Scanning electron microscopic findings on intraocular metallic foreign bodies

· Background: The study reported here was performed to investigate morphologic intraocular reactions on the surface of metallic intraocular foreign bodies (IOFB) with scanning electron microscopy. · Methods: Twenty-seven extracted IOFB were investigated. Of these, 22 were situated in the vitreous body; 19 had contact with the retina. Five IOFB had been removed from the anterior segment (control group). The duration of intraocular retention was 6 h to 24 days. Immediately after microsurgical removal the IOFB were fixed, dehydrated, dried, sputter-coated and investigated with a scanning electron microscope. Two IOFB from the vitreous were treated for collagen preservation.  · Results: Eighteen of 20 intravitreal IOFB showed fibers of fibrin on its surface; 11 of 20 were covered with a homogeneous layer. Within this layer a net of collagen fibers was detectable. A major cellular reaction was observed only on IOFB that injured the retina, pigment epithelium and choroid. · Conclusions: This morphologic study shows that: (1) a fibrin net develops in the vitreous around intravitreal IOFB; (2) depositions of amorphous material into the spaces of this net lead to dense coverage of the IOFB; (3) cellular reactions are not condition for the development of this coverage; (4) laceration of the retina induces a fibrocellular response. Received: 16 September 1997 Revised version received: 9 December 1997 Accepted: 10 December 1997     

Correction to: Force delivery modification of removable thermoplastic appliances using Hilliard precision thermopliers for tipping an upper central incisor

Clinical Oral Investigations -     

Primary orbital leiomyoma and leiomyosarcoma

A case of an extremely rare primary orbital leiomyoma in a 25-year-old male patient is presented who had a lifelong history of deviation of the left eye globe with slight enophthalmos and reduced motility. Because of pain and increasing deviation of the eye the tumor was totally resected. On histologic examination the tumor showed ossification which is extremely rare so that a calcifying fibroma had to be ruled out. In immunohistochemistry, however, this tumor stained with smooth muscle antigen. Less than 2% of cells stained positive for Ki-S1, a proliferation marker. The second case is a rare primary orbital leiomyosarcoma in an 84-year-old female patient that showed massive growth. After exenteration histologic examination showed a dedifferentiated highly malignant soft tissue tumor which expressed desmin and smooth muscle actin but was negative for myoglobin, S-100 and HMB-45.     

Iris angiographic changes in multifocal chorioretinitis with panuveitis

· Background:Multifocal chorioretinitis with panuveitis (MCP) is a chronic inflammatory disease of the peripheral retina and choroid with typical clinical appearance. Although obvious involvement of the anterior segment is often mild, severe chronic inflammatory reactions can occur after cataract surgery. Explantation of an intraocular lens (IOL) or primary aphakia may be necessary. In this pilot study we therefore examined the iris of patients with MCP by means of fluorescein angiography (IAG) to investigate iris vessel involvement.· Materials und methods:Twenty-one eyes of 13 patients with MCP (12 women, 1 man) were examined by IAG. The average age of the patients was 72.5±6.2 years, and the average duration of the disease prior to examination was 13 months. In 9 of 21 eyes a pars plana vitrectomy (PPV) was performed because of marked vitreous opacification. IAG was performed before and after surgery. · Results: Although clinically unremarkable the iris of 14/21 eyes showed avascular zones in IAG; 13/21 had irregular vessels such as vascular collaterals, and 10/21 exhibited neovascularization. All eyes showed leakage of dye at the pupillary margin, and in 15/21 there was leakage out of peripheral iris vessels. In 2 of 9 eyes angiographic changes such as avascular zones regressed after PPV. · Conclusion: Irides in patients with MCP that are unremarkable on slit-lamp examination may show marked angiographic changes. Thus IAG in those cases with planned cataract extraction and IOL, if necessary combined with PPV for vitreous opacification, may be warranted in order to better assess the prognosis after surgery. Received: 3 February 1999 Revised version received: 29 March 1999 Accepted: 13 April 1999     

General metastases in squamous cell carcinoma of the conjunctiva

BACKGROUND: Squamous cell carcinoma of the conjunctiva is rare. Together with epithelial dysplasia of the conjunctiva the incidence is reported to be 1.9 per 100,000 population and year. After adequate therapy total cure is often achieved. Generalised metastases are however extremely rare. PATIENT AND METHOD: The case of a 71-year old white male patient is presented. Because of a recurrent conjunctival tumour in his right eye local resections had to be performed. The histopathological diagnosis was epithelial dysplasia. After a 3-year history a squamous cell carcinoma developed. In spite of multiple operations total excision of the tumour could not be achieved. Exenteration was refused by the patient. After radiotherapy of the orbit a temporary improvement was observed. However, 9 years later the patient died of general metastases to the long bones, the spine, and the ribs. RESULTS: Histological examination of material obtained during hemilaminectomy of the vertebrate bodies 8 and 9 confirmed the diagnosis of metastases of a squamous cell carcinoma. CONCLUSION: Although extremely rare, general metastases after squamous cell carcinoma of the conjunctiva must be kept in mind. This has to be considered when obtaining informed consent of the patient, planning adequate therapy and follow-up.     

Schwere intra- und postoperative suprachorioidale Blutungen

BACKGROUND: The aim of this study was to analyze risk factors, therapeutic strategies, and functional and anatomic results of eyes with severe suprachoroidal hemorrhage. PATIENTS: Eight of 11 bleeding episodes occurred intraoperatively and 3/11 postoperatively. Bleeding was associated with the following surgical procedures: perforating keratoplasty (5x), extracapsular cataract extraction (3x), pars plana vitrectomy (2x), intracapsular cataract extraction (1x). RESULTS: Nine operations were performed with general anesthesia, two after retrobulbar injection. Ocular risk factors (e.g., prior operations, ocular diseases) and general risk factors (e.g., cardiovascular diseases, diabetes) were analyzed. At the end of the follow-up time visual acuity had improved in three eyes, and it was unchanged in one eye and worse in seven eyes. Four eyes were amaurotic; two of them had to be enucleated. CONCLUSIONS: In spite of using state-of-the-art surgical techniques the prognosis of suprachoroidal bleeding remains serious. Patients who have a combination of several ocular and general risk factors almost exclusively are the ones who afflicted by this complication.