This study was designed to test a hypothesis that the esterification of the primary 6-hydroxyl groups on β-cyclodextrin (β-CD) may disrupt its crystallinity, thereby enhancing its aqueous solubility and increasing its ability to solubilize water-insoluble compounds. 6-acyl-o-β-CD derivatives with different chain length and substitution degree were synthesized by esterifying the primary hydroxyl groups at 6-position of β-CD with various acyl chlorides. X-ray diffraction patterns confirmed the existence of 6-acyl-o-β-CD derivatives as amorphous solid. Effects of chain length and substitution degree of the acyl groups on 6-acyl-o-β-CD/steroid complexation and solubilization were investigated with the phase solubility method. The results indicated that the solubilities of 6-acyl-o-β-CD derivatives were significantly higher than that of β-CD itself, which resulted in an increase in their ability to solubilize poorly water-soluble drugs such as steroids. The addition of side chains to β-CD did not change the stoichiometric ratio (2:1) of β-CD/steroid complexes. The increase in chain length can enhance the association of 6-acyl-o-β-CDs with steroids as it was evidenced from the apparent stability constants. A solubility study utilizing different combinations of 6-acyl-o-β-CDs, α-CD and 2,6- dimethyl-o-β-CD suggested a competitive complexation process among the family of acyl-β-CD derivatives. A non-competitive steroid complexation between 6-acyl-o-β-CDs and α-CD and between 6-acyl-o-β-CDs and 2,6-dimethyl-o-β-CD was observed.

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.

Background: The Caldwell-Luc (CL) procedure, an outdated operative procedure that is used to treat inflammatory sinus diseases, is rarely performed presently.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.