Diagnosis Chronic glaucoma with secondary angle closure following central retinal vein occlusion with hemorrhagic infarction of retina and neovascularization of iris. Disciform macular degeneration

Choroid Cases

Case 8

Case History 41 yo male; Shadow over his left eye for 6M IOP : normal, Vision: 20/20 OD, and 20/25 OS. Left fundus revealed a large grayish yellow mushroom–like mass that elevated the retina superonasally.

Case History Tumor contained very little pigment and was not completely opaque on transillumination. Visual field test revealed a scotoma corresponding to the tumor. Right eye : perfectly normal. Clinical diagnosis: Amelanotic melanoma of the chroid.

Case History Gross description: 25 x 24 x 23 mm. Optic nerve was cut flush with the globe. Slightly hazy cornea: 13.5 x 11 mm. Globe transmitted light well except for a round shadow 15x15mm, posteriorly. Eye was opened horizontally.

Case History Anterior segment was not remarkable. Lens was in place and vitreous clear. Arising within the choroid nasally, the posterior margin of the mass extended to the edge of the optic nerve head nasally. The retina overlying the mass contained small amounts of pigment.

Spindle cell type X10

Spindle cell type X40

Diagnosis. Malignant melanoma of choroid, spindle cell type ( fascicular pattern ) Retinal invasion, Retinal detachment.

Uveal melanoma Most common primary intraocular tumor of adult. Arise from dendritic melanocytes of the uvea Caucasians 8.5 x than African Americans. Most posterior uveal melanomas present with painless visual loss Uveal melanomas spread first to the liver Uveal malignant melanoma is the most common primary intraocular tumor of adult. Thesesmelanomas arise from the dendritic melanocyte s if the uvea. In the united state the incident of the uveal melanoma in whiite patient is 8.5 timrd greater than the incie\dent in African american.. Most poserior uveal melanoma present with painless visual loss. Most uveal melanomas spred first to the liver, thereby providing an excellent example of organ specific metastasis.

Cell type Spindle cell type Epithelioid cell type

Uveal melanoma Prognostic factor Size : Tumor height Cell type : Epithelioid cells Proliferative index Tumor-infiltrating lymphocytes associated with adverse outcome Extra ocular extention Monosomy 3 and trisomy 8 The presence of looping pattern

Case 9

Case History 18 yo female sustained a penetrating superior limbal wound of right eye. Next day the wound was repaired with excision of the prolapsed iris. One month later, the patient conplained persistent pain in the right eye and failing vision in left eye. Enunciation of the right eye were performed. A 41- year – old white man had noted a shadow over his left eye for a 6-month period. His intraocular pressure were normal, and his vision 20/20 and 20/25 in the right and left eyes, respectively. Examination of the left fundus revealed a large grayish yellow mass having a mushroom –like configuration elevating the retina superonasally. The tumor contained very little pigment and was not completely opaque on transillumination. Visual field test revealed a scotoma corresponding to the tumor. The right eye was perfectly normal. The clinical diagnosis at the time of enucleation was amelanotic melanoma of the chroid. 16

X10

Dalen-Fuchs nodule

Choriocapiralis

Sympathetic Ophthalmia (SO) Bilateral granulomatous panuveitis following surgical / accidental trauma to one eye, likely an autoimmune inflammatory response against ocular antigens. Uveitis ranges from 5 days up to 50years after injury; however, over 90 % cases occur from 2 weeks to within 1 year.

Sympathetic Ophthalmia (SO) Histologic findings Diffuse granulomatous uveal inflammation Eosinophils may be plentiful Plasma cells are few or moderate in number. Neutrophils rare or absent Sparing of choriocapillaris Epithelioid cells with phagocytosed pigment Dalen-Fuchs nodules Epithelioid cells between Bruch’s membrane and retinal pigment epithelium

Lens Cases

Case 10

Case History Clinical history not available. Gross description not available.

Lens x2

Thinning of nerve fiber layer Mild optic atrophy

Diagnosis Phacolytic glaucoma

Phacolytic glaucoma Secondary open angle glaucoma Hyper mature (White) cataract Milky material may be seen in the AC Denatured lens protein leak through the intact lens capsule in advanced cases and stimulates a bland macrophagic response. Obstruction of the trabecular meshwork by macrophages that have ingested lens material and free high-molecular-weight lens protein

Phacolytic glaucoma Histologic findings Hypermature cataract Macrophages filled with eosinophilic lens material are seen in the aqueous fluid and on and in the iris, occluding the anterior –chamber angle. The macrophages are not present on the corneal endothelium.

References Ocular Pathology sixth edition, Myron Yanoff Joseph W. Sassani Eye Pathology An atlas and Basic text, Eagle Robbins and Cotran Pathologic Basis of Disease 7th edition, Kumar Abbas Fausto AFIP ATLAS OF TUMOR PATHOLOGY Series 4, Tumors of the Eye and Ocular Adnexa, Font, Croxatto, Rao

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