Pyogenic granuloma of the eyes usually occurs after ocular surgery or inflammation related to the eyes, itself. This lesion is commonly related to procedures associated with chalazia, strabismus, or even enucleation. However, the incidence of pyogenic granuloma that arises directly from the lower canaliculi of the nasolacrimal system is rare and not being extensively reported. We report a case of an elderly lady who presented with pyogenic granuloma post EDCR with silicone stenting for left nasolacrimal duct obstruction. She presented with persistent left eye epiphora following procedure. The unusual site for pyogenic granuloma and it occurrence after EDCR raise the possibility that the condition is related to previous procedure and the material being used.
Granuloma, Pyogenic

Anti-vascular endothelial growth factor (VEGF) reduces choroidal thickness by choroidal hypoperfusion in diabetic macula oedema (DME) patients. Indirect effect of anti-VEGF towards outer retinal layers (ORL) which supplied by choroidal circulation has not been well described. We evaluate the ORL thickness between retinal pigment epithelium (RPE) with inner-segment-outer-segment photoreceptor junction (IS/OS) and RPE with external limiting membrane (ELM) in pre- and post-intravitreal Ranibizumab (IVR) treated eyes with central foveal diabetic macula edema. A total of 60 eyes (40 patients) were analysed. ORL thickness measured with optical coherence tomography at pre- and post-injection day 1, week 4 and week 6. Mean thickness of RPE-IS/OS was statistically significant over time (p=0.023) but not for RPE-ELM (p=0.216). Thickness ratio between RPE-IS/OS and RPE-ELM and central subfoveal thickness (CST) both showed statistically significant result over time with p=0.038 and p=0.000, respectively. We observed an initial reduction of ORL thickness at day 1 followed by increased in thickness at week 4 with subsequent reduction at week 6 was observed. ORL is an aspect that can be explore and emphasized further in patients considered for IVR injections. The long-term effects of IVR to the ORL however could not be concluded due to short follow up period.