• 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

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.

X10

Dalen-Fuchs nodule

Choriocapiralis

• 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)

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

Thank you!