Mesectodermal leiomyoma of the ciliary body extending into the anterior chamber

A neoplasm of the ciliary body extending from the equator to the iris and the anterior chamber was observed in an 18-year old girl. Because the visual acuity was lost and the clinical diagnosis was uncertain the eye was enucleated. Both optic and electron microscopic investigations allowed the diagnosis of the mesectodermal type of leiomyoma of the ciliary body.     

Free-floating cyst in the anterior chamber: ultrasound biomicroscopic reports

PURPOSE: To report a free-floating dislodged pigmented cyst in the anterior chamber and to describe the ultrasound biomicroscopic (UBM) features of the lesion. METHODS: Case report. RESULTS: A 26-year-old man presented with noise in his left eye in the prone position. Slit-lamp examination revealed a small pigmented mass lesion at the 6 o'clock position in the anterior chamber, slowly moving with changing head postures. UBM revealed an unfixed dislodged pigmented cyst with a thin wall and no internal reflectivity, changing its shape from ovoid to circular. Five years later, the anterior segment does not show any modification and the cyst has not changed in size or appearance. CONCLUSIONS: Cysts of the iris pigment epithelium arise in the posterior iris layer. They may be central, midzonal, peripheral, or dislodged. Dislodged cysts may be repositioned and fixed or free-floating in the vitreous or in the anterior chamber. Surgical removal must be considered only for a rapid enlargement or significant reduction in endothelial cell count. UBM can distinguish solid from cystic lesions, giving detailed information on internal structure, reflectivity, shape, and thickness.     

Ring melanoma of the ciliary body: clinical and ultrasound biomicroscopic characteristics

BACKGROUND: Diagnosis of ring melanoma is clinically difficult since the mass can remain hidden with standard slit-lamp biomicroscopy. The aim of this study was to evaluate the utility of ultrasound biomicroscopy (UBM) as a diagnostic tool for ring melanoma of the ciliary body. METHODS: This was a retrospective study of 6 eyes of 6 patients at Princess Margaret Hospital, Toronto, Ont., with a diagnosis of ring melanoma of the ciliary body. The tumor extension was measured clinically, gonioscopically, ultrasonographically (by UBM), and pathologically. RESULTS: Since 2000, 6 cases of ring melanoma have been diagnosed at Princess Margaret Hospital: 2 women and 4 men, median age 57 years. Five patients presented as uncontrolled hyperchromic glaucoma (83%). Ciliary body involvement on slit-lamp examination ranged from 60 to 180 degrees. Ciliary body involvement as assessed by UBM ranged from 180 to 300 degrees. Tumor extension according to pathological examination ranged from 210 to 360 degrees. With these measures, the ring melanoma clinical criteria were not filled by 5 patients. INTERPRETATION: UBM is an important tool in determining the extent of ciliary body involvement and classifying these lesions.     

Differential diagnosis of anterior chamber cysts with ultrasound biomicroscopy: ciliary body medulloepithelioma

PURPOSE: To describe a case with motile cyst in the anterior chamber in the right eye of a 7-year-old boy. METHODS: The right eye's visual acuity was 20/50. Intraocular pressure was 59 mmHg. Slit-lamp examination showed prominent rubeosis iridis and a grey-white mass floating freely in the anterior chamber. Ultrasound biomicroscopy revealed a cystic mass in the anterior chamber. A diagnostic cyclectomy with removal of the anterior chamber cyst was performed. Histopathology of the anterior chamber lesion showed an intact cyst composed of medullary epithelial cells. Medulloepithelioma with malignant criteria was diagnosed and the eye was enucleated. RESULTS: Pathology demonstrated an medulloepithelioma with a few mitotic figures and nuclear pleomorphisms within the ciliary body. The patient was followed for 8 months without any metastasis in the orbit or elsewhere. CONCLUSION: Intraocular medulloepithelioma is a rare embryonic benign or malignant neoplasm typically diagnosed in the first decade of life as a ciliary body mass. A dislodged, free-floating anterior chamber cyst associated with neovascular glaucoma is typical of medulloepithelioma in children. This unique presentation should be differentiated from congenital iris epithelial, post-traumatic, epithelial, parasitic and neoplastic cysts. Ultrasound biomicroscopy is useful for analysing the structure of the anterior segment mass. Ciliary body medulloepithelioma is characterized by echogenic mass heterogeneity and an irregular surface containing multiple cystic cavities. Lack of glial differentiation may predict a better clinical outcome in primary neuroectodermal brain tumours.     

Small ciliary body tumors: ultrasound biomicroscopic assessment and follow-up of 42 patients

PURPOSE: Detecting and following small tumors of the ciliary body is a particular challenge because of their location. Recently high-frequency ultrasound biomicroscopy (UBM) has been used to assist in this task. The aim of this study was to evaluate this subset of small ciliary body tumors through the use of UBM. DESIGN: Retrospective, noncomparative case series. METHODS: Forty-two patients with small ciliary body tumors (less than 4 mm) from our institution were included in the study with a median follow-up of 4.3 years. UBM was used to assess tumor characteristics including height, location, and internal and external features. The data were collected longitudinally, and statistical analysis was performed. RESULTS: Median initial tumor height was 2.05 mm (range 1.1 to 3.8 mm) as measured by UBM. By 5 years after diagnosis, five tumors (12%) exhibited growth. The overall mean growth rate was 0.026 mm per year (P = .00007). The most rapid period of growth was in the first year after diagnosis (growth rate 0.128 mm per year), after which the mean tumor size appeared to stabilize. CONCLUSIONS: UBM is a valuable tool for detecting and following small ciliary body tumors (less than 4 mm), as these lesions may go undetected by other methods. Despite the potential for local extension into the iris or choroid, few of the tumors in this study exhibited growth, suggesting that many of these tumors can be managed conservatively. UBM can be used to assess various internal tumor features; however, arriving at a specific diagnosis without histologic correlation is difficult.     

Ciliary body medulloepithelioma: clinical, ultrasound biomicroscopic and histopathologic correlation

A 3-year-old girl presented with a distorted pupil and decrease of visual acuity. A ciliary body mass at the superior-temporal quadrant could be seen at slit-lamp examination. Ultrasound biomicroscopy revealed a lesion with lobulated surface, arising at the ciliary body, composed of compact and cystic areas. An iridocyclectomy was performed but the tumour recurred after a few months. The eye was then enucleated. Histopathologic evaluation showed sheets and cords of proliferated medullary epithelium. Cystic spaces and Flexner-Wintersteiner rosettes were also seen. Those findings correlated well with ultrasound biomicroscopic images. The knowledge of echographic characteristics can significantly assist in the diagnosis of medulloepithelioma of the ciliary body.     

Ultrasound biomicroscopic measurement of development of anterior chamber angle

AIM: To establish normative values for the anterior segment in normal infants and children in relation to age. METHODS: Anterior segments were measured in 46 normal infants and children (21 males and 25 females, aged from 1 to 60 months (mean 17.09 (SD 16.99) months)), by use of ultrasound biomicroscopy. RESULTS: Anterior chamber depth, trabecular-iris angle, angle opening (trabecular-iris) distances at 250 and 500 microm from the scleral spur, and the thickness of the thickest part of the iris were 1724-3473 microm (2505 (SD 480) microm), 15.35-44.79 degrees (28.74 (7.46) degrees ), 116-367 microm (247.4 (65.9) microm), 166-509 microm (349.5 (87.1) microm), and 249-579 microm (434.6 (74.6) microm), respectively. All factors in this study showed a significant correlation with logarithm of age (r = 0.937, p = 0. 0001; r = 0.867, p = 0.0001; r = 0.929, p = 0.0001; r = 0.917, p = 0. 0001; r = 0.748, p = 0.0001), and significantly correlated with each other. CONCLUSIONS: Ultrasound biomicroscopy is a powerful tool for obtaining precise images and measurement of the development of the anterior segment in infants and children. Normative values were established for anterior segment dimensions in relation to age. Anterior chamber depth, trabecular-iris angle, angle opening distances at 250 and 500 microm from the scleral spur, and iris thickness showed linear increases in relation to logarithm of age.     

Ultrasound biomicroscopic dimensions of the anterior chamber in angle-closure glaucoma patients

In order to evaluate the morphologic types of appositional angle-closure glaucoma, biometric measurements were made in angle-closure glaucoma patients using Ultrasound biomicroscopy (UBM). Twenty-six patients with primary angle-closure glaucoma and 21 cataract patients with as a control group were examined. The angle-closure glaucomatous eyes were classified as type B in which the angle closure started at the bottom of the angle and type S in which the angle closure occurred in the vicinity of Schwalbe's line. The trabecular-ciliary process distance (TCPD, type B; 873.20+/-86.77 microm, type S; 832.52+/-82.96 microm, control; 1233.50+/-73.01 microm, p = 0.000) and the angle opening distance (AOD500, type B; 89.75+/-63.27 microm, type S; 88.85+/-72.95 microm, control; 304.40+/-104.30 microm, p = 0.000) were significantly shorter in patients with angle closure vice control group. No significant difference were noted in the three groups of patients in regards to iris thickness or ciliary process-iris angle. In this study, we have demonstrated that there are two types of appositional angle-closure and have shown the forward rotation of the ciliary process without changes of the ciliary process-iris angle in cases of angle-closure glaucoma.     

Ultrasound biomicroscopic measurement of anterior chamber angle in premature infants

AIM—To establish normative values for the anterior segment in premature infants in relation to postconceptional age and birth weight.
METHODS—Anterior segments were measured in 39 premature infants, 25 to 39 weeks' gestational age by use of ultrasound biomicroscopy and a muscle hook with topical anaesthesia.
RESULTS—Anterior chamber depth, trabecular-iris angle, angle opening (trabecular-iris) distances at 250 and 500 µm from the scleral spur, and the thickness of the thickest part of the iris showed linear increases in relation to postconceptional age and birth weight.
CONCLUSIONS—Ultrasound biomicroscopy is a powerful tool for obtaining precise images and measurement of the anterior segment in preterm neonates. Normative values were established for anterior segment dimensions in relation to postconceptional age and birth weight.

     

Leiomyoma of the ciliary body. Report of 2 cases

PURPOSE AND METHODS: The files of the Eye Pathology Institute contain only two cases of leiomyoma of the ciliary body. The diagnoses were re-evaluated, applying modern immunostainings. RESULTS: The tumors were composed of interlacing fascicles of spindle-shaped cells with bright eosinophilic cytoplasm and cigar-shaped nuclei. Both tumors were well-vascularized, mostly by thin, branching capillaries. Larger vessels were also seen. In one case the tumor perforated the sclera. The tumor cells reacted with the reticulum stain and the Masson trichrome and were positive for antibodies against: smooth muscle actin (SMA), muscle specific actin (MSA), laminin and vimentin (one case). CONCLUSION: Leiomyoma of the ciliary body is a rare smooth muscle cell tumor that may arise from either pericytes, ciliary - or intrascleral heterotopic muscle.     

水平角膜直径和前房直径与睫状沟直径的相关性研究

目的：探讨水平角膜直径(WTW)、水平前房直径(HACD)与水平睫状沟直径(S-S)间的相关性和影响因素。

方法：回顾性研究。收集我院2015-08/2016-08高度近视患者62例115眼,用SIRIUS眼前节分析系统测量WTW和HACD,UBM测量S-S,对比分析测量结果。

结果：所有患者中,WTW为11.91±0.37mm,HACD为12.45±0.43mm,S-S为11.78±0.46mm; 且HACD和S-S与年龄呈负相关(r=-0.423、-0.386,均P<0.05); 与中央前房深度(ACD)的相关性比较：ACD≤3.5mm组中WTW、HACD与S-S有相关性; ACD>3.5mm组中WTW、HACD与S-S无明显相关关系。

结论：(1)WTW与S-S相关性更好,受年龄、前房深度影响,患者年龄≥40岁或ACD>3.5mm时建议参照UBM测量S-S对ICL型号进行确定;(2)SIRIUS测量的WTW、HACD安全、简单、重复性好。     

Ultrasound biomicroscopic analysis of the effect of pilocarpine on the anterior chamber angle

Background: This study was carried out to determine the effects of pilocarpine on the anterior chamber angle in healthy volunteers. Methods: We measured changes in anterior chamber depth (ACD), trabecular-iris angle (TIA), angle opening distance at 250 and 500 m from the scleral spur (AOD250 and AOD500), and iris thickness using ultrasound biomicroscopy in 48 eyes of 48 normal volunteers (ages 18–57 years, mean 34.8 years) before and 1 h after instillation of 2% pilocarpine. Results: Pilocarpine altered the TIA by –18.6° to + 10.5° (mean –4.16°), and change in the TIA increased significantly and linearly in relation with decrease in the pretreatment TIA (r = 0.929). Pilocarpine altered AOD250 change by –136 to +94 m (mean –38 m) and AOD500 by –151 to +157 m (mean –42 m); changes in the AOD250 and AOD500 were significantly correlated to the pretreatment AOD250 and AOD500 values, respectively (r = 0.923 andr = 0.896, respectively). The pilocarpine-induced change in the ACD showed a linear relationship to the pretreatment ACD (r = 0.887). The changes in the TIA, AOD250 and AOD500 showed greater increases in association with lower pretreatment ACD (r = 0.848,r = 0.891,r = 0.842) and smaller change in the ACD (r = 0.834,r = 0.839,r = 0.812). Conclusions: The response of the anterior chamber angle to pilocarpine, narrowing or widening, depended on its pretreatment state. The ability to predict the pilocarpine-induced change in the angle before the instillation of pilocarpine would be helpful in treating patients with glaucoma.