Unexpected autopsy findings arising from postmortem ocular examination

Background.-A full autopsy at our institution includes removal of the eyes for pathologic examination. To our knowledge, the rate of ophthalmic findin gs at autopsy has not been documented previously. Design.-We retrospectively reviewed 277 consecutive autopsies conducted bet ween 1995 and 1999 in which the eyes were removed for examination. Ophthalm ic findings were placed in the following categories: I, major findings incl uded those that contributed to the patient's death, would have changed pati ent management, and/or may have important medical implications for close re latives; II, expected findings after ophthalmologic surgery and minor findi ngs that may have eventually required treatment; and III, incidental findin gs. Results.-Major findings (category I) were found in 32% of autopsies. Minor findings (category II) and incidental findings (category III) were document ed in 62% and 34% of autopsies, respectively. Only 14% of autopsies reveale d no ophthalmologic diagnoses. Conclusion ln our series, postmortem ocular examination revealed a number o f important findings, including several heritable and rare conditions. Eigh ty-six percent of autopsies disclosed at least one pathologic ophthalmologi c finding, approximately one third of which demonstrated findings significa nt enough to have likely required management. Diabetic retinopathy was the most frequent major finding. Malignant melanoma of the choroid was the most commonly found intraocular neoplasm. Chronic uveitis was the most common m inor finding. We conclude that important, often unexpected ophthalmic findi ngs are frequently encountered at autopsy, underscoring the relevance of ro utine postmortem examination of the eyes.