Basal cell carcinoma (BCC) is the most common cancer worldwide and more common than all other cancers combined.¹ About 3.3 million individuals in the United States are diagnosed each year with nonmelanoma skin cancer, and approximately 80% of the lesions are BCC tumors.² Periocular BCC is diagnosed in 4.4% to 18.0% of all BCCs, accounting for approximately 90% of malignant periocular tumors.^3,4 Although most periocular BCCs are curable by surgery, the disease progresses in a minority of patients to a more extensive locally advanced BCC for which surgery and radiotherapy are inappropriate because a cure is unlikely and/or because surgery might result in severe ocular morbidity. Treatment of periocular locally advanced BCC (POLA-BCC) is especially complex because the need to remove periocular or orbital tissues (exenteration or full-thickness eyelid resection) often results in severe disfigurement and poor visual outcome or blindness, leading to a dramatic reduction in functionality and quality of life.^5,6

Purpose: To evaluate the effect of a single subconjunctival aflibercept injection on formed corneal neovascularization. Methods: A prospective clinical trial, conducted at a single tertiary medical center. Included were consecutive patients with corneal pathologies complicated by corneal neovascularization, who were candidates for anti–vascular endothelial growth factor treatment at the discretion of a cornea specialist. A single subconjunctival injection of 0.08 mL of Aflibercept (Eylea 25 mg/mL) was administered near the limbus in proximity to the areas of maximal pathological neovascularization. Follow-up visits were scheduled on days 7, 30, 60, and 90 following injection. Best-corrected visual acuity (BCVA), intraocular pressure, slitlamp examination, digital cornea photography, specular microscopy, and anterior-segment optical coherence tomography were documented at each visit. The images were graded by a masked observer for density, extent, and centricity of corneal vascularization. Results: Six eyes of six patients were analyzed. No clinically significant ocular or systemic adverse events were documented. No change was noted in extent, density, or centricity of corneal blood vessels at seven, 30, and 90 days after injection (P>0.1 for all time point comparisons, Friedman test). Best-corrected visual acuity fluctuated insignificantly in 5/6 patients during follow-up time, and objective but not subjective improvement of BCVA was noted in one patient with no concurrent change of neovascularization. The recruitment has therefore halted prematurely. Conclusions: A single subconjunctival aflibercept injection seems to be well tolerated. However, it is ineffective for regressing formed corneal neovascularization.

Introduction. To compare the safety and efficacy of the Therapeutic Hyper-CL™ lens versus a standard bandage contact lens (PureVision B&L) for chronic corneal edema. Methods. Prospective, multicenter, randomized, crossover study. Chronic corneal edema patients were randomized to one of two arms. The first arm was fitted with the Therapeutic Hyper-CL™ lens while the second arm was fitted with a standard soft bandage contact lens. Both arms were treated with 5% sodium chloride 6 times a day. After a 7-day treatment period, there was a 7-day washout period, after which the arms were crossed over. Patients were evaluated at days 0 (baseline), 7 (following first treatment allocation), 14 (following washout), and 21 (following second treatment allocation). The primary outcomes were 3 lines of BCVA (best corrected visual acuity) improvement. Results. In total, 49 patients were enrolled. There was significantly greater BCVA improvement rate >3 lines (30.4% versus 17.4%, P=0.04) in the Therapeutic Hyper-CL™ lens group. The mean change in BCVA lines was significantly greater for the Therapeutic Hyper-CL™ lens (3.4 ± 6.7 versus 0.9 ± 2.3, P=0.02). Conclusions. The Therapeutic Hyper-CL™ lens was associated with a higher chance for significant visual acuity improvement when compared to a standard bandage contact lens combined with 5% sodium chloride. This trial is registered with NCT02660151.

Purpose: This study reviews all reported cases of lacrimal gland chronic lymphocytic leukemia (CLL) to identify patterns in clinical presentation, diagnosis, and management to aid in early recognition and treatment of this uncommon occurrence. Methods: A comprehensive search of medical literature databases was performed to identify studies reporting lacrimal sac involvement in CLL from 1970 to 2024. Data were extracted regarding demographics, symptoms, diagnostic methods, treatment, and outcomes. Results: Thirty-three cases of CLL lacrimal sac infiltration were identified. The median age was 71, with a slight female predominance of 54.5%. The most common symptoms were epiphora (63.6%) and pseudo-dacryocystitis or symptoms of dacryocystitis (48.5%). A significant proportion of patients (87.9%) had a known history of CLL at presentation. Chemotherapy combined with surgery was the most frequent treatment, 48.4%, with a positive response in 93.3% of patients. Local recurrence occurred in 10.3% of cases, predominantly in those treated with chemotherapy and surgery, or surgery alone. Conclusions: Lacrimal sac CLL, although rare, should be considered in patients with nasolacrimal duct obstruction, especially those with a prior CLL diagnosis. Early diagnosis can be aided by imaging and histopathological evaluation, and treatment typically results in favorable outcomes with low recurrence rates. Tailoring treatment based on individual patient factors is essential for optimal management.

Purpose: To examine the long-term success rate of pediatric endoscopic DCR surgery via telephone questionnaires, as determined by patients and their parents. Methods: This is a retrospective cohort study of all patients who underwent DCR surgery at the Schneider Children's Medical Center of Israel between 2010 and 2020. We performed long-term follow-ups to assess the quality of life, surgical complications, and satisfaction with surgical outcomes. Results: Our study includes seventy-nine patients with a total of 108 eyes. The mean age at the time of DCR was 7.05 years (Std = 4, min = 0.3, max = 17.7) Mean follow-up time was 5.7 years (Std =2.5, min = 1.4, max = 11.1). Tubes were inserted for a mean of 129 days (Std = 101). Fifty-seven patients (72%) declared they had no complications after surgery, three patients (4%) reported pain after surgery, and 14 patients (17.7%) reported tube extrusion, which occurred 7–21 days after surgery. Forty-four patients (56%) reported no recurrence of symptoms, 29 (37%) complained of mild epiphora, and 18 (23%) reported some ocular discharge. Sixty-eight patients (86%) stated that they did not undergo additional surgery, while the remaining 11 (14%) reported undergoing a revision operation for symptom control. Satisfaction rate (1–7) mean score reported was 6.15 (Std = 1.6). Sixty-two (78%) reported improved quality of life, while 17 (22%) reported no improvement. Our questionnaire results have been compared with the TEARS scores with similar findings. Conclusion: Regardless of its etiology, endoscopic DCR surgery in the pediatric population is safe and efficient, with a high long-term patient satisfaction rate, as reported via a telephone questionnaire.

Purpose: To describe the prevalence and outcome of motor vehicle accidents-associated ocular injuries. Methods: A survey of patients who presented to the emergency room at a level 1 trauma center with motor vehicle accidents-associated ocular injuries. A patient questionnaire and review of clinical notes were conducted for all patients. Results: Of 274 motor vehicle accident victims with ocular injuries who presented to the emergency room, 40 (15%) responded to the survey. Over half of them were driving a vehicle, and most reported wearing a seat belt or a helmet. Most ocular injuries were mild. The most common injuries were bone fractures, subconjunctival hemorrhage, eyelid involvement and corneal injury. Most respondents had no change in vision and perceived their ocular involvement as a minor part of their injury. Most respondents returned to work and to driving within a year. Conclusion: Our study sheds light on the details and extent of ocular involvement and the visual ability to perform daily activities following motor vehicle accidents.