The method of en face frozen section in clearing periocular basal cell carcinoma and squamous cell carcinoma.

BACKGROUND: The senior consultants Ross Benger and Andrew Gal have been using en face frozen section histological margin control in removing cancer from the periocular region since 1985. The aim of this study was to determine the percentage of cases in which more than one resection was necessary in order to achieve clear margins. METHODS: This is a retrospective study of patients treated at Drummoyne Eye Surgical Centre in the period 1999-2007, in whom removal of the eyelid cancer was decided to be with en face frozen section histological control. A record was kept of how many resections were necessary to achieve clear margins. Paraffin sections were subsequently examined for a final histopathological diagnosis. RESULTS: Two hundred and fifty people were included in the study, of whom 204 had basal cell carcinoma (BCC) and 32 had squamous cell carcinoma (SCC). One hundred and twenty BCCs had a full-thickness eyelid "wedge" resection, of which 45% needed more than the standard two frozen sections taken to achieve clear margins. Eighty-four BCCs were removed using ring resection, of which 35.7% needed more than the standard initial resections (peripheral annulus and deep disc) to achieve clear margins. CONCLUSIONS: Our study showed that a significant percentage of BCC and SCC lesions needed further resection after the initial frozen section edge checks to achieve clear margins. Intraoperative presence of the histopathologist increased the likelihood of achieving clearance of the cancer at a single operating session.

Switching from pro re nata to treat-and-extend regimen improves visual acuity in patients with neovascular age-related macular degeneration.

PURPOSE: To evaluate the visual outcome after transitioning from a pro re nata (PRN) intravitreal injection regimen to a treat-and-extend (TAE) regimen for patients with neovascular age-related macular degeneration (AMD). METHODS: A retrospective review of patients who were switched from a PRN regimen with intravitreal injections of bevacizumab, ranibizumab or aflibercept to a TAE regimen. The best corrected visual acuity (BCVA), central retinal thickness (CRT) and type of medication used at baseline, at the time of changing treatment regimen and at the end of the study were analysed. RESULTS: Twenty-one eyes of 21 patients met the inclusion criteria. Prior to the switch, the patients received a mean of 13.8 injections (median, 10; range, 3-39 injections) with the PRN regimen for 44 months (range, 3-100 months), which improved the visual acuity in five patients (24%). After a mean of 6.1 injections (median, 5; range, 3-14 injections) with the TAE regimen over 8 months (range, 2-16 months), the visual acuity improved in 12 patients (57%). The improvement in visual acuity during treatment with the TAE regimen was statistically significant (p = 0.005). The proportion of patients with a visual acuity of 0.2 or better was significantly higher after treatment with the TAE regimen than after treatment with the PRN regimen (p = 0.048). No significant differences in CRT were found between the two treatment regimens. CONCLUSION: Even after prolonged treatment and a high number of intravitreal injections, switching AMD patients from a PRN regimen to a strict TAE regimen significantly improves visual acuity.

Using the Burn Specific Health Scale-brief as a measure of quality of life after a burn-what score should clinicians expect?

BACKGROUND: How do clinicians determine the acceptable level of recovery of quality of life (QoL) after a burn? Many use the Burn Specific Health Scale (BSHS). The aim of this study was to examine normative values of the BSHS-Brief (BSHS-B) questionnaire in the general population. METHODS: Two random samples of the non-burned public were taken. Each individual completed either the physical or the generic questions adapted from the BSHS-B questionnaire. RESULTS: Of the 124 subjects who completed the physical questions, > 73% rated themselves 36/36. Group mean (SD) = 34.8 (2.9), median (IQR) = 36 (35-36), range 16-36. Advancing age was associated with reduced physical capability (p = 0.016). In contrast, 7.6% of the 105 subjects who answered the generic questions recorded a full score (84/84). Group mean (SD) = 71.3 (13.8), median (IQR) = 76 (66-80), range 10-84. CONCLUSION: The study showed the non-burned population do not respond with full scores to all questions in the BSHS-B. The result was more notable in the non-physical questions related to the psychological and environmental factors. The data presented prompts clinicians to collect and define acceptable recovery of quality of life after a burn as measured by the BSHS-B for their local burn population.