Cytopuncture microbiopsy during transcanalicular endoscopic lacrimal duct recanalization: A novel approach

Objective@#To describe the cytopuncture microbiopsy (CM) technique performed during transcanalicular endoscopic lacrimal duct recanalization (TELDR) in patients with primary acquired nasolacrimal duct obstruction (PANDO) as an alternative to open biopsy, the standard method used in collecting specimen.@*Methods@#This is a noncomparative, interventional case series with histopathologic correlation. Patients diagnosed with complete PANDO who underwent TELDR with balloon dacryoplasty and silicone intubation with CM at University of Santo Tomas Hospital from October 2014 to January 2017 were included.@*Results@#Twenty (20) tissue specimens from the lacrimal sac and nasolacrimal duct were obtained from 18 patients. There were 16 females and 2 males included in the study. Mean age was 57.5 years. All specimens revealed few clusters of benign epithelial cells with few degenerated mononuclear cells and lymphocytes, and singly scattered lymphocytes that are set in fibrinous background. Tissue cytology studies were negative for malignant cells.@*Conclusion@#CM is a minimally invasive procedure that offers an alternative to open biopsy technique that can be done routinely during TELDR.

Obstrução lacrimal pós-tratamento oncológico: revisão de literatura / Lacrimal drainage system obstruction after cancer treatment: a literature review

RESUMO A obstrução de via lacrimal é uma possível complicação decorrente de tratamentos oncológicos sistêmicos e locais. A epífora crônica gera grande impacto na qualidade de vida desses pacientes, e, como a fibrose terminal da via lacrimal pode necessitar de procedimentos complexos para sua resolução, é importante estarmos atentos a esse efeito adverso, com o objetivo de reconhecê-lo e tratá-lo precocemente, ou mesmo preveni-lo. Nesta revisão da literatura, os autores analisam todos os agentes quimioterápicos e radioterápicos associados à obstrução lacrimal e descrevem os mecanismos, a frequência, os tratamentos e a profilaxia. Os tratamentos oncológicos associados à obstrução lacrimal foram: radioterapia em cabeça e pescoço (dosagem acima de 45 a 75Gy), radioiodoterapia (dosagem acima de 150mCi) e quimioterapia com 5-FU, S-1, capecitabine e docetaxel. A obstrução lacrimal pode ser irreversível, e a intubação profilática das vias lacrimais é uma possibilidade descrita de tratamento profilático em casos de radioterapia e uso do 5-FU, S-1 e docetaxel. O tratamento cirúrgico de todos os casos é a dacriocistorrinostomia.

ABSTRACT Lacrimal duct obstruction can be a side effect of systemic and/or local cancer treatments. Chronic epiphora has a great impact on the quality of life of oncological patients. Since terminal fibrosis of the lacrimal system may require complex procedures, it is important to be aware of this adverse effect in order to recognize and treat it, or even prevent it. A literature review was performed to identify all types of systemic cancer treatment associated with lacrimal obstruction and to describe the mechanisms, frequency, treatment, and prophylaxis. The oncological treatments associated with lacrimal obstruction were head and neck radiotherapy (dosage above 45-75 Gy), radioiodine therapy (dosage above 150 mCi), and chemotherapy with 5-FU, S-1, Capecitabine and Docetaxel. Depending on the dose, this complication may be irreversible. Prophylactic intubation of the lacrimal system is an option for prophylaxis in cases of radiotherapy, use of 5-FU, S-1, and Docetaxel. Final surgical treatment is dacryocystorhinostomy.

Tumor de glándula lacrimal: a propósito de un caso / Lacrimal gland tumor: a case proposal

INTRODUCCIÓN: El carcinoma adenoide quístico (CAQ) es conocido por su lento crecimiento, su tendencia a la recurrencia local y al desarrollo de metástasis a distancia incluso décadas después del diagnóstico inicial, y a pesar de terapias agresivas. OBJETIVO: Presentar el caso de una paciente con CAQ de la glándula lagrimal, tumor muy infrecuente que representa casi el 10% de las lesiones orbitarias ocupantes de espacio. De éstas el 20-30% son de origen epitelial, de las cuales el 55% son lesiones benignas y el 45% malignas. El CAQ es el más común de los tumores epiteliales malignos de la glándula lagrimal (65%). CASO CLÍNICO: Presentamos el caso clínico de una paciente con CAQ de glándula lacrimal diagnosticado de forma incidental tras la realización de TAC desde la consulta de psiquiatría. RESULTADOS Y CONCLUSIONES: El síntoma de presentación más frecuente suele ser la proptosis, acompañada o no de dolor, aunque también puede presentarse como ptosis mecánica, reducción de visión y diplopía. La cirugía radical no ha demostrado mejorar la supervivencia o reducir la recurrencia local en comparación con un abordaje quirúrgico, más conservador en pacientes con tumores de menor tamaño y sin afectación ósea. Las mayores tasas de supervivencia se han conseguido, en pacientes tratados con quimioterapia, con quimioterapia citorreductiva intra-arterial seguida de exenteración orbital y radioterapia.

INTRODUCTION:The adenoid cystic carcinoma (ACC) is known for its slow growth, a tendency to local recurrence and the development of distant metastases even decades after the initial diagnosis, and despite aggressive therapies. AIM:We present the case of a patient with a lacrimal gland tumor. They are very rare tumors that represent almost 10% of space-occupying orbital lesions, of which 20-30% are of epithelial origin, of these, 55% are benign and 45% are malignant. The ACC is the most common malignant epithelial tumor (65%). CASE REPORT :We present the clinical case of a patient with ACC of the lacrimal gland incidentally diagnosed after performing a CT scan from the psychiatric office. RESULTS AND CONCLUSIONS:The most frequent presentation symptom is usually proptosis, accompanied or not accompanied by pain, although it can also occur as mechanical ptosis, vision reduction, and diplopia. Radical surgery has not been shown to improve survival or reduce local recurrence compared to a more conservative surgical approach in patients with smaller tumors and without bone involvement. The highest survival rates have been achieved, in patients treated with chemotherapy, with intra-arterial cytoreductors (IACC) followed by orbital exenteration and radiotherapy.

Oncocitoma em carúncula: relato de caso / Oncocytoma of the caruncle: a case report

RESUMO O oncocitoma é um tipo de neoplasia rara na prática clínica e descrito na literatura, principalmente quando localizado no olho. Quando localizado nos anexos oculares, é mais frequentemente na carúncula. Analisou-se o caso de uma paciente de 74 anos, caucasiana, que relatou desconforto visual no olho esquerdo, e cujo exame físico mostrou lesão tumoral na carúncula esquerda, com volume moderado, presença de neovascularização e secreção excessiva. A excisão cirúrgica da lesão foi realizada sob sedação, e a peça foi enviada para avaliação anatomopatológica. A lesão foi diagnosticada histologicamente como oncocitoma, sem malignidade, e a paciente não apresentou recidiva após o procedimento. Embora raro, esse tumor deve ser reconhecido pelos oftalmologistas, devido ao risco já relatado de desenvolvimento de adenocarcinoma.

ABSTRACT Oncocytoma is a neoplasm rarely observed in clinical practice and reported in the literature, especially when located in the eye. When described in the ocular adnexa, it is most often located in the caruncle. The case of a 74-year-old Caucasian female patient is reported. She complained of visual discomfort in the left eye, and physical examination showed a tumoral lesion in the left caruncle, of moderate volume, presence of neovascularization, and excessive secretion. Surgical excision of the lesion was performed under sedation, and the specimen was sent for pathological examination. The lesion was histologically diagnosed as oncocytoma with no malignancy, and the patient presented no recurrence after the procedure. Although rare, this tumor must be recognized by ophthalmologists due to the risk of developing adenocarcinoma, as already reported.

Rhinosporidiosis of the lacrimal sac masquerading as chronic dacryocystitis: a rare presentation

Rhinosporidiosis is a chronic infection of the mucous membrane caused by the Rhinosporiduim seeberi, which infects through transepithelial penetration. Although described worldwide, this entity is mostly found in the western hemisphere, afflicting young people, predominantly males, associated in many cases with recreational or professional contact with bath in ponds, rivers, or stagnant waters. The clinical features are varied depending on the affected membrane, in some cases mimicking other diseases postponing the correct diagnosis. Although nasal obstruction and epistaxis are the common clinical presentations in sinonasal rhinosporidiosis, patients with epiphora without a nasal mass often challenge the diagnosis. In the present case, we have documented a case of isolated lacrimal sac rhinosporidiosis masquerading as chronic dacryocystitis, which was successfully managed by endoscopic excision, accompanied by a literature review.

Puntoplastia en dos cortes modificada en estenosis de puntos y canalículos lagrimales inferiores / Modified two-snip punctoplasty for stenosis of inferior lacrimal points and canaliculi

RESUMEN Objetivo: Determinar los resultados alcanzados con la utilización de la puntoplastia en dos cortes modificada en el manejo de los pacientes con estenosis de los puntos y canalículos lagrimales inferiores. Métodos: Se realizó un estudio descriptivo y retrospectivo de una serie de casos, en el Hospital Universitario Clínico Quirúrgico "Comandante Manuel Fajardo", desde enero del año 2016 a diciembre de 2018. La muestra quedó conformada por 22 pacientes (38 ojos), sometidos a la técnica quirúrgica, y fue caracterizada de acuerdo con la edad, el sexo, el color de la piel, la bilateralidad, la localización anatómica de la obstrucción, los antecedentes patológicos personales, las complicaciones y la evaluación funcional final. Resultados: De un total de 22 pacientes, 17 estuvieron entre las edades de 60 y 79 años, el 72,7 por ciento del sexo femenino y el 86,4 por ciento con piel de color blanco. La blefaritis fue el principal antecedente oftalmológico encontrado (18,2 por ciento), la obstrucción fue bilateral en el 72,7 por ciento de los casos, y fundamentalmente a nivel del punto lagrimal (16 casos). El 86,8 por ciento no mostró complicaciones posoperatorias; 3 casos presentaron extrusión del tutor de silicona, los cuales estuvieron en relación con el fallo en el resultado final. En el 92,1 por ciento se constató el éxito de la cirugía. Conclusiones: La estenosis de la vía lagrimal se produce principalmente en mujeres, de raza blanca, mayores de 60 años y sin antecedentes patológicos referidos. La afectación es más frecuente a nivel del punto lagrimal. Con la técnica quirúrgica se logra un resultado excelente y con complicaciones mínimas(AU)

ABSTRACT Objective: Determine the results achieved by modified two-snip punctoplasty in the management of patients with stenosis of inferior lacrimal points and canaliculi. Methods: A retrospective descriptive study was conducted of a case series at Comandante Manuel Fajardo Clinical Surgical University Hospital from January 2016 to December 2018. The sample was 22 patients (38 eyes) undergoing the surgical technique. The variables studied were age, sex, skin color, bilaterality, anatomical location of the obstruction, personal pathological antecedents, complications and final functional evaluation. Results: Of the total 22 patients, 17 were in the 60-79 years age group, 72.7 percent were female and 86.4 percent were white. Blepharitis was the main ophthalmological antecedent (18.2 percent). Obstruction was bilateral in 72.7 percent of the cases, fundamentally at the lacrimal punctum (16 cases). 86.8 percent did not have any postoperative complication, whereas 3 presented extrusion of the silicone tutor. These were related to failure in the final result. Surgery was successful in 92.1 percent of the cases. Conclusions: Lacrimal duct stenosis prevails in white skin women aged over 60 years without reported pathological antecedents. The disorder is more common at the lacrimal punctum. The surgical technique used achieves excellent results with minimum complications(AU)

Canaliculitis / Canaliculitis

RESUMEN La canaliculitis es una entidad rara, con frecuencia mal diagnosticada por su similitud con otras enfermedades. Se reporta una paciente femenina, de 56 años de edad, remitida a la Consulta de Oculoplastia del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", por secreciones purulentas y epífora del ojo izquierdo. Al examen se observó hiperemia conjuntival, secreción purulenta, punto lagrimal inferior hiperémico, dilatado, y se constató salida de concreciones por este al comprimir el canalículo. Se confirmó el diagnóstico de canaliculitis aguda supurada con concreciones. Se indicó tratamiento quirúrgico, que consistió en la canaliculotomía con remoción de las concreciones. Un examen clínico detallado, con adecuado conocimiento de la vía lagrimal excretora, permitió el diagnóstico certero, con un tratamiento quirúrgico eficaz y una evolución satisfactoria(AU)

ABSTRACT Canaliculitis is an uncommon infectious disease. It is often misdiagnosed due to its overlapping presentation to other common entities. A 56-year-old female patient is reported. She was referred to Ramón Pando Ferrer Cuban Ophthalmologic Institute, Ocular Plastic Surgery consultation, suffering from punctal swelling, discharge, and epiphora. At ocular examination was described conjunctival hyperemia, pouting punctum and mucopurulent discharge. Punctal regurgitation of concretions appears under syringing. It was confirmed acute canaliculitis with concretions in the left eye. A canaliculotomy was performed, and the concretions were removed. Routine clinical examinations helped to get a right diagnosis of canaliculitis and the surgical result was satisfactory(AU)

Pilomatrix carcinoma of the lacrimal caruncle: a case report / Carcinoma pilomatricial da carúncula lacrimal: relato de caso

ABSTRACT A 45-year-old man presented with a 3-month history of a mass located in the caruncle of his right eye. An incisional biopsy had been performed one month prior by another specialist, and the histopathology report showed basal cell carcinoma. The mass was completely excised with a 2 mm safety margin, and the large conjunctival defect was reconstructed with one sheet of amniotic membrane allograft. A histological diagnosis of pilomatrix carcinoma was established. To prevent recurrence after surgery, we added bevacizumab (25 mg/mL, 1.25 mg/mL per drop) eye drops four times per day for three months. At the one-year follow-up, the patient showed no evidence of local recurrence or distant metastasis after initial excision and remains under close follow-up. Pilomatrix carcinoma should be considered in the differential diagnosis of a caruncular mass.

RESUMO Um homem de 45 anos apresentou história de massa na carúncula no olho direito durante 3 meses. Uma biópsia incisional foi realizada 1 mês antes por outro especialista e o laudo histopatológico mostrava carcinoma basocelular. A massa foi completamente excisada, com uma margem de segurança de 2 mm, e a grande lesão conjuntival foi reconstruída com uma folha de aloenxerto de membrana amniótica. Foi estabelecido um diagnóstico histológico de carcinoma pilomatricial. Para evitar a recorrência após a cirurgia, adicionamos colírio de bevacizumabe (25 mg/mL, 1,25 mg/mL por gota) quatro vezes ao dia durante três meses. No seguimento de 1 ano, o paciente não apresentou evidência de recidiva local ou metástase distante após a excisão inicial e continua sob acompanhamento próximo. O carcinoma pilomatricial deve ser considerado no diagnóstico diferencial de uma massa caruncular.

Uso da toxina botulínica na permanência de epífora após dacriocistorrinostomias / Use of botulinic toxin in epiphora not solved by dacryocystrhinostomies

Introdução: A Toxina Botulínica (TB) possui importantes aplicabilidades no tratamento de doenças oftalmológicas. Este trabalho apresenta a aplicação da TB no manejo da epífora, relacionada à obstrução baixa das vias de drenagem lacrimal, refratária à duas dacriocistorrinostomias (DCR). Descrição do caso: Paciente de 70 anos, sexo feminino, comparece ao serviço com queixa de epífora em ambos os olhos (AO) e histórico de dacriocistite aguda. Submetida à sondagem de vias lacrimais (AO), que sugeriu diagnóstico de obstrução baixa de vias lacrimais, e a duas DCR, em cada olho, ambas com resultado precário no controle da epífora. Foi então, realizada aplicação de TB em glândulas lacrimais em AO, com resultado satisfatório e remissão das queixas da paciente. Discussão: A aplicação da TB na glândula lacrimal gera inibição da excreção do conteúdo lacrimal e, consequente, redução dos efeitos da disfunção na drenagem causada pela obstrução baixa de vias lacrimais. Configura-se, portanto, como uma opção terapêutica relevante para o tratamento da epífora - principalmente para casos refratários ao tratamento cirúrgico convencional. O tratamento cirúrgico para epífora apresenta taxas de sucesso variando de 58-68%, já a aplicação de TB apresenta eficácia de 86%. Conclusão: O uso da TB em oftalmologia possui resultados promissores no tratamento de inúmeras doenças, como no caso relatado. Contudo, novos estudos são fundamentais para a definição de protocolos de utilização dessa droga, visando a otimizar sua eficácia e sua segurança para cada condição clínica. (AU)

Bilateral simultaneous endoscopic dacryocystorhinostomy: outcome and impact on the quality of life of the patients

Introduction: Bilateral simultaneous endoscopic dacryocystorhinostomy (endo-DCR) has received little attention in the literature, thus many surgeons continue to address bilateral nasolacrimal duct obstruction at two stages, rather than in the same setting. Objective: To evaluate the feasibility and the outcome of simultaneous bilateral Endo- DCR and its impact on the quality of life of the patients. Methods: We have conducted a retrospective analysis of patients who underwent bilateral simultaneous endo-DCR between March 2013 and February 2017 at our tertiary care institution. The reviewed data included clinical presentation; operative details; success rate; pre and postoperative evaluation of the symptoms of the patients, using the Nasolacrimal Duct Obstruction Symptom Score Questionnaire; satisfaction of the patients, and improvement in the quality of life, assessed by the Glasgow Benefit Inventory (GBI) questionnaire. Results: Out of 128 cases in which endo-DCRs were performed, 13 were bilateral (26 sides). Postoperative success was documented in 24 of the 26 sides (92.3%), with a mean follow-up duration of 16.2 months. The two failed sides were reported in the same case. The preoperative symptom score ranged between 12 and 80 (mean ± standard deviation [SD]: 38.23 ± 15.7). The postoperative symptom score was significantly lower (mean ± SD: 5.4 ± 12.9). The success rates in unilateral and bilateral cases were comparable, with no statistically significant difference. A notable improvement in the quality of life of the patients was also reported, with a mean GBI score of 81.38 ± 12.37. Conclusion: Our results support that a simultaneous bilateral endo-DCR is a safe procedure that offers a high success rate, spares the patient from the stress of a second surgery, provides the patient with a bilateral resolution of the symptoms, and confers an immediate improvement in the quality of life of the patients (AU)

Development of Predictive Models in Patients with Epiphora Using Lacrimal Scintigraphy and Machine Learning / 대한핵의학회잡지

PURPOSE: We developed predictive models using different programming languages and different computing platforms for machine learning (ML) and deep learning (DL) that classify clinical diagnoses in patients with epiphora. We evaluated the diagnostic performance of these models.METHODS: Between January 2016 and September 2017, 250 patients with epiphora who underwent dacryocystography (DCG) and lacrimal scintigraphy (LS) were included in the study. We developed five different predictive models using ML tools, Python-based TensorFlow, R, and Microsoft Azure Machine Learning Studio (MAMLS). A total of 27 clinical characteristics and parameters including variables related to epiphora (VE) and variables related to dacryocystography (VDCG) were used as input data. Apart from this, we developed two predictive convolutional neural network (CNN) models for diagnosing LS images. We conducted this study using supervised learning.RESULTS: Among 500 eyes of 250 patients, 59 eyes had anatomical obstruction, 338 eyes had functional obstruction, and the remaining 103 eyes were normal. For the data set that excluded VE and VDCG, the test accuracies in Python-based TensorFlow, R, multiclass logistic regression in MAMLS, multiclass neural network in MAMLS, and nuclear medicine physician were 81.70%, 80.60%, 81.70%, 73.10%, and 80.60%, respectively. The test accuracies of CNN models in three-class classification diagnosis and binary classification diagnosis were 72.00% and 77.42%, respectively.CONCLUSIONS: ML-based predictive models using different programming languages and different computing platforms were useful for classifying clinical diagnoses in patients with epiphora and were similar to a clinician's diagnostic ability.

An Unusual Case of Double Lacrimal Puncta

PURPOSE: Congenital double puncta are usually unilateral, and the accessory punctum exists on the medial side in a slit configuration that is distinct from the shape of the normal punctum. We report a case of an unusual case of double lacrimal puncta which the lateral, rather than the medial, punctum was judged to be the accessory punctum. CASE SUMMARY: A 39-year-old male patient with no underlying disease and no ophthalmologic history visited our clinic with right eye epiphora of 2 weeks duration. On slit lamp examination, double puncta were observed in the right lower eyelid and the remaining puncta were normal. On lacrimal syringing test and dacryocystography were performed and revealed incomplete obstruction with partial narrowing of the nasolacrimal duct. Silicone tube intubation was performed through the right lower medial punctum and symptoms improved postoperatively. CONCLUSIONS: The present case is an unusual case of double lacrimal puncta which has not been reported in Korea. Unlike the previous literature, the lateral, rather than the medial, punctum was judged to be the accessory punctum. Because accessory punctm can be present on the lateral side, it is necessary to distinguish between the accessory punctm and the main punctum through the accurate dacryocystography and lacrimal syringing test for the treatment of the patient.

Outcome of External Dacryocystorhinostomy and Monocanalicular Intubation in Patients with Total Obstruction of One Canalicus

PURPOSE: We sought to evaluate the outcomes of external dacryocystorhinostomy (DCR) and mono-canalicular intubation in patients with total obstruction of one canalicus. METHODS: Sixteen eyes of 16 patients with nasolacrimal duct obstruction and a single canaliculus obstruction who had undergone external DCR and monocanalicular intubation of the intact canaliculus were retrospectively included in the present study. The monocanalicular tube (Mini Monoka) was left in place for at least two months. Munk epiphora grading for the evaluation of epiphora and irrigation was performed both preoperatively and at 6 months postoperatively. RESULTS: Mean patient age was 46 ± 14.2 (range, 18 to 76) years. The inferior canaliculus was obstructed in nine eyes (group A) and the superior canaliculus was obstructed in seven eyes (group B), respectively. Eight eyes had chronic dacryocystitis and two of these eyes also had a history of acute dacryocystitis attack. Mean preoperative Munk scores were 3.89 in group A and 4.0 in group B. Ocular surface irritation occurred in one eye in group A. Artificial eye drops were prescribed and early tube removal was not performed. Spontaneous tube dislocation was recorded in one eye in group B. No other corneal, punctal, or canalicular complications were found. At six months, irrigation of intact canaliculus was patent in all eyes. Mucoid discharge, conjunctival hyperemia, and chronic conjunctivitis were also resolved. Postoperative Munk scores were 1.11 ± 0.9 in group A and 0.86 ± 0.9 in group B. Of note, preoperative and postoperative Munk scores were significantly different in both groups (group A, p = 0.006; group B, p = 0.017). The postoperative Munk scores were not statistically different between the two groups (p = 0.606). CONCLUSIONS: In patients with nasolacrimal duct obstruction and a total of one canaliculus obstruction, external DCR and monocanalicular intubation of the intact canaliculus is an effective surgical option.

Comparison Between Endoscopic Prelacrimal Medial Maxillectomy and Caldwell-Luc Approach for Benign Maxillary Sinus Tumors

OBJECTIVES: Endoscopic prelacrimal medial maxillectomy (EPMM) was previously reported to treat maxillary inverted papilloma. This study aimed to compare prelacrimal recess approach with the conventional Caldwell-Luc approach (CLA) to remove benign maxillary sinus tumors and to evaluate the usefulness of this approach based on our experience. METHODS: Ten patients who underwent EPMM at our hospital from January 2013 to December 2017 were reviewed. We also reviewed 30 patients who underwent benign maxillary sinus tumor resection via CLA during the same period. From medical records, postoperative pathological results, complications due to surgery, and recurrence rate were evaluated. RESULTS: There were eight inverted papilloma, one ameloblastoma, and one ossifying fibroma in the EPMM group. In the CLA group, all 30 cases were inverted papilloma. There were no cases of failure at gross total removal during surgery, and no recurrences were observed during follow-up in either groups. Mean follow-up period was 13.0 months in CLA group and 10.8 months in EPMM group. Regarding postoperative complications, 11 patients of the CLA group (37%) and three patients of the EPMM group (30%) had numbness around the cheek and upper lip area after surgery (P=0.715). In the CLA group, there were eight patients who had numbness lasting more than 3 months after surgery, and two patients had numbness for more than 1 year. However, facial numbness disappeared within 3 months in all patients in the EPMM group, in which epiphora was not observed. CONCLUSION: EPMM is the effective surgical approach for resecting benign maxillary sinus tumor compared with CLA. Although facial numbness was reported in EPMM, the duration of numbness was shorter than CLA.

Primary bilateral and symmetric MALT lymphoma of the lacrimal sac mimicking chronic dacryocystitis / Linfoma MALT primário, bilateral e simétrico do saco lacrimal simulando dacriocistite crônica

Abstract We report a case of primary bilateral mucosa associated lymphoid tissue (MALT) lymphoma of the lacrimal sac. MALT lymphoma is a subtype of Non-Hodgkin's Lymphoma of the ocular adnexa. When the primary site of the lymphoma is the lacrimal sac, it mimics chronic dacryocystitis. This may delay diagnosis, with potentially lethal results.

Resumo Descrevemos um caso de um linfoma MALT bilateral, simétrico e primário de saco lacrimal. O linfoma MALT é um subtipo do Linfoma Não-Hodkin dos anexos oculares. Quando o local primário do linfoma é o saco lacrimal, ele pode simular uma dacriocistite crônica. Essa situação pode atrasar o diagnóstico e ter consequências fatais.

Éxito del sondaje en la obstrucción congénita de la vía lagrimal: Diez años de experiencia / Success in probing for congenital nasolacrimal duct obstruction: Ten years experience

Introducción. La obstrucción congénita de la vía lagrimal es una patología común, de poca morbilidad, pero no exenta de complicaciones sin el diagnóstico y manejo correcto. Población y métodos. Estudio retrospectivo de 2005 a 2015 en pacientes que fueron sometidos a un procedimiento de sondaje. Se identificó edad al momento del procedimiento, género, lateralidad y presencia o ausencia de éxito con el procedimiento. Resultados. Se analizaron 137 ojos. La mediana de edad fue de 17 meses y la tasa de éxito total fue del 85,4%. Conclusión. La obstrucción congénita de la vía lagrimal con adecuado manejo conservador inicial tiene alta tasa de resolución espontánea y, en pacientes mayores de 12 meses, el sondaje tiene una alta tasa de éxito.

Introduction. The congenital nasolacrimal duct obstruction is a common pathology, with low morbidity, but not exempt of complications without the correct diagnosis and management. Methods. Retrospective study from 2005 to 2015 in patients who were submitted to a probing procedure. We identified age at procedure, gender, laterality and presence or absence of success with the procedure. Results. One hundred thirty-seven eyes were analyzed. The median age was 17 months and the total success rate was 85.4%. Conclusion. In congenital nasolacrimal duct obstruction there is a high rate of spontaneous resolution with the proper initial conservative management and, in patients older than 12 months, probing has a high rate of success.

A 20-year study on microvascular autologous transplantation of submandibular gland for treatment of severe dry eye / 北京大学学报(医学版)

Severe dry eye is a refractory ophthalmologic disease. Our multidisciplinary research group treated severe dry eye by microvascular autologous transplantation of submandibular gland (SMG) during the past 20 years. The SMG, with its blood vessels and Wharton's duct, was harvested from the submandibular triangle and transferred to the temporal area. The blood vessels in the SMG were anastomosed with the temporal blood vessels using a microsurgical technique. Then, the distal end of Wharton's duct was sutured to form an opening in the upper lateral conjunctival fold. The tear was replaced by the secretion of the transplanted SMG to lubricate the ocular surface. In our study, the surgical techniques of blood vessel management were continuously modified to increase the survival rate of the transplanted SMG. A novel surgical modality of partial transplantation of SMG was established to prevent postoperative epiphora. A clinical study with the largest case number in the world was conducted and the effectiveness of transplantation of SMG for severe dry eye was fully confirmed. In order to resolve two main clinical problems including ductal obstruction resulted from low secretion rate during the latent period, and epiphora due to over secretion of the transplanted SMG in the later term of transplantation, the regulation of the secretion mechanism of the normal and transplanted SMG were investigated. New opinions on mechanisms of saliva secretion were provided. Based on the priniciple of translational medicine, the results of related basic research were applied in the clinic. The clinical guidelines for secretion regulation of transplanted SMG were established. A concept of chronic obstructive sialadenitis of transplanted SMG was provided and its diagnostic criteria, diagnostic technique of sialography, and therapeutic regimen were established. As a result, the surgical success rate was obviously elevated, the surgical complications were decreased, and life quality of the patients was greatly improved.

Primary Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue of the Lacrimal Sac Mimicking Dacryocystitis

PURPOSE: We report a case of a young female patient who was diagnosed with a marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) of the lacrimal sac which mimicked dacrocystitis. CASE SUMMARY: A 23-year-old female suffered from epiphora for 3 years in the right eye. She had swelling and a painful lesion at the lacrimal sac 4 months prior and was referred to our hospital due to nasolacrimal duct obstruction and dacryocystitis. Lacrimal irrigation was performed with no passing and regurgitation with mucoid discharge. We performed orbital computed tomography and magnetic resonance imaging which showed a suspected tumor of the lacrimal sac in the right eye. We then performed excision and biopsy of the tumor through the skin approach. The patient was diagnosed with a MALT lymphoma with no systemic involvement. After six cycles of chemotherapy involving rituximab with cyclophosphamide, vincristine, and prednisone, the lesion of the mass and the painful symptoms decreased, which was regarded as a complete response. However, epiphora and eye discharge persisted, showing a nasolacrimal duct obstruction, so we performed endoscopic dacryocystorhinostomy with a lacrimal sac biopsy. The histological examination showed chronic inflammation, but not lymphoma. There was no recurrence of lymphoma at one year postoperatively. CONCLUSIONS: If there is an epiphora and palpable lesion in the lacrimal sac area, MALT lymphoma mimicking dacyocystitis may be suspected. After the lymphoma is first diagnosed by excision and biopsy, systemic chemotherapy with dacryocystorhinostomy could be an effective treatment.

Effects on Periocular Tissues after Proton Beam Radiation Therapy for Intraocular Tumors

BACKGROUND: To present our experience on orbital and periorbital tissue changes after proton beam radiation therapy (PBRT) in patients with intraocular tumors, apart from treatment outcomes and disease control. METHODS: Medical records of 6 patients with intraocular tumors who had been treated with PBRT and referred to oculoplasty clinics of two medical centers (Seoul National University Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center) from October 2007 to September 2014 were retrospectively reviewed. The types of adverse effects associated with PBRT, their management, and progression were analyzed. In anophthalmic patients who eventually underwent enucleation after PBRT due to disease progression, orbital volume (OV) was assessed from magnetic resonance (MR) images using the Pinnacle3 program. RESULTS: Among the six patients with PBRT history, three had uveal melanoma, and three children had retinoblastoma. Two eyes were treated with PBRT only, while the other four eyes ultimately underwent enucleation. Two eyes with PBRT only suffered from radiation dermatitis and intractable epiphora due to canaliculitis or punctal obstruction. All four anophthalmic patients showed severe enophthalmic features with periorbital hollowness. OV analysis showed that the difference between both orbits was less than 0.1 cm before enucleation, but increased to more than 2 cm3 after enucleation. CONCLUSION: PBRT for intraocular tumors can induce various orbital and periorbital tissue changes. More specifically, when enucleation is performed after PBRT due to disease progression, significant enophthalmos and OV decrease can develop and can cause poor facial cosmesis as treatment sequelae.

Combination Surgery of Silicone Tube Intubation and Conjunctival Resection in Patients with Epiphora

PURPOSE: To compare the success rates of performing only silicone tube intubation versus carrying out both conjunctival resection and silicone tube intubation. METHODS: The subjects of this study involved 62 patients (96 eyes) between October 2015 and May 2017 who were diagnosed as having punctal stricture or nasolacrimal duct stenosis. Out of 96 eyes, 47 underwent only silicone tube intubation, and 49 underwent both silicone tube intubation and conjunctival resection. Three parameters were measured at 1, 3, and 6 months after the surgery: the area of the tear meniscus using RTVue-100 anterior segment optical coherence tomography, the height of the tear meniscus using a slit lamp microscope, and the subjective satisfaction of patients as a result of improved sympotms like epiphora. The surgery was considered successful when the patients' experienced the resolution of symptoms and reduction of the area and height of the tear meniscus. RESULTS: The area of the tear meniscus, height of the tear meniscus, and subjective satisfaction of patients was superior in the group that underwent both silicone tube intubation and conjunctival resection compared silicone tube intubation only. Based on these results, the success rate of the surgery was 68.9% in the group that underwent only silicone tube intubation and 78.7% in the group that underwent both silicone tube intubation and conjunctival resection. CONCLUSIONS: The resection of relaxed plica semilunares seems to increase the success rate of silicone tube intubation through the reduction of the area and height of the tear meniscus. Therefore, after determining the degree of conjunctivochalasis, if it was found to be severe, a combination with conjunctival resection was expected to increase the success rate of the surgery.