was compared with that of the toad and rabbit tissues.
Acute uveal inflammation, characterised by conjunctival hyperaemia, limbal vascular injection, iritis and aqueous flare, was induced in the rabbit eye by a single intravitreal injection of 10 micrograms of Shigella endotoxin. Twenty-four, 48 and 72 h after endotoxin administration, lysosomal-rich fractions and cytosolic supernatants were prepared from iris-ciliary bodies and the enzymatic activities of some lysosomal hydrolases in these fractions were assayed. Acid phosphatase, aryl sulphatase and N-acetyl-B-D-glucosaminidase exhibited increased activities in the lysosomal preparations from inflamed iris-ciliary bodies, relative to the activities of the same enzymes in lysosomal fractions from normal iris-ciliary bodies. No significant differences in activities were obtained for these enzymes in cytosolic supernatants from normal and inflamed iris-ciliary bodies. The results suggest that during acute ocular inflammation the lysosomal hydrolases are retained in their organelles at an elevated state of activity.
A retrolenticular fibrovascular membrane occurred in the setting of a ciliary body mass in a 10-year-old black girl who had been successfully treated for a rhabdomyosarcoma of the lung. The results of a transscleral biopsy of the mass demonstrated it to be a pigmented adenoma of the ciliary body. A lensectomy and membranectomy were performed to aid in the follow-up and rehabilitation of the eye. At 9 months after surgery, the patient had 20/25 vision with no evidence of tumor growth. This case demonstrates an unusual cause of cyclitic membrane formation and suggests that transscleral biopsy may be a useful adjunct in the management of selected ciliary body masses.
AIM: To demonstrate the ultrasound biomicroscopic features of a ciliary body melanocytoma with extrascleral extension, and a conservative approach in its management. METHOD: Observational case reports. Two cases of ciliary body melanocytoma were suspected at presentation, confirmed histologically by biopsy, and subsequently monitored for change by serial ultrasound biomicroscopic imaging. The main outcome measures were anatomical and functional preservation of the eye, with avoidance of formal surgical excision. RESULTS: Ultrasound biomicroscopy allows clear visualisation of the tumours, and the ultrasound characteristic is of low homogeneous internal reflectivity. 5 year follow up with observation only demonstrates success with this conservative management approach. Histopathological evaluation confirmed melanocytoma. CONCLUSIONS: Melanocytoma is a rare tumour. However if considered in the differential diagnosis at presentation and confirmed histologically, further management with use of the ultrasound biomicroscope as an accurate mode of imaging is an acceptable technique for preservation of the eye and avoids surgical excision.
CLINICAL CASE: We report the case of a 25 year old woman who attended our Hospital with a pigmented lesion in anterior chamber angle of her right eye. She complained of reduced visual acuity on the same eye. On examination, and once complementary tests were performed, a pigmented lesion located on the iris root and ciliary body of her right eye was confirmed. A decision to perform a local resection was made and there were no surgical complication. Histology results confirmed the diagnosis of ciliary body melanocytoma. DISCUSSION: Ciliary body melanocytoma is a benign rare lesion with only 40 cases described in the literature. A local resection of this benign lesion should be considered as alternative to enucleation, even though differential diagnosis with malignant melanoma must also be considered.
Ocular aldehyde oxidase was purified for the first time from bovine ciliary body cytosol by ammonium sulfate fractionation and successive HPLC using DEAE anion-exchange and hydroxyapatite columns. The purified enzyme was homogeneous by the criterion of sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The molecular weight of the enzyme was estimated to be about 150,000 by electrophoresis and to be about 300,000 by gel filtration HPLC on a TSK gel G3000SWXL column, indicating that the enzyme consists of two subunits with the same molecular weight. On the other hand, nicotinamide N-oxide reductase activity was associated with aldehyde oxidase activity throughout the purification steps of the latter enzyme. This fact indicated that nicotinamide N-oxide reductase activity of the ciliary body cytosol is due to aldehyde oxidase present in the tissue preparation.
BACKGROUND: Opticin is a recently discovered glycoprotein present predominantly in the vitreous humour. It is synthesised and secreted by the ciliary body epithelium (CBE) from the initiation of CBE development in the embryo, and production continues throughout life. AIM: To determine whether a variety of ciliary body tumours synthesise opticin to characterise further its role in ciliary body health and disease. METHODS: Immunohistochemistry was used to determine the distribution of opticin in normal human CBE, and in hyperplastic and neoplastic CBE lesions. RESULTS: Opticin was immunolocalised to the basal cell surface and basement membrane material of the non-pigmented CBE in nine donor eyes as well as four hyperplastic lesions of the CBE (Fuchs's adenoma). By contrast, none of eight neoplastic lesions (two adenoma and six adenocarcinoma) of CBE stained for opticin. CONCLUSION: The present series supports the theory that opticin is produced by the non-pigmented CBE throughout adult life. Loss of opticin expression by this tissue is associated with and could contribute towards neoplastic transformation.
We examined eye lesions in five lines of transgenic mice carrying the human rasT24 oncogene driven by the type I gamma glutamyl transferase (gamma GT) promoter. In three lines, hyperplasia developed as early as 11.5 days postconception in the outer neuroectodermal layer, which gives rise to ciliary body and retinal pigment epithelium. At birth, the eyes from many animals contained adenomas, and by day 27, mice developed invasive adenocarcinomas originating in the region of the ciliary body. Microphthalmia, cataracts, and chronic nongranulomatous inflammation involving the anterior and/or posterior segments of the eye were also found. gamma GT is detectable histochemically as early as 11.5 gestational days in the outer neuroectodermal layer and after birth is more abundant in the ciliary body than in the retinal pigment epithelium. Using a reverse transcriptase-polymerase chain reaction, we found that type I (but not types II or III) gamma GT RNA is made by the mouse eye; the gamma GT(I)rasT24 transgene transcription product was detected in the eyes of all five transgenic lines. The sequential progression of hyperplasia to invasive neoplasms in the ciliary body in response to gamma GT(I)rasT24 expression differs from the process in the kidney of these animals in which tubular hyperplasia and microadenomas with little evidence of progression are the major lesions.