Yoon Duck Kim

Transcanalicular Laser-Assisted Revision of Failed Dacryocystorhinostomy

BACKGROUND AND OBJECTIVEnDespite the high success rate of external dacryocystorhinostomy (DCR), recurrent tearing after DCR can be troublesome. The authors performed transcanalicular revision in 6 patients with failed DCR.nnnPATIENTS AND METHODSnWith the use of a continuous wave Nd:YAG laser with a sclerostomy probe, the internal ostium was reopened by a transcanalicular approach. The authors applied 0.4 mg/ml of mitomycin-C around the opening for 5 minutes intranasally and inserted a silicone tube as a stent.nnnRESULTSnA total of 7 operations were performed in 6 patients. The operation was successful after the first revision in 5 of the 6 patients, but 1 of the patients required a second procedure.nnnCONCLUSIONSnThe transcanalicular laser-assisted revision has several advantages. It is simple and fast, skin incision is avoided, there is good hemostasis, it is less traumatic, and there is less postoperative morbidity.

The smooth surface tunnel porous polyethylene enucleation implant.

BACKGROUND AND OBJECTIVEnTo describe early clinical results with the porous polyethylene smooth surface tunnel (SST) enucleation implant.nnnPATIENTS AND METHODSnUncontrolled, prospective interventional case series of patients undergoing enucleation with placement of the SST implant. This implant consists of a porous polyethylene sphere with a smooth anterior surface containing pre-drilled tunnels to facilitate direct suturing of the rectus muscles to the implant without use of an implant wrap. Postoperatively, socket healing was assessed, and prosthesis and socket motility were evaluated by the surgeon using an ordinal scale (0 = no motility to 4 = excellent motility).nnnRESULTSnThirty patients received the SST implant, with a mean follow-up of more than 23 months. Two cases of exposure occurred and were managed surgically without the need for explantation. Mean socket motility was 3.1 on a 0 to 4 ordinal scale, with mean prosthesis motility of 2.8.nnnCONCLUSIONnThe SST implant provides satisfactory socket motility and is generally well tolerated in the anophthalmic socket without the need for wrapping material.

Current treatment of lacrimal gland carcinoma

Purpose of review The traditional treatment for lacrimal gland carcinoma is orbital exenteration followed by radiation therapy. However, orbital exenteration does not prevent distant relapse and death, and some patients experience local–regional recurrence after exenteration. More recently, eye-sparing surgery and adjuvant radiation therapy and chemotherapy have gained popularity in the treatment of lacrimal gland carcinoma. Preliminary studies show that these approaches are associated with reasonable local control rates and ocular toxicity profiles. In this review, we discuss recent studies of treatment of lacrimal gland carcinoma, including studies of potential molecular treatment targets. Recent findings Recent studies suggest promising results for neoadjuvant intra-arterial chemotherapy followed by orbital exenteration and adjuvant intravenous chemotherapy, but only in patients with an ‘intact lacrimal artery’. Recent studies of globe-sparing surgery followed by adjuvant proton radiation therapy or concurrent chemoradiation suggest good local control, reasonable rates of eye preservation, and low risk of serious ocular toxic effects. Larger tumor size and predominant basaloid histology seem to be associated with higher risk of local–regional recurrence and distant metastasis. One study showed oncogenic mutations in more than half of cases of lacrimal gland adenoid cystic carcinoma, with KRAS mutations in 10 of 24 patients, suggesting potential benefit of treatments targeting the EGFR–RAS–RAF cascade. Summary In selected patients with lacrimal gland carcinoma, eye-sparing surgery with eye-sparing radiation therapy offers preservation of visual function with good local control and minimal radiation-induced ocular toxic effects. In patients with recurrent or metastatic disease, a search for actionable cancer-associated mutations may be prudent.

A Case of Orbital Lipoblastoma: Temporal Evolution of Imaging Findings

Lipoblastoma is a rare tumor that is not commonly seen in the orbit. The authors present clinical features, histopathologic findings, changes in the radiologic findings over time, and the radiological-pathological correlation of orbital lipoblastoma in an infant. A 3-month-old male infant presented with a palpable mass on the left upper eyelid. The patient was observed for 1 year with magnetic resonance imaging. At the age of 15 months, the patient underwent excisional biopsy. Histopathologic examination showed features of hypocellular lobules with a mixture of adipocytes of various stages of maturity and myxoid stroma separated by prominent fibrous septa, confirming a diagnosis of orbital lipoblastoma. [J Pediatr Ophthalmol Strabismus. 2017;54:e67-e70.].