Diagnosis and excision of breast multi-focal lesions by ultrasound-guided vacuum-assisted biopsy:a comparative evaluation

Objective To compare and evaluate the efficacy of diagnosis and excision for appropriately selected breast multi-focal lesions and solitary lesion by ultrasound-guided vacuum-assisted biopsy(UGVAB).Methods Among 392 appropriately selected patients,187 patients with multi-focal lesions and 205 patients with solitary lesion were treated by the 8-gauge UGVAB from May 2007 to June 2009.All lesions were removed as completely as possible.The patients with benign pathology underwent physical and ultrasound examinations at one week and 6 months after procedure.Results During the procedure,only three patients had vasovagal syncope and twenty others complained of other intraoperative discomfort.An accurate pathological diagnosis was obtained in all lesions.There was no apparent false-negative result among the 696 lesions with benign pathology at a follow-up of 6 months after procedure.The rates of malignant or premalignant pathology,postoperative complications and residual lesions in patients with multi-focal lesions were higher than those in patients with solitary lesion.If each lesion was considered as a subject of study,there was no significant difference between the two groups.Conclusion UGVAB is an effective method for diagnosis and excision of appropriately selected breast multi-focal lesions and can be used routinely.

The refractive outcome of Toric Lentis Mplus implant in cataract surgery

AIM： To evaluate the refractive outcome of Toric Lentis Mplus intraocular lens（IOL） implant.· METHODS： This is a retrospective case series.Consecutive patients with corneal astigmatism of at least1.5 D had Toric Lentis Mplus IOL implant during cataract surgery. The exclusion criteria included irregular astigmatism on corneal topography, large scotopic pupil diameter（〉6 mm）, poor visual potential and significant ocular comorbidity. Postoperative manifest refraction,uncorrected distance visual acuity（UDVA）, best-corrected distance visual acuity（BCVA）, uncorrected intermediate visual acuity at（UIVA） 3/4 m and uncorrected near visual acuity（UNVA） were obtained.·RESULTS： There were 70 eyes from 49 patients in this study. Patients were refracted at a median of 8.9wk（range 4.0 to 15.5） from the operation date. Sixty-five percent of eyes had 6/7.5（0.10 log MAR） or better, and99% 6/12（0.30 log MAR） or better postoperative UDVA.Eighty-nine percent could read Jaeger（J） 3（0.28 log MAR）and 95% J5（0.37 log MAR） at 40 cm. The median magnitude of astigmatism decreased from 1.91 D to 0.49 D（Wilcoxon, P〈0.001） after the operation. The range of the cylindrical error was reduced from 1.5-3.95 D（keratometric） preoperatively to 0.00-1.46 D（subjective refraction transposed to corneal plane） postoperatively.· CONCLUSION： Toric Lentis Mplus IOL has good predictability in reducing preexisting corneal astigmatism.

Mechanism of delayed conduction of fellow eyes in patients with optic neuritis

To test the hypothesis that latency delay in the fellow eyes of optic neuritis（ON） patients and to compensate for delayed transmission of visual information, latency change of multi-focal visual evoked potential（mf VEP） traces in fellow eyes of 15 ON patients were analyzed. Patients with low risk（LR） for developing multiple sclerosis（MS） were examined separately from MS patients to isolate effect of cortical plasticity from potential pathological changes in disseminated disease. The small increase in latency in fellow eyes of LR group was statistically not significant. In MS patients, the latency was significantly delayed（P〈0.02）. The magnitude of the latency change in the fellow eyes did not correlate with the severity of latency delay in the affected eyes（R^2〈0.02, P=0.3）. The differences between ON patients with and without MS, reported here, suggest that the presence of disseminated disease plays critical role in latency delay of the fellow eye.

Inverted Internal Limiting Membrane Flap Technique for Repair of Large Macular Holes： A Short-term Follow-up of Anatomical and Functional Outcomes

Background：Inverted internal limiting membrane （ILM） flap technique has recently been reported in a limited number of studies as an effective surgical technique for the management of large macular holes （MHs） with fair MH closure rates as well as gains in visual acuity.In the current study,longitudinal changes in multi-focal electroretinogram （mfERG） responses,best-corrected visual acuity （BCVA） and spectral-domain optical coherence tomography （SD-OCT） were evaluated in eyes with large MHs managed by this technique.Methods：A prospective noncontrolled interventional study of eight patients （eight eyes） with large MHs （minimum diameter 〉400 μm） was conducted.All MHs were treated with pars plana vitrectomy and indocyanine green-assisted inverted ILM flap technique.SD-OCT images were used to assess the anatomical outcomes of surgery while BCVA and mfERG were used to evaluate the functional outcomes during a 3-month follow-up.Results：All patients underwent successful intended manipulation and translocation of the ILM flap without flap dislocation and achieved complete anatomical closure.Partial microstructural reconstruction,demonstrated on SD-OCT as restoration of the external limiting membrane and the ellipsoid zone,was observed in all cases as early as 1 month after surgery.Functionally,as compared to baseline,all patients showed improvements in BCVA and all but one in mfERG response during follow-up.However,Pearson＇s test revealed no significant correlations between BCVA and mfERG responses of the fovea and of the macular area at each evaluation time point.Conclusions：Inverted ILM flap technique appeares to be a safe and effective approach for the management of large idiopathic MHs with favorable short-term anatomical and functional results.Postoperative reconstruction of the microstructure generally shows good consistency with improvements in both BCVA and mfERG response,of which the latter might be a supplement for the former in postoperative functional follow-up.