The use of chemotherapeutic agents in high doses in the treatment of advanced-stage cancer enhances drug toxicity, and ocular complications are not uncommon. In this article, we discuss the ocular toxicity in six patients with advanced nonpretreated colorectal cancer who received megadoses of carmustine and mitomycin with the support of autologous bone marrow transplantation. The results obtained did not reveal any subjective or objective pathologic conditions of the ocular apparatus with particular attention to orthoptic examinations, the anterior segment, and the fundus. No patient had changes in visual acuity. Tonometry did not demonstrate significant variations. There were, however, qualitative and quantitative changes in the tear films of all patients, leading to damage to the corneal and conjunctival epithelium.

An 18-month-old boy presented with a six-month history of irritation OD. Examination under anesthesia found a 7 mm cyst involving the inferior aspect of the iris OD. There was elevated intraocular pressure, marked injection of the episclera and conjunctiva, and shallowing of the anterior chamber. The cyst was excised. Microscopic examination detected compression of the iris stroma that was caused by an intrastromal cyst lined with nonkeratinizing epithelium forming two layers. Most cystic lesions of the iris that arise during the neonatal period result from separation of the epithelial layers of the iris. In this case, in the absence of trauma, the cyst appeared to have resulted from a developmental inclusion of conjunctival epithelium into the iris stroma.

Orbital hemorrhagic lesions include a group of heterogeneous conditions that may be idiopathic or caused by trauma, surgery, or preexisting vascular tumors or malformations. We report clinical, computed tomographic, and magnetic resonance imaging features of eight cases of orbital hemorrhage (2 cystic lymphangiomas, 2 subperiosteal hematomas, 1 traumatic hematoma, 1 hemorrhagic varix, 1 cholesterol granuloma, and 1 postsurgical hemosiderin deposit). The differential diagnosis of orbital hemorrhagic lesions may be difficult because of their relative rarity and nonspecific presentation. In particular, on computed tomography, cholesterol granulomas may simulate a lacrimal gland epithelial tumor and subperiosteal hematomas, a lymphoid tumor. Magnetic resonance imaging is an ideal imaging technique because of its ability to identify blood and blood products in all stages of degradation. Treatment can be limited to observation in varices, lymphangiomas, and trauma if vision is not threatened; otherwise, surgical blood drainage should be attempted. Cholesterol granulomas are best treated by curettage through an extraperiosteal orbitotomy. For subperiosteal acute or subacute hemorrhages, surgical drainage is recommended if the blood is not spontaneously reabsorbed within a few weeks.

We measured the amplitude of accommodation in the supine and prone positions of young subjects. We found that gravity does not influence accommodative amplitude. These findings support Schachar's zonular function and accommodative hypotheses that the lens is stable and under tension during accommodation.

Tuberculosis is a common illness among patients with acquired immunodeficiency syndrome (AIDS), and therefore, choroidal tubercles are expected to be found in these patients. Nevertheless, this association (AIDS-induced choroidal tuberculosis) is infrequently reported in the literature. We report four cases of patients with AIDS and tuberculosis who did not have any visual complaints and in whom a routine funduscopic examination disclosed the presence of choroidal nodules. These lesions were not accompanied by vitritis, iridocyclitis, or any sign of uveitis as has been reported in cases of tuberculous choroiditis in patients with AIDS by others in the literature.

We reviewed and analyzed the visual acuities achieved and the complications after 949 cataract operations done by ophthalmology residents during the transitional period in which an intracapsular cataract extraction technique was replaced by an extracapsular one. The available records of all patients from 1982 through 1991 were reviewed. Eighteen intracapsular and 896 extracapsular cataract extractions were performed, followed by 906 primary and 43 secondary implants. Posterior capsular rupture occurred in 6.3% of the cases with vitreous loss in 3.4%. Cystoid-macular edema was the most common postoperative complication. The postoperative visual acuity was 20/40 or better in 91% of cases, and it was better than the preoperative visual acuity in 99.5% of cases. With appropriate training and supervision, a resident can achieve good results by doing extracapsular cataract extractions with lens implantations. These results were comparable to those reported by others.

A 26-year-old man presented with an insidious loss of vision OD. He had amblyopia OD as a child secondary to congenital esotropia. Ophthalmic examination revealed a large mass beneath his right retina near the posterior pole. He also had glaucoma and a rapidly developing cataract. Ultrasound detected a choroidal mass, which was consistent with a melanoma. The patient chose enucleation over radiation therapy as his treatment modality. Pathologic evaluation of the tumor revealed a necrotic melanocytoma with a large malignant melanoma arising from its center that was comprised mainly of epithelioid cells. Malignant melanoma arising in a necrotic melanocytoma is an extremely rare event, and we believe this to be the first description of this event in a young patient with an amblyopic eye.

A 15-year-old girl and her 13-year-old brother had high myopia, mottled retinas with nonrecordable electroretinographic responses OU, and mental retardation. Both siblings had normal pupillary reactions to light, normal levels of serum amino acids, no nystagmus, no obesity, and no polydactyly. A consanguineous marriage of the patients' parents was found. We believe that the association of high myopia, retinal dystrophy, and mental retardation noted in these siblings may be uncommon.

A new hypothesis about zonular function is presented that has implications in regard to the cause and treatment of ocular hypertension and open-angle glaucoma. This hypothesis is based on the concept that the lens is under constant tension. The anterior and posterior zonules serve a different function than do the equatorial zonules. The anterior and posterior zonules are passive in terms of structural support of the lens; the equatorial zonules are the active components during accommodation.

Schachar's hypothesis of accommodation states that there is increased zonular tension during accommodation and the observed in vivo changes in lenticular curvature that occur during accommodation are the result of zonular forces. To demonstrate that there can be steepening of the central curvature of the lens with increased zonular tension, profile photographs of an equatorially unstretched and stretched gelatin-filled balloon and profile photographs from the literature of an unstretched and equatorially stretched human lens were digitized. Their radii of curvature were determined. We found that equatorial stretching of both the gelatin-filled balloon and the human lens produced central curvature steepening that was consistent with Schachar's hypothesis of accommodation.

Central areolar choroidal dystrophy (CACD) is a rare, bilateral, autosomal dominant macular dystrophy. Early in the course of the dystrophy, there is fine, symmetric mottling of the retinal pigment epithelium in the macula, often in a bull's-eye pattern. This progresses to geographic atrophy of the macula without noticeable drusen or flecks. This article describes the funduscopic, angiographic, and electrophysiologic findings in three patients with three generations of a pedigree with CACD. Generalized photoreceptor dysfunction was present in the oldest patient and manifested by delayed electroretinographic implicit timing. Age-related generalized photoreceptor abnormality is hypothesized in CACD.

Discrete and confluent iris hamartomas in a 42-year-old man with neurofibromatosis type 1 is reported.