Background/Objectives: This paper reviews three cases of rhegmatogenous retinal detachment (RRD) with giant retinal tear (GRT), focusing on surgical management and outcomes, and synthesizes the current literature on the subject. Methods: We retrospectively analyzed three cases of male patients diagnosed with RRD with GRT at our hospital from April 2022 to November 2023. The patients, aged 57, 66, and 60, underwent surgical interventions, with postoperative follow-up extending up to six months. All patients underwent pars plana vitrectomy (PPV), endolaser photocoagulation, fluid–air exchange, and intravitreal gas injection (perfluoropropane (C3F8) 14%) in each case. Surgeries were performed within four days of the patients’ initial visits. Outcome measures included visual acuity improvement, intraocular pressure stabilization, and retinal reattachment rates. Complications in the patients were also evaluated. Results: The patient who had not previously undergone cataract surgery (Case 1) had it concurrently with the retinal surgery. Four months after the initial surgery, Case 3 developed a secondary epiretinal membrane (ERM) and subsequently underwent ERM removal surgery. Postoperative care involved the tailored use of anti-inflammatory medications and frequent monitoring to mitigate complications such as proliferative vitreoretinopathy, epiretinal membrane formation, and redetachment. Conclusions: While limited by the small sample size, this report underscores the potential benefits of prompt surgical intervention, meticulous postoperative care, and proactive management of complications in RRD with GRT. Insights from these cases, supported by multiple literature reviews, may inform treatment strategies and highlight areas for further research in larger, more diverse patient populations.

Chronic myeloid leukemia (CML) is a clonal myeloproliferative neoplasm arising in hematopoietic stem cells. It may initially present with ocular symptoms, as illustrated by the case of a previously healthy 25-year-old woman who presented with a five-day history of floaters in her left eye. Fundus examination revealed bilateral retinal hemorrhages, Roth spots, increased vascular tortuosity, a left preretinal hemorrhage, and a left vitreous hemorrhage. Retinopathy secondary to a hematologic disorder was considered; the patient was promptly referred to hematology–oncology. Laboratory evaluation demonstrated leukocytosis with anemia, peripheral smear showed 1% myeloblasts, 40% myelocytes, and basophilia. Cytogenetic analysis confirmed t(9;22)(q34;q11.2), and quantitative polymerase chain reaction (PCR) detected a BCR::ABL1 (b3a2) transcript. A diagnosis of bilateral leukemic retinopathy was established, and the patient promptly started appropriate therapy for CML. This case underscores the importance of recognizing ocular findings—such as Roth spots, intraocular hemorrhages, and increased vascular tortuosity—as potential indicators of systemic malignancy and ensuring early referral and management. Early ophthalmic recognition of such findings can be vision- and life-saving.

Background/Objectives: Primary acquired lacrimal drainage obstruction (PALDO) is a common cause of epiphora. Although dacryoendoscopic recanalization (DER) is widely performed, its long-term success is limited by restenosis related to fibro-inflammatory processes. This study aimed to evaluate the efficacy of a novel Q-needle for targeted intraductal delivery of antifibrotic and anti-inflammatory agents during DER. Methods: A retrospective review was performed on 190 eyes treated with DER, silicone tube intubation (SI), and retrograde intraductal injection via the inferior meatus using a Q-needle. A mixture of dexamethasone (1 mL), 5-fluorouracil (1 mL), and triamcinolone acetonide (1 mL) was administered directly into the obstruction site under endoscopic visualization. Obstruction type was classified intraoperatively as secretory or structural based on dacryoendoscopic findings. Results: The overall surgical success rate was 92.1%, with significantly greater success in secretory-type PALDO compared to the structural type (96.8% vs. 87.4%, p = 0.031). These outcomes contrast with previous reports in which secretory-type PALDO was associated with poorer prognosis after DER. Conclusions: The improved outcomes in the secretory group suggest a potential role of combined antiproliferative and multi-phase anti-inflammatory therapy in effectively addressing the key mechanisms of restenosis. Q-needle–assisted intraductal injection during DER may represent a simple and safe adjunctive approach to improve surgical consistency and long-term patency in patients with PALDO.

Vision-language models (VLMs) are increasingly evaluated for retinal image interpretation, but end-task discrimination does not establish whether a prediction depends on the optical coherence tomography (OCT) image. We evaluated RetinaVLM, LLaVA-Med, and Qwen3.6-27B under zero-shot and parameter-efficient adaptation using an APTOS-2021 cohort (128 training, 21 validation, and 69 test eyes) and a 100-eye cross-site stress-test cohort. The primary readout compared forced-choice continue/stop scores obtained with a real OCT B-scan and a uniform-grey image while holding the generated rationale fixed; it therefore estimates a rationale-conditioned direct image contrast rather than total image dependence. Across 22 internal cells, 21 confidence intervals included an AUC of 0.5, while one Qwen zero-shot cell was inversely aligned (AUC 0.354, 95% CI 0.224–0.493). No positively aligned cells survived the Benjamini–Hochberg adjustment. Selected backbones produced image-responsive biomarker outputs, including pigment epithelial detachment balanced accuracy up to 0.93, whereas a five-field tabular reference model achieved decision AUC 0.731 (95% CI 0.603–0.846). Similar direct-contrast findings occurred in the second-site stress test. Because the generated rationales were not verified as faithful representations of latent computation, the grey image was out of distribution, and the cohorts were small, null direct contrasts cannot show that the models ignored OCT or establish equivalence to no discrimination.