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Leister N, Löser J, Gostian AO, Gostian M, Rokohl AC, Fieber MA, Alkan D, Schumacher C, Löw V, Gordon E, Böttiger BW, Heindl LM. Postoperative Pain Following Eye Enucleation: A Prospective Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:614. [PMID: 38674260 PMCID: PMC11051797 DOI: 10.3390/medicina60040614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Enucleation of an eye is the most invasive procedure in ophthalmologic surgery. It can be the result of various diseases (malignant/chronic/trauma/infection) and is nevertheless relatively rare, but leads to the loss of a strongly innervated neuronal organ. This study systematically evaluates postoperative pain levels following enucleation of the eye globe. Materials and Methods: This prospective single-center study enrolled twenty-four patients undergoing enucleation of the eye globe. Perioperatively all patients completed (preoperative day, day of surgery, 1st, 2nd, and 3rd day following surgery) standardized questionnaires concerning their pain experience and treatment-related side-effects (internal protocol, QUIPS, painDETECT®). Patients received usual pain therapy in an unstandardized individual manner. Results: Preoperatively, mean average pain intensity of all included patients was 3.29 ± 2.46 (range, 0-8), 3.29 ± 3.24 (range, 0-8) on the day of surgery, 4.67 ± 1.90 (range, 2-10) on day 1, 3.25 ± 1.39 (range, 1-6) on day 2, and 2.71 ± 1.30 (range, 1-6) on day 3 after surgery. Mean maximum pain intensity was 4.71 ± 3.28 (range, 0-10) preoperatively, 4.04 ± 3.78 (range, 0-10) on the day of surgery, 5.75 ± 2.01 (range, 2-10) on day 1, 4.25 ± 1.89 (range, 2-10) on day 2, and 3.88 ± 1.54 (range, 2-8) on day 3 after surgery. Nineteen patients (79.2%) stated that they would have preferred more pain therapy. Conclusions: Patients undergoing eye enucleation report pain sensations in need of intervention in this university hospital. Thus, effective standardized pain treatment concepts are now a high priority to be established in an interdisciplinary manner containing standardized regimens and continuous regional procedures. Awareness of this problem in the medical team should be sharpened through targeted training and information.
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Affiliation(s)
- Nicolas Leister
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Johannes Löser
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
- Department of Palliative Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Antoniu-Oreste Gostian
- Department of Otolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Magdalena Gostian
- Department of Anesthesiology and Intensive Care Medicine, Malteser Waldkrankenhaus St. Marien, 91054 Erlangen, Germany;
| | - Alexander C. Rokohl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (A.C.R.); (E.G.); (L.M.H.)
| | - Marc A. Fieber
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Deniz Alkan
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Christine Schumacher
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Vanessa Löw
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Erik Gordon
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (A.C.R.); (E.G.); (L.M.H.)
| | - Bernd W. Böttiger
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Ludwig M. Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (A.C.R.); (E.G.); (L.M.H.)
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Kim AH, Kim J, Nayer ZH, Plum W, Glass LRD. Management of traumatic globe subluxation with optic nerve and extraocular muscle transection. Orbit 2023:1-6. [PMID: 38009285 DOI: 10.1080/01676830.2023.2283185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/07/2023] [Indexed: 11/28/2023]
Abstract
A care algorithm for partial globe subluxation cases with optic nerve and at least one extraocular muscle (EOM) transection is presented after a literature review was performed using key term variations of globe, ocular, subluxation, optic nerve evulsion or transection, and trauma. Partial globe subluxation cases with transection of the optic nerve and at least 1 EOM were included. Exclusion criteria included globe rupture, complete enucleation defined by a globe without at least 1 EOM attachment, or unclear details confirming optic nerve transection. Including the patient presented herein, a total of 24 patients with 26 eyes were analyzed. About 73.08% of cases underwent initial repositioning (n = 19), with 11.54% of those requiring secondary enucleation or evisceration (n = 3). Of the secondarily managed cases, 2 of the 3 cases listed pain (n = 2) and inadequate cosmesis (n = 1) as rationale. We found that 26.92% of cases underwent initial enucleation (n = 7), citing lack of visual potential and limiting later complications. Most cases favored repositioning, which was typically sustainable. Initial repositioning can improve cosmetic outcome and psychological impact. Given the low risk of later management, cases of traumatic partial subluxation with EOM and optic nerve transections should attempt initial repositioning.
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Affiliation(s)
- Angela H Kim
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
- College of Medicine, The State University of New York at Downstate Medical Center, Brooklyn, New York, USA
| | - Janice Kim
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Zacharia H Nayer
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - William Plum
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Lora R Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
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Maheshwari D, Ingle I, Tara TD, Ramugade-Shinde S, Pillai MR, Kader MA, Rengappa R, Uduman MS. Impact of glaucoma on vision-specific quality of life in monocular glaucoma patients using the Indian vision function questionnaire. Indian J Ophthalmol 2023; 71:2760-2766. [PMID: 37417117 PMCID: PMC10491069 DOI: 10.4103/ijo.ijo_413_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/23/2023] [Accepted: 03/28/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To evaluate the determinants affecting the quality of life in monocular glaucoma patients using the Indian vision function questionnaire. Methods: In this prospective cross-sectional study, total of 196 patients were divided into two groups: cases and controls. Indian Vision Function Questionnaire (IND-VFQ) was administered and analyzed. One hundred twenty-nine (58.6%) patients who had lost their vision in one eye due to glaucoma were included as cases and 67 (30.4%) patients who had lost their vision due to other causes were taken as controls. Results Median composite score of subscales was 54.62 (29.7-74.7) in group 1 and 45.38 (23.7-76.7) in group 2. The psychosocial impact scale was the most affected scale, the median scores were 33.02 (0 to 60.0) and 19.07 (0 to 53.0) in groups 1 and 2, respectively. Among all dimensions of IND-VFQ, the highest score was for color vision 100.0 (0-100.0) and 100.0 (0-100.0), and the lowest median score was found in mental health and dependency in both the groups. Multiple linear regression analysis demonstrated that visual acuity was associated with a low score (P < 0.001). Female gender was significantly associated with the overall score in the univariate model (P = 0.006). Conclusion Monocular glaucoma patients have a poor general and vision-related quality of life. Depression associated with monocularity and the perception of dependency and being a burden on their family members greatly impacted the mental health of the participants.
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Affiliation(s)
| | - Isha Ingle
- Glaucoma Consultant at WYW Center, University Pittsburg Medical Center, Pittsburg, Pennsylvania, United States
| | - Techi Dodum Tara
- Glaucoma Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | | | - Madhavi R Pillai
- Glaucoma Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Mohideen A Kader
- Glaucoma Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
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Landau Prat D, Zvi D, Zloto O, Hartstein M, Vardizer Y, Ben Simon GJ. Acquired Anophthalmic Socket: Clinical Course and Treatment Options. Int Ophthalmol Clin 2023; 63:163-185. [PMID: 37439616 DOI: 10.1097/iio.0000000000000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
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Clinical Congenital Anophthalmos and Microphthalmos-Experiences of Patients and Their Parents after More than 10 Years of Treatment. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010034. [PMID: 36670585 PMCID: PMC9856451 DOI: 10.3390/children10010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
Congenital clinical anophthalmos and blind microphthalmos describe the absence of an eye or the presence of a small eye in the orbit. Between 1999 and 2013, 97 children with anophthalmos or microphthalmos were treated with self-inflating, hydrophilic gel expanders at the Rostock Eye Clinic. More than a decade later, this study investigated the perspective of patients and parents regarding the treatment, the surgical outcome, and the emotional and social well-being of the patients. A total of 22 families with 16 patients sighted in the other eye and six patients blind in both eyes participated. Questionnaires were developed, including items on physical, emotional, social, and medical aspects. The patients felt emotionally stable and integrated into their social environment, with no major limitations reported by the majority. These statements were confirmed by most of the parents. Parents (67%) indicated that the success of the operation was already apparent after the first intervention and that the current situation did not play a role in the patients' social environment. The study provided new insights into the therapy results, the postoperative care, and the social and emotional stability of the prosthesis-wearing patients, indicating the chosen expander methods as promising in terms of positive postoperative care.
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Chan AX, Saseendrakumar BR, Ozzello DJ, Ting M, Yoon JS, Liu CY, Korn BS, Kikkawa DO, Baxter SL. Social determinants associated with loss of an eye in the United States using the All of Us nationwide database. Orbit 2022; 41:739-744. [PMID: 34969350 PMCID: PMC9243193 DOI: 10.1080/01676830.2021.2012205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify common factors associated with the loss of an eye using the NIH All of Us database. METHODS In this case-controlled study, we extracted electronic health record and socio-demographic data for 231 cases of eye loss from All of Us enrollment sites. Controls (N = 924) matched the demographic characteristics of the 2020 United States Census. Bivariate analyses and multivariable logistic regression identified variables significantly associated with increased odds of eye loss. OUTCOME MEASURES Medical and social determinants associated with increased odds of losing an eye. RESULTS Among cases, the average age (standard deviation) was 60.1 (14.4) years. The majority (125, 54.1%) were male. 87 (37.7%) identified as African American, and 49 (21.2%) identified as Hispanic or Latino. Loss of eye was more likely in those with ocular tumor (odds ratio [OR] 421.73, 25 95% confidence interval [CI] 129.81-1959.80, p < .001), trauma (OR 13.38, 95% CI 6.64-27.43, p < .001), infection (OR 11.46, 95% CI 4.11-32.26, p = .001) or glaucoma (OR 8.33, 95% CI 4.43- 15.81, p < .001). African American (OR 2.39, 95% CI 1.39-4.09, p = .002) and Hispanic or Latino (OR 1.80, 95% CI 1.01-3.15, p = .04) participants were disproportionately affected. CONCLUSIONS Racial and ethnic disparities exist among those with loss of an eye from underlying conditions. Addressing health inequities may mitigate the risk of this morbid outcome.
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Affiliation(s)
- Alison X. Chan
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA
| | - Bharanidharan Radha Saseendrakumar
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA
| | - Daniel J. Ozzello
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA
| | - Michelle Ting
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA
| | - Jin Sook Yoon
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA
| | - Catherine Y. Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA
| | - Bobby S. Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA
| | - Don O. Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA
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Ahrabi B, Omidvari S, Mollazadeh Ghomi S, Ahmady Roozbahany N, Vafaei-Nezhad S, Shirazi Tehrani A, Abbaszadeh HA, Darabi S. Therapeutic Effects of Combination Therapy and Photobiomodulation Therapy on Retinal Regeneration. J Lasers Med Sci 2022; 13:e36. [PMID: 36743147 PMCID: PMC9841384 DOI: 10.34172/jlms.2022.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/27/2022] [Indexed: 01/27/2023]
Abstract
Introduction: Many systemic and ocular diseases cause macular edema (ME). Macular edema is seen in two primary forms; the first is diffuse thickening of the macula, and the other is a macula with a distinct petaloid (cloverleaf) appearance called cystoid macular edema. Macular edema has a known role in the reduction of visual equity, and many options have been proposed for the reversal of this condition. Methods: Articles on the effects of macular laser grid photocoagulation on diabetic macular edema (DME) or cystoid macular edema published between 2000 and 2022 were collected from PubMed, Google Scholar, and Web of Science. The following keywords were used for the search: "macular laser photocoagulation", "macular edema", "cystoid macular edema", "intravitreal pharmacotherapies", and "antivascular endothelial growth factor". Two hundred nineteen articles were found in google scholar and 165 articles in PubMed, and a total of 58 articles were included in the study after applying the exclusion criteria. Results: We investigated the effects of various lasers photocoagulation such as Focal and/or grid macular laser, subthreshold micropulse laser (SMPL), as well as intravitreal pharmacotherapies with triamcinolone acetonide, and fluocinolone, and extended released intraocular implants such as Ozurdex, Retisert, Iluvien, and anti-vascular endothelial growth factors such as bevacizumab (Avastin), Eyela, and Lucentis. Corticosteroids were more effective than lasers, although some researchers have found that lasers and combined lasers and corticosteroids are more effective. In addition, some studies have shown that the frequency and concentrations of intravitreal pharmacotherapies are effective in increasing visual outcomes. Conclusion: The results of the studies showed that the combined intravitreal corticosteroids are much more effective in improving visual acuity (VA) than a single corticosteroid, and the low concentration of the drug is safer. Still, corticosteroids have side effects such as increased intraocular pressure and glaucoma. Therefore, combining the medication with a laser is much more reasonable than each alone. Also, the subthreshold photocoagulation laser (670 nm) is better at reducing the central macular thickness (CMT) and improving VA than the micro pulse yellow laser and pan-retinal photocoagulation (PRP).
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Affiliation(s)
- Behnaz Ahrabi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samareh Omidvari
- Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shamim Mollazadeh Ghomi
- Cellular and Molecular Research Center, Research Institute for Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Navid Ahmady Roozbahany
- Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Vafaei-Nezhad
- Department of Anatomical Sciences, School of Medicine, Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Atefeh Shirazi Tehrani
- Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hojjat Allah Abbaszadeh
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to Hojjat Allah Abbaszadeh, Shahram Darabi,
| | - Shahram Darabi
- Cellular and Molecular Research Center, Research Institute for Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran,Correspondence to Hojjat Allah Abbaszadeh, Shahram Darabi,
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van Renterghem V, Ruiters S, Mombaerts I. Motility of the Ocular Prosthesis in Anophthalmic Patients: Objective and Patient-perceived Findings. Orbit 2022:1-6. [PMID: 35924421 DOI: 10.1080/01676830.2022.2107687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM To study the impact of the prosthesis motility on the Quality of Life (QoL) in anophthalmic patients. METHODS Cross-sectional, observational study of 100 anophthalmic patients, of whom 64% had an acryl implant, 6% an Allen implant, 1% a hydroxyapatite implant, 4% a dermis fat graft, 16% no implant, and 9% an unknown implant. We quantitatively assessed the motility of the prosthesis with Kestenbaum glasses and the QoL with a validated questionnaire covering five domains: General functional abilities and care, wearing comfort, physical appearance, psychological and social functioning. Associations between measured prosthetic eye motility, patient-perceived motility, and satisfaction were made. RESULTS Motility of the prosthesis was impaired with an average loss of 76%, and correlated with Cosmetic satisfaction (adduction P = .02, abduction P = .008, elevation P = .04) and Social satisfaction (adduction P = .03, abduction P = .003). The patient-perceived motility of the prosthesis correlated with General functioning abilities (horizontal P = .0004, vertical P = .0004), Comfort (horizontal P = .001, vertical P = .003), Cosmetic satisfaction (horizontal P = .0002, vertical P = .0002), Psychological satisfaction (horizontal P = .001, vertical P = .001), and Social satisfaction (horizontal P = .002, vertical P = .003). CONCLUSIONS Ocular prosthetic motility has a significant impact on patient-perceived satisfaction and physical appearance, and predicts coping with the prosthetic condition on the psychosocial level. This highlights the need of introducing patient-reported outcome measures in the prosthetic rehabilitation of the anophthalmic patient.
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Affiliation(s)
| | - Sébastien Ruiters
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
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McCullagh D, Puls N, Beaconsfield M, Dempster M, Jackson J, Williams M. Psychological aspects of living with an artificial eye. Orbit 2022; 41:745-750. [PMID: 35226567 DOI: 10.1080/01676830.2021.2013505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Artificial eye clinics address physical and aesthetic aspects of orbital prostheses, but psychological effects may not be formally addressed. In general, without effective coping mechanisms, stress can lead to anxiety and depression. This study aims to determine, in the context of having an artificial eye, whether coping strategies, as well as perception of illness and other demographic and clinical variables are associated with anxiety or depression. METHODS Consecutive patients attending two artificial eye clinics were invited to participate in this audit. Participants completed questionnaires: HADS, Brief IPQ and Brief COPE. Variables with a correlation coefficient of ≥0.2 with anxiety or depression were included in regression modeling. The extent to which the participants' emotional and cognitive representations of their artificial eye related to feelings of anxiety and depression was determined. RESULTS In the cohort of 208, clinically significant anxiety was present in 29.5% and clinically significant depression was present in 8.4%. Perceptions of the impact of the artificial eye and self-blame as a coping strategy were correlated with anxiety. Depression levels were higher when participants believed that their artificial eye had a greater impact on their life, when they lived alone, and when they used substances as a coping strategy. CONCLUSION Significant levels of anxiety exist in those living with artificial eyes, with various coping strategies used. Addressing this and offering alternative coping strategies may improve patient well being and overall satisfaction.
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Affiliation(s)
- Donal McCullagh
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, UK
| | - Nicholas Puls
- Ocular Prosthetics Department, Moorfields Eye Hospital, London, UK
| | | | | | - Jonathan Jackson
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, UK
| | - Michael Williams
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, UK.,School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, UK
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Padavettan C, Nivean P, Kheerthana N, Shah A, Nivean M. Quality of life among prosthetic shell users – Questionnaire based. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_158_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shapira Y, Worrell E, Litwin AS, Malhotra R. The UK National Artificial Eye Questionnaire Study: predictors of artificial eye wearers' experience Part 2 - visual function and quality of life. Eye (Lond) 2022; 36:140-147. [PMID: 33649575 PMCID: PMC8727567 DOI: 10.1038/s41433-021-01459-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/18/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To report associations with visual function and quality of life (QOL) in artificial eye wearers. METHODS Multicentre, observational, cross-sectional, nationwide study, within the National Health Service England. Items were adopted from the National Eye Institute Visual Function Questionnaire, and incorporated in the National Artificial Eye Questionnaire (NAEQ). The NAEQ was completed by 951 respondents. Multiple regressions assessed associations between the QOL scores and the experiences of artificial eye wearers, their routine management, changes over time, baseline and demographic parameters. RESULTS Parameters predictive of a better QOL composite score included longer artificial eye wear (β = 0.18, p < 0.001), better appearance (β = 0.17, p < 0.001), better comfort (β = 0.14, p = 0.001), tumour-related anophthalmia (β = 0.13, p = 0.003), male gender (β = 0.13, p < 0.001), shorter period of adjustment to monocular vision (β = 0.12, p < 0.001) and use of soap for cleaning (β = 0.09, p = 0.046). The composite score continued to improve beyond 10 years of prosthesis wear (≤2 years mean 72.80 ± 1.65 versus >10 years mean 79.45 ± 0.70; p = 0.001). Both better prosthesis appearance (β = 0.14, p = 0.022) and improved motility (β = 0.13, p = 0.042) predicted a better dependency score. Use of lubricating ointment predicted a worse dependency score (β = 0.23, p = 0.003). Neither the frequency of removal, nor the cleaning frequency of the artificial eye correlated with QOL scales. CONCLUSIONS Multiple factors in the artificial eye experience were found to predict visual function and QOL aspects. This study underscores the need to generate a dedicated QOL questionnaire for use in anophthalmic patients.
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Affiliation(s)
- Yinon Shapira
- grid.412941.b0000 0004 0489 5315Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex UK
| | - Emma Worrell
- grid.412941.b0000 0004 0489 5315Maxillofacial Prosthetics, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex UK
| | - Andre S. Litwin
- grid.412941.b0000 0004 0489 5315Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex UK
| | - Raman Malhotra
- grid.412941.b0000 0004 0489 5315Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex UK
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Abstract
PURPOSE Prophylactic enucleation of a ruptured globe with no light perception within 14 days of injury to prevent sympathetic ophthalmia (SO) has been an established dictum in academic teaching for more than 100 years. This treatment strategy was originally based on observation, speculation, and careful thought, but there was never any scientific proof. This review summarizes and updates the current state of our knowledge about globe rupture and SO, examines the origin and validity of the 14-day rule, and emphasizes the importance of trying to save the traumatized eye whenever possible. METHODS A comprehensive literature review of SO and globe rupture was performed. RESULTS SO is a rare disorder that may potentially occur following traumatic globe rupture as well as following a variety of other intraocular surgeries. Vitreoretinal surgery may be a more common cause than trauma according to some studies. SO may still occur despite having the eye removed within 14 days of the trauma. A variety of new medications including biologic agents are now available to treat SO with improved efficacy in suppressing the associated ocular inflammation and allowing retention of some useful vision. Removing the traumatized, blind eye may have other important psychological consequences associated with it that require consideration before eye removal is carried out. Retaining the blind, phthisical, disfigured eye avoids phantom vision and phantom pain associated with enucleation as well as providing a good platform to support and move an overlying prosthetic eye. Data on the occurrence of SO following evisceration and enucleation with and without predisposing factors confirms the exceedingly low risk. CONCLUSION Most civilian open globe injuries can be successfully repaired with modern, advanced microsurgical techniques currently available. Because of the exceedingly low risk of SO, even with the severity of open globe trauma during military conflicts being more devastating as a result of the blast and explosive injuries, today every attempt is made to primarily close the eye rather than primarily enucleate it, providing there is enough viable tissue to repair. The 14-day rule for eye removal after severe globe ruptures is not scientifically supported and does not always protect against SO, but the safe time period for prophylactic eye removal is not definitively known. In the exceptional cases where SO does occur, several new medications are now available that may help treat SO. We advocate saving the ruptured globe whenever possible and avoiding prophylactic enucleation to prevent the rare occurrence of SO. When an eye requires removal, evisceration is an acceptable alternative to enucleation in cases that do not harbor intraocular malignancy.
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Quaranta-Leoni FM, Fiorino MG, Quaranta-Leoni F, Di Marino M. Anophthalmic Socket Syndrome: Prevalence, Impact and Management Strategies. Clin Ophthalmol 2021; 15:3267-3281. [PMID: 34393477 PMCID: PMC8354770 DOI: 10.2147/opth.s325652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Anophthalmic socket syndrome determines functional deficits and facial deformities, and may lead to poor psychological outcomes. This review aims to comprehensively evaluate the features of the syndrome, based on literature review and authors’ clinical and surgical experience. An electronic database (PubMed,MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on anophthalmic socket syndrome was performed. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Different types of orbital implants were evaluated; the management of implant exposure was examined; different orbital volume enhancement procedures such as secondary implantation, subperiosteal implants and the use of fillers in anophthalmic patients were described; the problems related to socket contraction were outlined; the treatment options for chronic anophthalmic socket pain and phantom eye syndrome were assessed; the most recent advances in the management of congenital anophthalmia were described. Current clinical evidence does not support a specific orbital implant; late exposure of porous implants may be due to pegging, which currently is seldom used; filler absorption in the orbit appears to be faster than in the dermis, and repeated treatments could be a potential source of inflammation; socket contraction results in significant functional and psychological disability, and management is challenging. Patients affected by anophthalmic socket pain and phantom eye syndrome need specific counseling. It is auspicable to use a standardized protocol to treat children affected by clinical congenital anophthalmia; dermis fat graft is a suitable option in these patients as it helps continued socket expansion. Dermis fat graft can also address the volume deficit in case of explantation of exposed implants and in contracted sockets in both children and adults. Appropriate clinical care is essential, as adequate prosthesis wearing improves the quality of life of anophthalmic patients.
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Affiliation(s)
- Francesco M Quaranta-Leoni
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy.,Oftalmoplastica Roma, Rome, 00197, Italy
| | - Maria Grazia Fiorino
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy
| | | | - Matteo Di Marino
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy
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14
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Martel A, Baillif S, Thomas P, Almairac F, Galatoire O, Hamedani M, Fontaine D, Lanteri‐Minet M. Phantom eye pain: a multicentric study in 100 patients. Acta Ophthalmol 2021; 99:e753-e760. [PMID: 33124153 DOI: 10.1111/aos.14657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Phantom eye syndrome (PES) is an underestimated complication of eye amputation (EA) characterized by phantom eye pain (PEP), phantom visions and/or phantom sensations. The aim of this study was to assess PEP prevalence, features, risk factors, social and psychological consequences and associated quality of life. METHODS A questionnaire study was conducted in three oculoplastic departments between April 2016 and July 2017. Patients >18 years who had undergone EA ≥3 months earlier were included and asked to complete a prestamped questionnaire. Patient's characteristics, preoperative, surgical and postoperative data were collected. RESULTS Of the 185 questionnaires given, 115 (62%) were returned for analysis. Hundred patients with a mean age of 65.1 years (29-92; SD = 13.0) were included. Eye amputation (EA) indications were uveal melanoma (n = 24, 24%), trauma (n = 20, 20%), retinal detachment (n = 20, 20%), glaucoma (n = 14, 14%) and endophthalmitis (n = 12, 12%). Forty-seven (47%), 30 (30%) and 38 (38%) patients experienced PEP, phantom visions and phantom sensations, respectively. Anxiety and depression [Hospital Anxiety Depression scale (HADS) score ≥8 for both] were diagnosed in 34 (34%) and 42 (42%) patients, respectively. The mean EQ-5D-3L and EQ-5D visual analogue scale scores were 0.8 (0.06-1; SD = 0.2) and 68 (0-100; SD = 22), respectively. Preoperative eye pain (p = 0.031), glaucoma (p = 0.027), postoperative anxiety with HADS score ≥8 (p = 0.012) and ≥11 (p = 0.014), aesthetic discomfort (p = 0.002) and EQ-5D-3L score <0.8 (p < 0.001) were significantly associated with PEP in the univariate analysis. In the multivariate analysis, only anxiety (HADS score ≥8) was significantly associated with PEP (p = 0.009). CONCLUSION Phantom eye pain (PEP) is a common complication of EA strongly associated with postoperative anxiety.
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Affiliation(s)
- Arnaud Martel
- Ophthalmology Department University Hospital of Nice Nice France
| | | | - Pierre Thomas
- Neurology Department University Hospital of Nice Nice France
| | - Fabien Almairac
- Neurosurgery Department University Hospital of NiceFédération Hospitalo‐Universitaire InovPainCote d'Azur University Nice France
| | | | - Mehrad Hamedani
- Oculoplastic Department Jules Gonin Eye Hospital Lausanne Switzerland
| | - Denys Fontaine
- Neurosurgery Department University Hospital of NiceFédération Hospitalo‐Universitaire InovPainCote d'Azur University Nice France
| | - Michel Lanteri‐Minet
- Pain Evaluation and Management Department University Hospital of NiceFédération Hospitalo‐Universitaire InovPainCote d'Azur University Nice France
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15
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Vardizer Y, Sobeh T, Prat DL, Ben Simon GJ, Tomkins-Netzer O. Assessing the results of anophthalmic prostheses. Indian J Ophthalmol 2021; 69:1876-1881. [PMID: 34146048 PMCID: PMC8374791 DOI: 10.4103/ijo.ijo_2682_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Anophthalmic sockets cause disfigurement that may result in emotional and social distress. The choice of procedure and implant is based upon the surgeon's experience. There remains no standardization of cosmetic result. We sought to identify quantifiable anatomical features and functional properties related to a successful cosmetic result in patients with ocular prosthesis and to determine correlations between self-reported and third-party assessment of cosmetic success. Methods This was a prospective observational study, which included 107 adult patients (50.1% female; age 53.08 ± 18.64 years, range 18-89) with acquired anophthalmia following prosthesis fitting. Patients completed a self-assessment questionnaire on self-perception of body image and ocular properties. Three independent examiners assessed cosmetic score. Assessed variables included prosthesis movement, eyelid symmetry, prosthesis stability, and socket fullness. Results The general cosmetic result was 8.1 ± 2.19 (on a predetermined scale of 1-10) as perceived by the patients and 7.2 ± 0.19 by the examiners. Interexaminer correlation was high for all variables (P < 0.05). A good cosmetic result was correlated with prosthesis movement (P = 0.02), eyelid symmetry (P = 0.001), and prosthesis stability (P = 0.01). Factors that correlated with a good cosmetic result on multivariate analysis were prosthesis movement (odds ratio [OR] 4.95, P = 0.004), eyelid symmetry (OR 4.51, P = 0.006), and socket fullness (OR 3.56, P = 0.005). No correlation was observed between patients' perceptions of the overall cosmetic result and those of the examiners. Conclusion The cosmetic result of prosthesis use among anophthalmic patients is generally good, as perceived by both patients and examiners. Good eyelid position and symmetry, orbital fullness, and prosthesis motility were associated with a better cosmetic result.
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Affiliation(s)
- Yoav Vardizer
- Ophthalmology Department, Bnei Zion Medical Center; Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology; Vardizer Ocularist Clinic, Haifa, Israel
| | - Tamer Sobeh
- Ophthalmology Department, Bnei Zion Medical Center, Haifa; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Landau Prat
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Guy J Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Tomkins-Netzer
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology; Ophthalmology Department, Lady Davis Carmel Medical Center, Haifa, Israel
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16
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Martel A, Baillif S, Thomas P, Almairac F, Galatoire O, Hamedani M, Fontaine D, Lanteri-Minet M. Phantom vision after eye removal: prevalence, features and related risk factors. Br J Ophthalmol 2021; 106:1603-1609. [PMID: 33980507 DOI: 10.1136/bjophthalmol-2021-319091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/08/2021] [Accepted: 04/23/2021] [Indexed: 12/14/2022]
Abstract
AIM Phantom eye syndrome is a poorly understood and underestimated complication of eye removal (ER). Seeing with the amputated eye, referred to as phantom vision (PV), is undoubtedly the most intriguing and confusing complication experienced by anophthalmic patients. The aim of the study was to assess PV prevalence, clinical features and risk factors after ER. METHODS A multicentric questionnaire-based study was conducted between April 2016 and July 2017. Patients >18 years who underwent ER >3 months ago had a socket examination before inclusion. Data recorded included patients' demographics, and preoperative, surgical and postoperative features. RESULTS One hundred patients (53 men) with a mean age of 65.1 years (29-92; SD=13.0) were included. ER indications were: uveal melanoma (n=24, 24%), trauma (n=20, 20%), retinal detachment (n=20, 20%), glaucoma (n=14, 14%) and endophthalmitis (n=12, 12%). Thirty (30%) patients experienced PV. Elementary and complex visual hallucinations were experienced by 80% and 20% of patients, respectively. PV usually appeared within the first postoperative month and tended to decrease over time. Risk factors for PV were the preoperative use of proton beam therapy (p=0.006), uveal melanoma (p=0.014), enucleation (p=0.015), anxiety with a Hospital and Anxiety Depression (HAD) score ≥8 (p=0.042), depression with a HAD score ≥8 (p=0.030), phantom eye pain (p=0.044) and phantom eye sensations (p=0.002). CONCLUSION PV was reported by one-third of our patients. Despite being widely misunderstood, ophthalmologists and neurologists should be aware of this complication to adequately reassure patients.
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Affiliation(s)
- Arnaud Martel
- Ophthalmology, University Hospital Centre Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - Stephanie Baillif
- Ophthalmology, University Hospital Centre Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - Pierre Thomas
- Neurology, University Hospital Centre Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - Fabien Almairac
- Neurosurgery, University Hospital Centre Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | | | | | - Denys Fontaine
- Neurosurgery, University Hospital Centre Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - Michel Lanteri-Minet
- Pain Evaluation and Management Department, University Hospital of Nice, Fédération Hospitalo-Universitaire InovPain, Cote d'Azur University, University Hospital Centre Nice, Nice, Provence-Alpes-Côte d'Azur, France
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17
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Ruiters S, De Jong S, Mombaerts I. Measuring quality of care and life in patients with an ocular prosthesis. Graefes Arch Clin Exp Ophthalmol 2021; 259:2017-2025. [PMID: 33547966 DOI: 10.1007/s00417-021-05088-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE In patients with an anophthalmic condition, the primary determinants of success of ocular prosthetic rehabilitation are satisfaction with care and quality of life (QoL). The aim of this study is to develop a condition-specific questionnaire as a patient-reported outcome measure for patients with an ocular prosthesis. METHODS Observational cross-sectional prospective study. We included 100 patients (52 female, 48 male, > 18 years old) with an anophthalmic and ocular prosthetic condition existing for 2 years or more. The patients completed a pre-tested 72-item questionnaire regarding their experience on living with an ocular prosthesis in four domains of QoL: single vision and care, wearing comfort, physical appearance and motility, and psychosocial functioning. Associations with demographic factors and condition- and prosthesis-related variables were investigated with multivariate analysis. The questionnaire was reduced with principal component analysis to obtain the Global Ocular Prosthesis Score (GOPS). RESULTS Satisfaction scores for each QoL domain were high with a mean visual analogue score between 7.2 and 7.6. Patients were generally satisfied with the physical appearance of the artificial eye and reported adequate psychosocial functioning. Patients described the reduced peripheral visual field and socket discharge as chief complaints. The test was reduced to a 20-item questionnaire. The mean GOPS was 70.87 (median 75.00). CONCLUSIONS Patients with longstanding ocular prosthetic wear are satisfied with their physical appearance and report adequate psychosocial functioning. A concise 20-item questionnaire for the anophthalmic condition is a valuable tool to quantitatively measure patient-reported outcome of ocular prosthetic rehabilitation. TRIAL REGISTRATION NUMBER NCT04321382, 03/2020, retrospectively registered.
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Affiliation(s)
- Sébastien Ruiters
- Department of Ophthalmology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium.
| | | | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
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18
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Ullrich K, Worrell E, Shapira Y, Litwin A, Malhotra R. The UK National Artificial Eye Questionnaire Study: comparisons between cosmetic shell and artificial eye users. Part 2: maintenance, management and quality of life. Br J Ophthalmol 2021; 106:736-740. [PMID: 33397655 DOI: 10.1136/bjophthalmol-2020-317020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/06/2020] [Accepted: 12/11/2020] [Indexed: 11/04/2022]
Abstract
AIMS To compare the unique experiences related to artificial eye (AE) versus cosmetic shell (CS) wear. METHODS In this observational, cross-sectional study, the National Artificial Eye Questionnaire was employed nationwide within the National Health Service England. This second part of the study assesses daily management and care experiences, as well as visual function and quality of life aspects. RESULTS Overall, 951 respondents wore an AE, while 238 wore a CS. Both AE and CS respondents rated a relatively high score for a beneficial effect of prosthesis polishing, with an average score of 80.08±0.87 versus 77.17±1.73 (p=0.13, respectively). CS respondents removed and cleaned their prosthesis more frequently than AE respondents (p<0.0001, p=0.002, respectively). CS respondents instilled lubrication more frequently than AE respondents (p=0.022) with 33.3% versus 43.7% of AE and CS wearers, respectively, lubricating on at least a daily basis. The overall QOL composite score was similar in both AE and CS groups (approximately 77%, p=0.74). Social functioning was similar, and relatively high in both groups (approximately 86%, p=0.77). CONCLUSIONS This study characterises unique aspects of CSs versus AEs in a large national cohort. The results should provide reinforcement to the gain in popularity of CSs.
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Affiliation(s)
- Katja Ullrich
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK
| | - Emma Worrell
- Maxillofacial Prosthetics, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK
| | - Yinon Shapira
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK
| | - Andre Litwin
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK
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19
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Casslén B, Jugård Y, Taha Najim R, Odersjö M, Topa A, Andersson Grönlund M. Visual function and quality of life in children and adolescents with anophthalmia and microphthalmia treated with ocular prosthesis. Acta Ophthalmol 2020; 98:662-670. [PMID: 32356375 DOI: 10.1111/aos.14424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/09/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate health-related quality of life (HR-QoL), vision-related (VR-)QoL and perceptual visual dysfunction (PVD) among individuals with anophthalmia (A) and microphthalmia (M) treated with ocular prosthesis. METHODS The study comprised 15 individuals (mean age 6.6 years; range 1.7-14.1) with unilateral A or M. Three validated instruments measuring HR-QoL and VR-QoL were used: The Pediatric QoL Inventory (PedsQL), consisting of physical and psychosocial self-report and parent-proxy report (2-18 years); Children's Visual Function Questionnaire (CVFQ); and Effects of Youngsters' Eyesight on Quality of Life (EYE-Q). Perceptual visual dysfunctions (PVDs) were assessed by history taking according to a specific protocol. RESULTS A/M children and their parents showed low HR-QoL scores (PedsQL total score: 66.3; 69.6) compared with controls (83.0; 87.61) (p = 0.0035 and <0.0001, respectively, unpaired t-test). No differences were found between A/M children and parents, but parents tended to underestimate their children's emotional state. A/M children with subnormal visual acuity (VA) for age scored lower in physical health compared with A/M children with normal VA (p = 0.03, Mann-Whitney U-test). No significant VR-QoL differences between A/M children and references or between A/M children with subnormal or normal VA for age were found. More A/M children than controls exhibited PVDs in ≥1 area (7/11 versus 4/118; p < 0.0001, Fisher's exact test). CONCLUSION A/M individuals show poor HR-QoL and increased PVDs. No difference in QoL was found between children and parents, though the children tended to score lower in emotional well-being. A/M children with subnormal VA showed lower physical health score. These problems indicate the necessity of a thorough multidisciplinary assessment and follow-up of children with A/M.
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Affiliation(s)
- Beatrice Casslén
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Ylva Jugård
- Department of Ophthalmology Södra Älvsborg Hospital Region Västra Götaland Borås Sweden
| | - Rezhna Taha Najim
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Marie Odersjö
- Department of Otolaryngology Sahlgrenska University Hospital Region Västra Götaland Gothenburg Sweden
| | - Alexandra Topa
- Department of Clinical Genetics and Genomics Sahlgrenska University Hospital Region Västra Götaland Gothenburg Sweden
- Department of Laboratory Medicine Institute of Biomedicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology Sahlgrenska University Hospital Region Västra Götaland Mölndal Sweden
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The UK National Artificial Eye Questionnaire study: predictors of artificial eye wearers' experience part 1-comfort and satisfaction. Eye (Lond) 2020; 35:2233-2240. [PMID: 33106611 DOI: 10.1038/s41433-020-01236-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/11/2020] [Accepted: 10/15/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To report associations with comfort and with appearance satisfaction in artificial eye wearers. METHODS Multicentre, observational, cross-sectional study, nationwide within the National Health Service England. The National Artificial Eye Questionnaire (NAEQ) was completed by 951 respondents. Multiple regressions assessed associations between the experiences of artificial eye wearers, routine management, changes over time, baseline and demographic parameters and their reported comfort, satisfaction with appearance and prosthesis motility. RESULTS Better comfort levels were associated with needing less lubrication (β = 0.24, p < 0.001), older age (β = 0.17, p = 0.014), less discharge (β = 0.16, p < 0.001), less frequent cleaning (β = 0.16, p = 0.043), and male gender (β = 0.06, p = 0.047). Greater satisfaction with the appearance of the artificial eye was associated with better perceived motility (β = 0.57, p < 0.001). Black ethnic origin predicted a lower satisfaction with the appearance (β = -0.17, p = 0.001). Greater satisfaction with the motility was associated with a better appearance rating (β = 0.51, p < 0.001), longer time of having an artificial eye (β = 0.13, p < 0.001), older age (β = 0.11, p = 0.042), and a shorter adjustment time (β = -0.07, p = 0.016). Of the testimonials concerning appearance aspects, the majority (21/45, 46.7%) were related to the effect on social interactions. CONCLUSIONS The results suggest that more attention should be given to the "dry anophthalmic socket syndrome" as a key cause of discomfort. Young patients are concerned particularly about the motility of the artificial eye. Over time satisfaction with the artificial eye movement is likely to improve.
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21
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The prevalence of anophthalmic socket syndrome and its relation to patient quality of life. Eye (Lond) 2020; 35:1909-1914. [PMID: 32929179 DOI: 10.1038/s41433-020-01178-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/29/2020] [Accepted: 09/02/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Following removal of the eye, soft tissue changes of the eyelids and orbit may develop into an anophthalmic socket (AS) syndrome, which is often attributed to orbital volume deficiency. While adequate primary orbital volume replacement is nowadays standard of care, patients may still present with facial asymmetry. The aim of this study is to provide insights into these changes and their impact on patient quality of life (QoL). METHODS Cross-sectional study of 59 patients with longstanding ocular prosthetic wear after enucleation or evisceration surgery. The alignment, function, and laxity of the eyelids of the anophthalmic side were compared to those of the fellow side. The QoL was assessed with a 4-item questionnaire specific for the prosthetic condition. The different aspects of AS syndrome were analysed in relation to disease-specific and prosthetic data and to the patient QoL scores. RESULTS Clinical AS syndrome was prevalent in 53% of patients with acquired anophthalmia. The anophthalmic side was statistically significantly different from the fellow side for the known AS syndrome features such as superior sulcus depression, margin reflex distance 1, and enophthalmia, but also for new features such as levator muscle function and lagophthalmia (P < 0.05). The difference was correlated with duration of prosthetic wear, prior orbital radiotherapy, and size of the prosthesis (P < 0.05). QoL scores were not correlated to the separate features of AS syndrome, except for a positive correlation between wearing comfort of the prosthesis and upper eyelid ptosis (P < 0.05). CONCLUSION Patients with an ocular prosthesis show a relatively high prevalence of one or more distinct clinical features of AS syndrome, which do not negatively affect patient QoL. These findings underscore the importance to tailor prosthetic and surgical treatment to the patient's perceived QoL rather than to the objective clinical findings.
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Shapira Y, Worrell E, Ullrich K, Litwin A, Malhotra R. UK National Artificial Eye Questionnaire study: comparisons between cosmetic shell and artificial eye users. Part 1: demographics, comfort and satisfaction. Br J Ophthalmol 2020; 105:1346-1351. [PMID: 32892161 DOI: 10.1136/bjophthalmol-2020-317015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/01/2020] [Accepted: 08/16/2020] [Indexed: 11/04/2022]
Abstract
AIMS To compare the unique experiences related to artificial eye (AE) versus cosmetic shell (CS) wear. METHODS In this observational, cross-sectional study, the National Artificial Eye Questionnaire (NAEQ) was employed nationwide within the National Health Service England. The proportions or mean values of the aetiology of sight or eye loss, demographics, length of prosthesis wear, reported adjustment time to the prosthesis, comfort, discharge and satisfaction of appearance were compared between AE and CS respondents. RESULTS Overall, 951 respondents wore an AE, while 238 wore a CS. In both, trauma was the leading cause for the prosthesis (47.6% and 44.1%, respectively); however, these groups differed in the proportions of the other aetiologies (p<0.0001). AE respondents were generally older (p=0.002) and had longer overall prosthesis wear (p<0.0001) compared with CS respondents. The overall comfort score was similarly, relatively high in both AE and CS respondents (80.4±0.73 vs 81.41±1.45; p=0.51). The discharge-related patient satisfaction ranking was relatively low, in both groups, with a small trend towards worse discharge scores among AE wearers (59.41±0.76 vs 62.26±1.52, p=0.094). Self-reported length of time that has taken to adjust to wearing the prosthesis was not significantly different (p=0.17). Appearance of the eye (p=0.032) and motility of the prosthesis (p<0.0001) were ranked superior by CS respondents compared with AE. CONCLUSIONS This study characterises unique aspects of CS versus AE in a large national cohort. The results should provide reinforcement to the gain in popularity of CS.
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Affiliation(s)
- Yinon Shapira
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Emma Worrell
- Maxillofacial Prosthetics, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Katja Ullrich
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Andre Litwin
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
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Dave TV, Nayak A, Palo M, Goud Y, Tripuraneni D, Gupta S. Custom ocular prosthesis-related concerns: patient feedback survey-based report vis-à-vis objective clinical grading scales. Orbit 2020; 40:357-363. [PMID: 32744109 DOI: 10.1080/01676830.2020.1797826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: To report the outcomes of a survey on patients' concerns and satisfaction with custom ocular prosthesis (COP) wear and compare with objective clinician grading scales.Methods: The questionnaire was answered by 156 participants. General social concerns and prosthesis-related concerns were plotted on a scale of 0 to 10, indicating least to maximum satisfaction and also not concerned to very concerned. Comparison between subjective patient and objective clinician scores was done.Results: The mean age at presentation was 27.53 ± 15.53 years (range 3-72 years).For patients that underwent a prior surgical procedure, mean satisfaction with the surgery was 9.42 ± 1.27. Mean satisfaction with the COP was 8.98 ± 1.75. The median satisfaction score for the primary surgery as well as for the outcome of the custom ocular prosthesis was 10. Commonest prosthesis-related concerns were reduced motility (mean 3 ± 2, median 3), watering, crusting and discharge (mean 2 ± 2, median 2), and difference in the size of the prosthetic eye relative to the other eye (mean 1 ± 2, median 1). Subjective patient concern responses and the objective clinician grading correlated strongly for movement of the prosthesis (r = -0.84, p < .0001), periocular fullness (r = 0.65, p < .0001), color of the prosthesis (r = -0.8, p < .0001) and size relative to the other eye (r = 0.7, p < .0001).Conclusion: Custom ocular prosthesis usage had a high satisfaction score with minimal concerns. Commonest prosthesis-related concerns correlated strongly with objective clinician grading.
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Affiliation(s)
- Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, India
| | - Arpita Nayak
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, India
| | - Mansha Palo
- Ocular Prosthesis Laboratory, LV Prasad Eye Institute, Hyderabad, India
| | - Yashwanth Goud
- Ocular Prosthesis Laboratory, LV Prasad Eye Institute, Hyderabad, India
| | | | - Sachin Gupta
- Ocular Prosthesis Laboratory, LV Prasad Eye Institute, Hyderabad, India
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Abstract
Anophthalmic patients not only cause obvious functional deficits and facial deformities, but lead to poor psychological outcomes, although prosthesis wearing can offer improvements in psychological well-being to some extent. The study aimed to comprehensively evaluate the psychological symptoms and analyze related factors in anophthalmic patients wearing ocular prosthesis.Total of 150 anophthalmic patients and 120 control subjects were included in this cross-sectional study. Baseline characteristics survey and the symptom checklist-90 scale were completed by all participants to assess the psychological symptoms and analyze their related factors by multivariate analysis.The anophthalmic patients exhibited the increased levels of somatization, depression, anxiety, and hostility compared with control subjects. The most prominent symptom was hostility with the median score of 1.20. Female patients presented with higher somatization, depression, anxiety, and hostility. Marital status single was positively associated with depression, anxiety, and hostility symptoms. Lower education and cause of enucleation were related to higher levels of hostility.Anophthalmic patients wearing ocular prosthesis presented with more prominent hostility and somatization besides its higher depression and anxiety symptoms. The findings suggest that for female single anophthalmic patients with low education, especially caused by trauma, timely psychological assessment and intervention should be provided to avoid undesirable consequences.
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25
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Saxby E, Davies R, Kerr J. Living with an artificial eye-the emotional and psychosocial impact. Eye (Lond) 2019; 33:1349-1351. [PMID: 30890777 PMCID: PMC7005835 DOI: 10.1038/s41433-019-0398-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 01/31/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Edward Saxby
- Ophthalmology specialist trainee, Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK.
| | - Rhys Davies
- Ophthalmology specialist trainee, Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK
| | - Jan Kerr
- Consultant Ophthalmologist, Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK
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Rokohl AC, Koch KR, Trester M, Heindl LM. [Cryolite glass ocular prostheses and coralline hydroxyapatite implants for eye replacement following enucleation]. Ophthalmologe 2019; 115:793-794. [PMID: 29737403 DOI: 10.1007/s00347-018-0726-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A C Rokohl
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50924, Köln, Deutschland.
| | - K R Koch
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50924, Köln, Deutschland
| | - M Trester
- Institut Trester - Institut für Augenprothetik, Köln, Deutschland
| | - L M Heindl
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50924, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO), Köln-Bonn, Deutschland
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27
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Weintraub N, Reshef N, Pe'er J, Frenkel S, Rot I, Shoshani N, Weintraub M. The impact of monocular vision on motor function and quality of life in survivors of retinoblastoma. Pediatr Blood Cancer 2019; 66:e27623. [PMID: 30688019 DOI: 10.1002/pbc.27623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/19/2018] [Accepted: 12/08/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Monocular vision has been found to have a negative effect on children's motion processing and motor functions. Yet, knowledge of motor function of survivors of retinoblastoma (RB) with monocular vision (due to enucleation, for example) is limited. This study examined motor function and its relationship to visual-related and health-related quality of life (HRQOL) in survivors of RB with monocular vision. PROCEDURE Parents of 27 survivors of RB, who underwent an enucleation of one eye resulting in monocular vision, and of 21 typically developing children between the ages of 6 and 12, were administered questionnaires relating to their children's motor function (DCDQ), as well as vision-related function (CVFQ) and HRQOL (PedsQL). RESULTS Of the 27 survivors of RB, 7 (25.6%) were found to have difficulties in motor functions, compared with 1 (4.8%) child in the control group. The difficulties were faced mainly in daily function requiring control during movement, including jumping, running, and ball playing. Additionally, significant correlations were found between motor functions and children's QOL. Finally, survivors of RB with monocular vision were found to have lower QOL, specifically physical- and school-related QOL. CONCLUSION Survivors of RB who have monocular vision have a higher rate of decreased motor function and lower QOL. These results point to a need for ongoing assessment of survivors of RB to allow timely detection of motor deficits and to institute appropriate therapeutic interventions.
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Affiliation(s)
- Naomi Weintraub
- School of Occupational Therapy, Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Nurit Reshef
- School of Occupational Therapy, Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jacob Pe'er
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shahar Frenkel
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ido Rot
- Department of Social Work, Meuhedet Health Services, Jerusalem, Israel.,Department of Pediatric Hematology-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Naomi Shoshani
- Department of Pediatric Hematology-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michael Weintraub
- Department of Pediatric Hematology-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Alyn Hospital, Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
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Black JM, Jacobs RJ, Phillips JR, Acosta ML. The changing scope of Optometry in New Zealand: historical perspectives, current practice and research advances. J R Soc N Z 2019. [DOI: 10.1080/03036758.2019.1587476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joanna M. Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Robert J. Jacobs
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - John R. Phillips
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Monica L. Acosta
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
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Dave VP, Pappuru RR, Tyagi M, Pathengay A, Das T. Endoscopic vitrectomy in endophthalmitis: initial experience of 33 cases at a tertiary eye care center. Clin Ophthalmol 2019; 13:243-251. [PMID: 30787589 PMCID: PMC6368127 DOI: 10.2147/opth.s185716] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the presentation and management outcomes of endophthalmitis with endoscopic vitrectomy. Methods This is a retrospective interventional case series conducted at a tertiary eye care center in south India. Thirty three eyes of 33 patients were included. The medical records of the patients who underwent endoscopic vitrectomy for endophthalmitis from April 2014 to March 2018 were reviewed. Data with regard to age, gender, etiology of endophthalmitis, corneal and retinal examination, type of intervention, final anatomic and visual outcome, and the total follow-up were collected. The main outcome measures were the final visual acuity and evisceration rates. Results The mean age at presentation was 46.84±19.89 years, with a median age of 50 years. Based on etiology, 13 eyes (39.4%) were post-trauma endophthalmitis, eleven eyes (33.33%) were post-cataract surgery, three eyes (9.09%) were endogenous, three eyes (9.09%) were post-perforated corneal ulcer, two eyes (6.06%) were post-retinal surgery, and one eye (3.03%) was post-combined cataract and corneal surgery. Twenty-four eyes (72.72%) had a favorable anatomic outcome at the last visit, and five eyes (15.15%) had a favorable visual outcome. Of those with unfavorable visual outcome, ten eyes had further visual potential. Sixteen eyes (48.48%) showed a positive culture on microbiologic evaluation. The predominant organism isolated was Pseudomonas aeruginosa. Evisceration was required only in one eye (3.03%). Conclusion Endoscopic vitrectomy allows early management of endophthalmitis in spite of hazy media. This ensures a reasonable visual outcome, controls the infection, and reduces the incidence of evisceration in these eyes.
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Affiliation(s)
- Vivek Pravin Dave
- Smt Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad 500034, Telangana, India,
| | - Rajeev R Pappuru
- Smt Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad 500034, Telangana, India,
| | - Mudit Tyagi
- Smt Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad 500034, Telangana, India,
| | - Avinash Pathengay
- Retina and Uveitis Department, GMR Varalaxmi Campus, LV Prasad Eye Institute, Hanumanthawaka Chowk, Visakhapatnam 530040, Andhra Pradesh, India
| | - Taraprasad Das
- Smt Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad 500034, Telangana, India,
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30
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Curragh DS, Kamalarajah S, Lacey B, White ST, McNab AA, Kalantzis G, Dolman PJ, Selva D, Rajak SN. Primary replacement for the management of exposed orbital implant. Orbit 2019; 38:461-467. [PMID: 30706748 DOI: 10.1080/01676830.2019.1573262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: We present a series of primary orbital implant replacement for cases of implant exposure to describe our experience of this one-staged surgical approach. Methods: This study reports on a one-stage technique which involved the removal of the exposed implant or dermis fat graft (DFG) and insertion of a secondary (replacement) in the same procedure, with a variety of materials, including autologous tissue. Re-exposure in a socket where a DFG was placed was defined as a new defect in the newly epithelialized conjunctiva or dehiscence of the dermis-conjunctiva junction. All cases of primary replacement for the management of exposed orbital implant, porous and non-porous, were included, even when there were clinical signs suggestive of infection. The primary outcome was the rate of re-exposure, requiring additional surgical procedures. Infection following primary replacement was a secondary outcome. Results: Seventy-eight patients had primary replacement for the management of an exposed orbital implant. 6.4% had re-exposure at a mean follow-up of 49.7 months (9.1% for ball implants and 4.5% for DFG). The rate of exposure was higher in those with prior signs of infection than those without (8% vs. 3.6%). Re-exposure occurred in 4.5% of cases with DFG implantation, 4.3% of cases with non-porous implants and in 20% of cases with porous implants. Conclusion: Primary replacement for management of exposed orbital implant, porous and non-porous, has a high rate of successful outcome even in cases with presumed or confirmed infection.
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Affiliation(s)
- David S Curragh
- Department of Ophthalmology, Royal Victoria Hospital , Belfast , UK
| | | | - Brendan Lacey
- Department of Ophthalmology, Royal Victoria Hospital , Belfast , UK
| | - Stephen T White
- Department of Ophthalmology, Royal Victoria Hospital , Belfast , UK
| | - Alan A McNab
- Centre for Eye Research Australia and Department of Ophthalmology, University of Melbourne, and Royal Victorian Eye and Ear Hospital , Melbourne , Australia
| | - George Kalantzis
- Department of Ophthalmology, St. James' University Hospital, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Peter J Dolman
- Department of Ophthalmology and Visual Sciences, University of British Columbia , Vancouver , Canada
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital , Adelaide , Australia
| | - Saul N Rajak
- The Sussex Eye Hospital, Brighton and Sussex University Hospital , Brighton , UK
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Concerns of Anophthalmic Patients Wearing Cryolite Glass Prosthetic Eyes. Ophthalmic Plast Reconstr Surg 2018; 34:369-374. [PMID: 29194103 DOI: 10.1097/iop.0000000000001021] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify the main concerns of patients experienced in wearing cryolite glass prosthetic eyes and to investigate how these have changed over time. METHODS One hundred six patients experienced in wearing prosthetic eyes for at least 2 years were asked to complete an anonymous questionnaire regarding prosthetic eye concerns at the time of initial eye loss and at the present time. Main outcome measures included changes in levels of concern over time. RESULTS Initially, the participants were mainly concerned about their appearance, health of the fellow eye, and coping with monocularity. Over time, there was a significant increase of the level of concern regarding the health of the remaining eye (p < 0.001) and regarding watering, crusting, and discharge (p < 0.001). Loss of balance did not change significantly (p = 0.302). All other concerns decreased significantly over time (p < 0.001), with levels of concern about appearance decreasing the most. The current leading concern was the health of the remaining eye followed by concerns about watering, crusting, and discharge. Length of time since natural eye loss was the most important explanatory variable, with significant impact on the concerns about appearance (p = 0.013), retention of the prosthetic eye (p = 0.002), and eyelid contour (p = 0.004). CONCLUSIONS Health of the remaining eye is the most common current concern of anophthalmic patients, acknowledging the need of good ophthalmologic follow up after losing an eye. The second most important concern is with watering, crusting, and discharge, suggesting further research for establishing an evidence-based protocol for cryolite glass prosthetic eye maintenance and supportive treatment.
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Dahlmann-Noor A, Tailor V, Abou-Rayyah Y, Adams G, Brookes J, Khaw PT, Bunce C, Papadopoulos M. Functional vision and quality of life in children with microphthalmia/anophthalmia/coloboma-a cross-sectional study. J AAPOS 2018; 22:281-285.e1. [PMID: 29730053 DOI: 10.1016/j.jaapos.2018.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 01/25/2018] [Accepted: 01/29/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the child's and parental perception of functional visual ability (FVA), vision-related and health-related quality of life (VR-QoL, HR-QoL) in children with microphthalmia/anophthalmia/coloboma (MAC). METHODS Between June 25, 2014, and June 3, 2015, we carried out a cross-sectional observational study at Moorfields Eye Hospital, London, UK, enrolling 45 children 2-16 years of age with MAC attending our clinics, and their parents. To assess FVA, VR-QoL, and HR-QoL we asked participants to complete three validated tools, the Cardiff Visual Ability Questionnaire for Children (CVAQC), the Impact of Vision Impairment for Children (IVI-C) instrument, and the PedsQL V 4.0. The main outcome measures were the FVA, VR-QoL, and HR-QoL scores, reported by children and parents. RESULTS In children with MAC, FVA is moderately reduced, with a median CVAQC score of -1.4 (IQR, -2.4 to 0.4; range, -3.0 [higher FVA] to +2.8 [lower FVA]). VR-QoL and HR-QoL are greatly reduced, with an IVI-C median score of 63 (IQR, 52-66; normal VR-QoL, 96), a median self-reported PedsQL score of 77 (IQR, 71-90; normal HR-QoL, 100) and parental score of 79 (IQR, 61-93), and a family impact score of 81 (67-93). Psychosocial well-being scores are lower than physical well-being scores. Parents and children have a different perception of the impact of the condition on the child's HR-QoL. CONCLUSIONS MAC has a significant impact on a child's FVA and QoL, similar to that described by children with acute lymphoblastic leukaemia and chronic systemic conditions. Children and families may benefit from psychosocial support.
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Affiliation(s)
- Annegret Dahlmann-Noor
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom; Pediatric Service, Moorfields Eye Hospital, London, United Kingdom.
| | - Vijay Tailor
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | | | - Gillian Adams
- Pediatric Service, Moorfields Eye Hospital, London, United Kingdom
| | - John Brookes
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom; Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom
| | - Peng T Khaw
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom; Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom
| | - Catey Bunce
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom; London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom; Primary Care & Public Health Sciences, King's College London, United Kingdom
| | - Maria Papadopoulos
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom; Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom
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Affiliation(s)
- Marcelo Coelho Goiato
- Department of Dental Material and Prosthesis, Sao Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
| | - Fernanda Pereira de Caxias
- Department of Dental Material and Prosthesis, Sao Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
| | - Daniela Micheline dos Santos
- Department of Dental Material and Prosthesis, Sao Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
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Abstract
OBJECTIVE To study the quality of life of Chinese pediatric patients with retinoblastoma (RB) after enucleation and the influencing factors. METHODS A questionnaire survey was performed on 71 cases of pediatric patients with RB after enucleation and 80 cases of healthy children, using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL™ 4.0). RESULTS The social dimension scores, school dimension scores, and total scores for the PedsQL™ 4.0 among the pediatric patients with RB were statistically significantly lower than those of healthy children. The influencing factors were unilateral/bilateral affected eyes, diagnosis age, and ocular prosthesis satisfaction. CONCLUSION Early discovery, timely treatment, increased eye salvage rate, and cosmetic effects of ocular prosthesis were key factors for increasing the quality of life of pediatric patients with RB. Attention should be paid to the health, social, and school development of pediatric patients with RB.
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Affiliation(s)
- Lili Zhang
- Eye Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Gao
- Eye Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Shen
- Eye Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Survey of Ocular Prosthetics Rehabilitation in the United Kingdom, Part 2: Anophthalmic Patients' Satisfaction and Acceptance. J Craniofac Surg 2018; 28:1297-1301. [PMID: 28582288 DOI: 10.1097/scs.0000000000003656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM Ocular prostheses are integral for anophthalmic patients. Part 1 of this study reported that patients' aetiology, opinions, and attitudes significantly affected their prosthetic eyes experience. Part 2 investigates the patient satisfaction and acceptance in light of some of the aetiological demographics reported in Part 1. METHODOLOGY One hundred sixty questionnaires were delivered to anophthalmic patients attending oculoplastic clinic. Etiological aspects presented in the questionnaire were disseminated in part 1. Patient satisfaction was assessed through 8 closed-end statements reflecting aspects concerning patient's views on prosthesis comfort and appearance; patient's expectations, self-esteem, and perception; and cooperation with ocularist. Each statement had 3 categories as agree, moderately agree, and disagree. A total of 126 questionnaires were returned (response rate was 78.8%). Data was analyzed using SPSS software. Association coefficients and correlations between variables were also analyzed. RESULTS Total number of responses for the 8 statements was 888, averaging of 111 (expected 126) respondent per statement. Overall, 95.4% of our patients agreed with all satisfaction statements presented echoing very high satisfaction rate with their ocular prosthetics. Having an eye replacement that covers the defect is associated with high satisfaction among patients regardless of ocular prosthetic type. Patient acceptance of prosthesis in relation to employment status was high but not the same among the different categories (P > 0.05). High satisfaction with ocular prosthetics was prevalent among both genders, but there were no statistically significant differences in percentages of agreement in all statements (P > 0.05). Satisfaction and acceptance with ocular prosthetics was the same among all age groups of 12 to 85 years old (P > 0.05). CONCLUSIONS The patient satisfaction is associated with the interplay of different variables that is related to ocular prosthesis design and its ability to disguise disfigurement (ie, prosthesis shape, resemblance to existing contra-lateral eye, etc.); patients themselves (ie, gender, age, occupation, marital status, etc); and psychological well-being and social support provided. Anophthalmic patients of the north west of England are significantly happy with their ocular prosthetic rehabilitation and support they receive from their regional hospital. Ocular prosthetics enhances their psychological well-being and social interaction and factors like patients' sex, age, employment status, and type of ocular prosthesis have no effect on their acceptance and satisfaction.
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Maskey B, Mathema SRB, Shrestha K, Bhochhibhoya A. A Simplified Approach to Fabricate a Hollow Ocular Prosthesis. J Prosthodont 2018; 28:849-852. [PMID: 29322593 DOI: 10.1111/jopr.12757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 11/29/2022] Open
Abstract
The prosthetic rehabilitation of a large anophthalmic socket is always a challenge. It demands an equally sized ocular prosthesis to replace lost tissue volume. A conventional solid acrylic ocular prosthesis may be deterrent to retention and esthetics because of its weight, which can be reduced by eliminating the mass of material within it. This article attempts to present a simplified and accurate technique to fabricate a hollow ocular prosthesis using silicone putty cavity form. It is removed prior to final processing and serves to ensure appropriate uniform thickness of acrylic resin and optimal weight reduction of the definitive prosthesis without compromising mobility, esthetics, and structural integrity.
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Affiliation(s)
- Brijesh Maskey
- Department of Prosthodontics and Maxillofacial Prosthetics, People's Dental College and Hospital, Kathmandu, Nepal
| | - Suraj R B Mathema
- Department of Prosthodontics and Maxillofacial Prosthetics, People's Dental College and Hospital, Kathmandu, Nepal
| | - Kanchana Shrestha
- Department of Prosthodontics and Maxillofacial Prosthetics, People's Dental College and Hospital, Kathmandu, Nepal
| | - Amar Bhochhibhoya
- Department of Prosthodontics and Maxillofacial Prosthetics, People's Dental College and Hospital, Kathmandu, Nepal
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Koch KR, Trester W, Müller-Uri N, Trester M, Cursiefen C, Heindl LM. [Ocular prosthetics. Fitting, daily use and complications]. Ophthalmologe 2017; 113:133-42. [PMID: 26160105 DOI: 10.1007/s00347-015-0091-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Ocular prosthetics make a decisive contribution to the functional, esthetic and psychosomatic rehabilitation of patients after ocular extirpation. OBJECTIVES This article provides an overview of the fitting, daily care and complications of ocular prosthetics. METHODS The study comprised a PubMed literature review and own clinical results. RESULTS Ocular prosthetics made from cryolite glass or perspex can be manufactured and fitted 5-8 weeks after removal of the eye. During this period a conformer is placed within the conjunctival sac in order to prevent scar formation and shrinking of the socket. Artificial eyes can be worn continuously, only interrupted by a short but regular cleaning procedure. Artificial tears and lid hygiene improve the comfort of wearing. Glass prostheses have to be renewed every 1-2 years, while perspex prostheses need to be polished once a year. Complications, such as giant papillary conjunctivitis or blepharoconjunctivitis sicca are facilitated by poor fit, increased age and inappropriate care of the prosthetic device. In the case of socket shrinkage or anophthalmic socket syndrome, surgical interventions are needed to re-enable the use of an artificial eye. CONCLUSION Adequate fitting, daily care of ocular prosthetics and therapeutic management of associated complications are mandatory for a durable functional, esthetic and psychosomatic rehabilitation after ocular extirpation.
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Affiliation(s)
- K R Koch
- Zentrum für Augenheilkunde, Uniklinik Köln, Kerpener Straße 62, 50924, Köln, Deutschland.
| | - W Trester
- Institut für Augenprothetik Trester, Köln, Deutschland
| | - N Müller-Uri
- Institut für Kunstaugen und ophthalmologische Hilfsmittel, Wiesbaden, Deutschland
| | - M Trester
- Institut für Augenprothetik Trester, Köln, Deutschland
| | - C Cursiefen
- Zentrum für Augenheilkunde, Uniklinik Köln, Kerpener Straße 62, 50924, Köln, Deutschland
| | - L M Heindl
- Zentrum für Augenheilkunde, Uniklinik Köln, Kerpener Straße 62, 50924, Köln, Deutschland
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Han YS, Kavoussi SC, Adelman RA. Visual recovery following open globe injury with initial no light perception. Clin Ophthalmol 2015; 9:1443-8. [PMID: 26316683 PMCID: PMC4540122 DOI: 10.2147/opth.s87852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was to analyze eyes presenting with no light perception (NLP) after open globe injury (OGI) to determine visual outcomes and prognostic indicators for visual recovery. Methods The records of consecutive patients with at least 6 months of follow-up presenting with OGI and NLP to a single institution between January 1, 2003 and December 31, 2013 were reviewed for demographics, ophthalmic history, context and characteristics of injury, ocular examination findings, surgical interventions, and follow-up visual acuity. Unpaired t-tests and Fisher’s Exact tests were used for statistical analysis. Results Twenty-five patients met our inclusion criteria. The mean age was 50.4±25.5 (range 8–91) years. Four patients (16%) regained vision (hand motion in three patients and light perception in one patient) while 21 patients (84%) remained with NLP or had a prosthesis at final follow-up. Fourteen eyes (56%) were enucleated; nine (36%) were secondary enucleations. Although the sample sizes were small, neither ocular trauma score nor wound size was found to predict visual recovery. Conclusion Four patients regained some vision after presenting with NLP due to OGI. These findings suggest that, in select cases, physicians should discuss the possibility of regaining some vision.
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Affiliation(s)
- Yong S Han
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Shaheen C Kavoussi
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
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Ye J, Lou L, Jin K, Xu Y, Ye X, Moss T, McBain H. Vision-Related Quality of Life and Appearance Concerns Are Associated with Anxiety and Depression after Eye Enucleation: A Cross-Sectional Study. PLoS One 2015; 10:e0136460. [PMID: 26317860 PMCID: PMC4552790 DOI: 10.1371/journal.pone.0136460] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 08/03/2015] [Indexed: 12/02/2022] Open
Abstract
Aims To investigate the association of demographic, clinical and psychosocial variables with levels of anxiety and depression in participants wearing an ocular prosthesis after eye enucleation. Methods This cross-sectional study included 195 participants with an enucleated eye who were attending an ophthalmic clinic for prosthetic rehabilitation between July and November 2014. Demographic and clinical data, and self-reported feelings of shame, sadness and anger were collected. Participants also completed the National Eye Institute Visual Function Questionnaire, the Facial Appearance subscale of the Negative Physical Self Scale, and the Hospital Anxiety and Depression Scale. Regression models were used to identify the factors associated with anxiety and depression. Results The proportion of participants with clinical anxiety was 11.8% and clinical depression 13.8%. More anxiety and depression were associated with poorer vision-related quality of life and greater levels of appearance concerns. Younger age was related to greater levels of anxiety. Less educated participants and those feeling more angry about losing an eye are more prone to experience depression. Clinical variables were unrelated to anxiety or depression. Conclusions Anxiety and depression are more prevalent in eye-enucleated patients than the general population, which brings up the issues of psychiatric support in these patients. Psychosocial rather than clinical characteristics were associated with anxiety and depression. Longitudinal studies need to be conducted to further elucidate the direction of causality before interventions to improve mood states are developed.
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Affiliation(s)
- Juan Ye
- Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Lixia Lou
- Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Kai Jin
- Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Yufeng Xu
- Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Xin Ye
- Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Timothy Moss
- Centre for Appearance Research, Faculty of Health and Life Science, University of the West of England, Bristol, United Kingdom
| | - Hayley McBain
- School of Health Sciences, City University London, London, United Kingdom
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Phantom eye syndrome: a review of the literature. ScientificWorldJournal 2014; 2014:686493. [PMID: 25548790 PMCID: PMC4273592 DOI: 10.1155/2014/686493] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 12/26/2022] Open
Abstract
The purpose of this literature review was to describe the main features of phantom eye syndrome in relation to their possible causes, symptoms, treatments, and influence of eye amputation on quality of life of anophthalmic patients. For this, a bibliographical research was performed in Pubmed database using the following terms: “eye amputation,” “eye trauma,” “phantom eye syndrome,” “phantom pain,” and “quality of life,” associated or not. Thirteen studies were selected, besides some relevant references contained in the selected manuscripts and other studies hallowed in the literature. Thus, 56 articles were included in this review. The phantom eye syndrome is defined as any sensation reported by the patient with anophthalmia, originated anophthalmic cavity. In phantom eye syndrome, at least one of these three symptoms has to be present: phantom vision, phantom pain, and phantom sensations. This syndrome has a direct influence on the quality of life of the patients, and psychological support is recommended before and after the amputation of the eyeball as well as aid in the treatment of the syndrome. Therefore, it is suggested that, for more effective treatment of phantom eye syndrome, drug therapy should be associated with psychological approach.
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McBain HB, Ezra DG, Rose GE, Newman SP. The psychosocial impact of living with an ocular prosthesis. Orbit 2013; 33:39-44. [PMID: 24205995 DOI: 10.3109/01676830.2013.851251] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Many patients are satisfied with their ocular prosthesis, but some describe problems with social interactions, body image and self-esteem. Although both clinical practice and research suggest that the severity of a disfiguring condition does not predict distress, there has been little research with patients living with an ocular prosthesis. The objective was to explore the psychological impact of living with an artificial eye or cosmetic shell and determine the relationship between psychological well-being and clinical and psychosocial factors. METHODS A cross-sectional study between March and September 2008 at the ocular prosthesis clinic of Moorfields Eye Hospital, UK. The primary outcome measures were mood as measured by the Hospital Anxiety and Depression Scale (HADS) and appearance-related social anxiety and social avoidance, as measured by the Derriford Appearance Scale (DAS24). RESULTS Mean scores on the HADS and DAS24 were within normal range, but a considerable proportion of participants were experiencing significant levels of distress. Psychosocial adjustment was unrelated to most clinical and demographic variables, but was associated with a series of cognitive processes. CONCLUSIONS Psychological variables, rather than clinical or demographic factors, are associated with how a patient adjusts to wearing an ocular prosthesis. Such factors might be amenable to change through psychosocial intervention.
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Affiliation(s)
- Hayley B McBain
- Health Services Research, City University , London , United Kingdom
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Morgan-Warren PJ, Mehta P, Ahluwalia HS. Visual function and quality of life in patients who had undergone eye removal surgery: a patient survey. Orbit 2013; 32:285-293. [PMID: 23895462 DOI: 10.3109/01676830.2013.814687] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To measure aspects of self-reported vision-related health status and assess the impact of treatment in patients who have undergone eye removal surgery (evisceration or enucleation), using a patient administered questionnaire. METHODS In this non-randomised, questionnaire-based cohort study, patients were identified from the Artificial Eye Service referral register from 2003 to 2010. A self-administered questionnaire based upon previously published scales was completed to measure aspects of visual function and the impact of treatment. RESULTS Thirty-six completed questionnaires were obtained. Mean age at surgery was 54.1 years (range 13-90), with 83% male. Indication for eye-removal was trauma in 14(39%) cases. Ten (28%) had ocular co-morbidity in the fellow-eye. The main reported difficulties were with peripheral vision or distance judgements, in 64% patients. The majority of drivers (66%) had maintained the ability to drive. Self-consciousness was reported in 28(78%) patients, and 56% were able to continue work or activities with no perceived limitations. Overall comfort and aesthetic improvement were noted by the majority. Procedure-specific information leaflets for patients were appreciated. CONCLUSIONS This survey increases our knowledge of aspects of vision-related health status following ocular pathology or trauma that requires eye removal, and may enable improved pre-operative patient counselling. Effects on peripheral vision may be noted most significantly, but the majority can continue normal activities with little difficulty. Overall improvement in comfort and appearance occurs in most patients, although feelings of self-consciousness are common.
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Affiliation(s)
- Peter J Morgan-Warren
- Department of Ophthalmology, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road , Coventry, CV2 2DX , United Kingdom
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Predictive factors for comorbid psychiatric disorders and their impact on vision-related quality of life in patients with high myopia. Int Ophthalmol 2013; 34:171-83. [PMID: 23783655 DOI: 10.1007/s10792-013-9805-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 05/21/2013] [Indexed: 12/22/2022]
Abstract
To determine the incidence of depression and anxiety disorders in patients with high myopia as well as the factors that would predict the development of psychiatric complications and their impact on vision-related quality of life (VR-QoL). Two hundred and five patients with pathologic myopia (axial length ≥26.50 mm) were studied. Incidence of depression and anxiety disorders was determined using the Hospital Anxiety and Depression Scale (HADS). VR-QoL was determined by the 25-item National Eye Institute Visual Function Questionnaire. Incidence of depression was 22.0 % and incidence of anxiety disorder was 25.9 %. Absence of children was the only factor significantly associated with the presence of depression, and a past history of cataract surgery was the only factor significantly associated with the presence of anxiety disorder. Factors which decreased the VR-QoL were in order of importance--anxiety disorder, decreased visual acuity in the best eye, depression, and being female. Responses of the subjects to two HADS statements 'I can laugh and see the funny side of things' and 'I can enjoy a good book or radio or television program' identified 82.2 % of depressed patients, and 'I get sudden feelings of panic' and 'I can sit at ease and feel relaxed' identified 71.7 % of patients with anxiety disorder. Twenty-two to 26 % of highly myopic patients had psychiatric disorders which had a strong negative impact on their VR-QoL. Two statements from the HADS questionnaire can be used to screen highly myopic patients for depression or anxiety disorders.
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Abstract
PURPOSE This study compared the general health-related quality of life (HRQOL) and the vision-specific HRQOL in patients following the surgical removal of 1 eye who had good vision in the remaining eye to a group of binocular patients with good vision in OU. METHODS The Medical Outcomes Study Short Form 12 and the National Eye Institute Visual Function Questionnaire HRQOL surveys were administered to 29 patients who had surgical removal of an eye who attended an ocular prosthetics clinic and to 25 binocular persons who accompanied a patient. All subjects in each group had best-corrected visual acuity of 20/40 or better. Overall statistical significance was tested using Cramer's V followed by individual t tests for independent groups for each of the scales on the 2 questionnaires to determine whether the means between the 2 groups differed statistically. RESULTS The patient group had a mean age of 50.98 years (range, 19-76 years). The control group had a mean age of 49.46 years (range, 18-76 years). The mean time after loss of vision was 28.03 years (range, 1-71 years), and the mean time from surgical removal of the eye was 23.6 years (range, 0.5-59.5 years). There was an overall significant difference between the 2 groups on the 15 derived subscales of the 2 forms (Cramer's V, p = 0.0025). Three general HRQOL subscales (Short Form 12-mental component summary, Short Form 12 physical component summary, and National Eye Institute Visual Function Questionnaire-General Health) showed no differences between the 2 groups (p = 0.48, p = 0.81, and p = 0.78, respectively). Three of the 12 vision-specific National Eye Institute Visual Function Questionnaire subscales demonstrated statistically significant differences between the patient and control groups: peripheral vision (p = 0.0006), role difficulties (p = 0.015), and the composite score (p = 0.014). In addition, 2 monocular patients had given up driving compared with no binocular subjects (p = 0.056). CONCLUSIONS This population of monocular patients had general physical and mental HRQOL equivalent to the normal binocular group despite the surgical removal of 1 eye. However, the reduced vision-specific HRQOL of monocular patients on the National Eye Institute Visual Function Questionnaire indicates that there are substantial residual visual deficits even after prolonged monocular status.
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Atay A, Peker K, Günay Y, Ebrinç S, Karayazgan B, Uysal Ö. Assessment of health-related quality of life in Turkish patients with facial prostheses. Health Qual Life Outcomes 2013; 11:11. [PMID: 23351906 PMCID: PMC3564838 DOI: 10.1186/1477-7525-11-11] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 01/23/2013] [Indexed: 11/29/2022] Open
Abstract
Background Facial prostheses are intended to provide a non-operative rehabilitation for patients with acquired facial defects. By improving aesthetics and quality of life (QOL), this treatment involves reintegration of the patient into family and social life. The aim of this study was to evaluate the perception of QOL in adult patients with facial prostheses and to compare this perception with that of a control group. Methods The study participants consisted of 72 patients, who were divided into three equal-sized groups according to the type of prosthesis (OP- orbital prosthesis, AP- auricular prosthesis, NP - nasal prosthesis) and 24 healthy control participants without any congenital or acquired deformity of face or body. Clinical and socio-demographic data were gathered from each person’s medical chart. Participants completed the Turkish version of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF). Descriptive statistics, independent sample t-tests, Pearson's chi-square test, ANOVA, ANCOVA, and Pearson correlation were used to analyse the data. Results Compared with the control participants, patients with NP scored lower on the all domains of QOL and all three patient groups had lower scores on overall QOL and its domains of physical and environmental health. Patients with OP reported significantly lower physical health scores than those with AP, while patients with NP reported significantly lower overall QOL and psychological health scores than those with AP. Female patients had lower environmental domain scores than did male patients. The patient’s age and income correlated with social relationships QOL, while the patient’s income and the age of facial prosthesis were correlated with environmental QOL. Conclusion Patients with facial prostheses had lower scores in overall QOL, physical and environmental health domains than the control participants. Socio-demographic and clinical characteristics such as age, gender, income, localization of the defect, and age of facial prosthesis were associated with patients’ QOL. These findings may provide valuable information about the specific health needs of these patients that may affect their well-being. Further studies are needed to confirm these results. Use of the WHOQOL-BREF may provide valuable information for determining patients’ needs and priorities as well as for planning and developing comprehensive prosthetic rehabilitation programs.
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Affiliation(s)
- Arzu Atay
- Department of Prosthodontics, GATA Haydarpaşa Training Hospital Dental Service, Usküdar, Istanbul, Turkey.
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Abstract
PURPOSE To evaluate eye-amputated patients' health-related quality of life, perceived stress, self-rated health, job separation because of illness or disability and socioeconomic position. METHODS Patients were recruited from a tertiary referral centre situated in Copenhagen. Inclusion criteria were eye amputation, i.e. evisceration, enucleation, orbital exenteration or secondary implantation of an orbital implant during the period 1996-2003, and participation in a previous investigation (2005). In total, 159 eye-amputated patients were included, and completed a self-administered questionnaire containing health-related quality of life (SF-36), the perceived stress scale and answered questions about self-rated health, job changes because of illness or disability and socioeconomic status. These results were compared with findings from the Danish Health Interview Survey 2005. RESULTS The eye-amputated patients had significantly (p < 0.05) lower scores (poorer health) on all SF-36 subscales and more perceived stress compared to the general population. In all, 43.3% of the patients rated their health as excellent or very good compared to 52.1% of the general population. In total, 25% of the study population has retired or changed to a part-time job because of eye disease. The percentage of eye amputated patients, who were divorced or separated, was twice as high as in the general population. CONCLUSION The impact of an eye amputation is considerable. The quality of life, perceived stress and self-rated health of many eye-amputated patients are drastically changed. Eye amputation has a marked negative influence on job separation because of illness or disability and on socioeconomic position.
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Affiliation(s)
- Marie L R Rasmussen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Eye Pathology Institute, Copenhagen, Denmark.
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Rasmussen MLR. The eye amputated - consequences of eye amputation with emphasis on clinical aspects, phantom eye syndrome and quality of life. Acta Ophthalmol 2010; 88 Thesis 2:1-26. [PMID: 21108770 DOI: 10.1111/j.1755-3768.2010.02039.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In this thesis the term eye amputation (EA) covers the removing of an eye by: evisceration, enucleation and exenteration. Amputation of an eye is most frequently the end-stage in a complicated disease, or the primary treatment in trauma and neoplasm. In 2010 the literature is extensive due to knowledge about types of surgery, implants and surgical technique. However, not much is known about the time past surgery. THE PURPOSE OF THE PHD THESIS WAS To identify the number of EA, the causative diagnosis and the indication for surgical removal of the eye, the chosen surgical technique and to evaluate a possible change in surgical technique in Denmark from 1996 until 2003 (paper I); To describe the phantom eye syndrome and its prevalence of visual hallucinations, phantom pain and phantom sensations (paper II); To characterise the quality of phantom eye pain, including its intensity and frequency among EA patients. We attempted to identify patients with increased risk of developing pain after EA and investigated if preoperative pain is a risk factor for a later development of phantom pain (paper III); In addition we wanted to investigate the health related quality of life, perceived stress, self rated health, job separation due to illness or disability and socio-economic position of the EA in comparison with the general Danish population (paper IV). THE STUDIES WERE BASED ON Records on 431 EA patients, clinical ophthalmological examination and an interview study of 173 EA patients and a questionnaire answered by 120 EA patients. CONCLUSIONS The most frequent indications for EA in Denmark were painful blind eye (37%) and neoplasm (34%). During the study period 1996-2003, the annual number of eye amputations was stable, but an increase in bulbar eviscerations was noticed. Orbital implants were used with an increasing tendency until 2003. The Phantom eye syndrome is frequent among EA patients. Visual hallucinations were described by 42% of the patients. The content were mainly elementary visual hallucinations, with white or colored light as a continuous sharp light or as moving dots. The most frequent triggers were darkness, closing of the eyes, fatigue and psychological stress. Fifty-four percent of the patients had visual hallucinations more than once a week. Ten patients were so visually disturbed that it interfered with their daily life. Approximately 23% of all EA experience phantom pain for several years after the surgery. Phantom pain was reported to be of three different qualities: (i) cutting, penetrating, gnawing or oppressive (n=19); (ii) radiating, zapping or shooting (n=8); (iii) superficial burning or stinging (n=5); or a mixture of these different pain qualities (n=7). The median intensity on a visual analogue scale, ranging from 0 to 100, was 36 [range: 1-89]. One-third of the patients experienced phantom pain every day. Chilliness, windy weather and psychological stress/fatigue were the most commonly reported triggers for pain. Factors associated with phantom pain were: ophthalmic pain before EA, the presence of implant and a patient reported high degree of conjunctival secretion. A common reason for EA is the presence of a painful blind eye. However, one third of these patients continue to have pain after the EA. Phantom sensations were present in 2% of the patients. The impact of an eye amputation is considerable. EA patients have poorer health related quality of life, poorer self-rated health and more perceived stress than does the general population. The largest differences in health related quality of life between the EA patients and the general population were related to role limitations due to emotional problems and mental health. Patients with the indication painful blind eye are having lower scores in all aspects of health related quality of life and perceived stress than patients with the indication neoplasm and trauma. The percentage of eye amputated which is divorced or separated was twice as high as in the general population. Furthermore, 25% retired or changed to part-time jobs due to eye disease and 39.5% stopped participating in leisure activities due to their EAs.
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Affiliation(s)
- Marie Louise Roed Rasmussen
- University of Copenhagen, Department of Neuroscience and Pharmacology, Section of Eye Pathology, Frederik den V's vej 11, DK-2100 Copenhagen, Denmark.
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