Surgical and Anatomic Consideration in Endoscopic Dacryocystorhinostomy of a Patient with Damaged Sinonasal Anatomy Post-Caldwell-Luc Surgery: A Case Report.

Background: The Caldwell-Luc (CL) procedure, an outdated operative procedure that is used to treat inflammatory sinus diseases, is rarely performed presently. However, physicians may encounter patients with a history of CL surgery who develop considerable postoperative changes that may lead to diagnostic confusion in imaging evaluation; increase the difficulty of future surgery, such as sinonasal surgery; and increase the incidence of future intraoperative complications. Case summary: A 67-year-old man with a surgical history of chronic sinusitis reported epiphora of the left eye for five years. Balloon dacryocystoplasty was attempted but failed. Endo-DCR (Endoscopic dacryocystorhinostomy) was indicated; however, preoperative CT (computed tomography) imaging and nasal endoscopic examination showed sinonasal anomalies and the loss of internal landmarks for localizing the lacrimal sac. Preoperative CT results indicated previous CL surgery. Endo-DCR was performed with the aid of nasal forceps and a 20-gauge vitreoretinal fiberoptic endoilluminator. A six-month follow-up revealed the complete resolution of symptoms and no signs of recurrence. Conclusions: Epiphora might be a delayed complication of the CL procedure. Before performing endo-DCR, ophthalmologists should be familiar with the sinonasal anatomy and carefully assess preoperative imaging to identify anatomical variations. Nasal forceps and transcanalicular illumination can assist in determining the precise location of the lacrimal sac during endo-DCR.

Adjuvant Intravitreal Bevacizumab Injection for Choroidal and Orbital Metastases of Refractory Invasive Ductal Carcinoma of the Breast.

The efficacy of combined intravitreal bevacizumab injection with systemic chemotherapy, palliative radiotherapy, and hormonal therapy to treat choroidal and orbital metastases is not known. Herein, we report the case of a 48-year-old woman with systemic chemotherapy-resistant choroidal and orbital metastases of the left eye originating from a stage IV invasive ductal carcinoma of the left breast. We describe the addition of a single intravitreal injection of bevacizumab in addition to treatment with systemic chemotherapy, hormonal therapy, and palliative radiotherapy. The patient's outcome at 6-month follow-up was favorable, as the metastatic lesion reduced in size and visual acuity improved. Combined treatment with intravitreal bevacizumab injection, systemic chemotherapy, palliative radiotherapy, and hormonal therapy can resolve ocular metastatic lesions originating from breast cancers.

Lamellar macular hole in diabetic retinopathy.

PURPOSE: To describe the clinical features and surgical outcomes of diabetic retinopathy-associated lamellar macular hole and compare them with those of idiopathic lamellar macular hole. METHODS: A total of 17 eyes with diabetic retinopathy-associated lamellar macular hole and 30 eyes with idiopathic lamellar macular hole undergoing surgery were retrospectively enrolled. Baseline best-corrected visual acuity, preoperative optical coherence tomography characteristics, and final best-corrected visual acuity were compared between two groups. RESULTS: Both the baseline and the final best-corrected visual acuity in the diabetic retinopathy group were significantly worse than those in the idiopathic group (p = 0.029 for baseline, p = 0.002 for final). Lamellar macular hole in diabetic retinopathy tended to have a wider opening (p < 0.001) and a thinner residual base (p = 0.023). The width and height of parafoveal schisis in diabetic retinopathy-associated lamellar macular hole were both larger than those in idiopathic lamellar macular hole (p < 0.001 for both). After operation, both groups achieved significant improvement in best-corrected visual acuity (p < 0.01 for both). CONCLUSION: Compared with idiopathic group, diabetic retinopathy-associated lamellar macular hole had worse baseline best-corrected visual acuity, wider defect, and more pronounced parafoveal schisis. However, significant visual improvement could be obtained after operation. All cases in both groups achieved good anatomical outcomes with normalization of foveal contour and reduction of parafoveal schisis.