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Huang JJ, Saleem A, Liao EX, Larocque M, Menon G, Murtha A, Solarte C, Weis E. Incidence of Strabismus Post-Plaque Brachytherapy in Patients With Uveal Melanoma. Am J Ophthalmol 2024; 262:161-169. [PMID: 38307213 DOI: 10.1016/j.ajo.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE To determine the incidence and type of strabismus in patients with uveal melanoma treated with plaque brachytherapy. DESIGN Multicenter, retrospective incidence estimation study. METHODS A total of 438 eyes of 438 patients with uveal melanoma treated with plaque brachytherapy between October 2011 and May 2021. Intervention was Iodine 125, and Palladium 103 plaque brachytherapy. The variables reviewed included incidence of nonresolving strabismus post-plaque brachytherapy, type of strabismus developed, extraocular muscles operated, and modality of treatment received. RESULTS A total of 438 patients underwent plaque brachytherapy treatment for uveal melanoma. Eleven patients developed strabismus post-plaque brachytherapy (2.5%, n = 11/438). Of these patients, 5 (1.1%, n = 5/438) developed strabismus immediately postoperation. Specifically, 2 patients (0.5%, n = 2/438) developed strabismus immediately postoperation due to slipped muscles, 2 patients (0.5%, n = 2/438) due to decompensated phorias, and 1 patient (0.5%, n = 1/438) due to a fibrotic muscle. Six patients (1.4%, n = 6/438) developed late-onset sensory strabismus. A total of 355 patients (81.1%, n = 355/438) had their extraocular muscles disinserted during surgery, with the lateral rectus being the most common, accounting for 45.4% (n = 161/355), followed by the superior rectus at 26.8% (n = 95/355). Strabismus surgery was the most common treatment modality, comprising 72.7% (n = 8/11) of patients. CONCLUSIONS The incidence of strabismus after plaque brachytherapy treatment for uveal melanoma was low and primarily classified as late-onset sensory strabismus. Previous studies may underestimate the long-term incidence of strabismus after plaque brachytherapy by focusing primarily on strabismus present immediately postoperatively.
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Affiliation(s)
- Jordan J Huang
- From the Cumming School of Medicine, University of Calgary, Calgary, Canada (J.J.H., A.S., E.X.L.)
| | - Aqsa Saleem
- From the Cumming School of Medicine, University of Calgary, Calgary, Canada (J.J.H., A.S., E.X.L.)
| | - Emily X Liao
- From the Cumming School of Medicine, University of Calgary, Calgary, Canada (J.J.H., A.S., E.X.L.)
| | - Matthew Larocque
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (M.L., G.M., A.M.)
| | - Geetha Menon
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (M.L., G.M., A.M.)
| | - Albert Murtha
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (M.L., G.M., A.M.)
| | - Carlos Solarte
- Department of Ophthalmology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (C.S., E.W.); Division of Ophthalmology, Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Canada (E.W.)
| | - Ezekiel Weis
- Department of Ophthalmology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (C.S., E.W.); Division of Ophthalmology, Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Canada (E.W.)..
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Dirim AB, Turker IC, Besirli A, Ozturk M, Yesilkaya EC, Kutucu OK, Oskan EE. Assessment of Anxiety, Depression, Self-Esteem, and Quality-of-Life in Patients Undergoing Surgical Removal of an Eye. BEYOGLU EYE JOURNAL 2024; 9:86-94. [PMID: 38854898 PMCID: PMC11156473 DOI: 10.14744/bej.2024.05826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/14/2024] [Accepted: 05/09/2024] [Indexed: 06/11/2024]
Abstract
Objectives The objective of this study was to compare anxiety, depression, self-esteem, and quality of life in patients who underwent surgical removal of an eye with those of controls as well as to test the correlations of these variables in both groups. Methods Beck anxiety inventory (BAI), Beck depression inventory (BDI), 36-item short-form health survey (SF-36), and Rosenberg self-esteem scale were administered to 29 patients with surgical removal of an eye and 30 control subjects. Results The patient group had significantly lower scores on physical functioning, role limitations due to physical and emotional problems, pain, and general health perception domains of SF-36, as well as significantly higher BDI (p=0.004) scores as compared to controls. The study groups did not differ significantly with respect to BAI scores and energy/vitality, mental health, and social functioning domain scores of SF-36 (p>0.05). Conclusion This population of monocular patients had similar mental health-related and Beck's Anxiety Inventory scores equivalent to the control group despite the surgical removal of one eye. However, lower scores for some SF-36 domains and higher depression levels in this patient group suggest that psychiatric rehabilitation should be considered after eye removal to improve the psychological outcomes and quality of life in these patients.
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Affiliation(s)
- Ayse Burcu Dirim
- Department of Ophthalmology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ibrahim Cagri Turker
- Department of Ophthalmology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Asli Besirli
- Department of Psychiatry, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mine Ozturk
- Department of Ophthalmology, Istanbul Haseki Training and Research Hospital, Istanbul, Türkiye
| | - Elif Ceren Yesilkaya
- Department of Ophthalmology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Oguz Kaan Kutucu
- Department of Ophthalmology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ekin Ece Oskan
- Department of Ophthalmology, Istanbul Haseki Training and Research Hospital, Istanbul, Türkiye
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Huang Y, Guo Y. Quality of life among people with eye cancer: a systematic review from 2012 to 2022. Health Qual Life Outcomes 2024; 22:3. [PMID: 38185647 PMCID: PMC10773080 DOI: 10.1186/s12955-023-02219-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Eye cancer is a serious eye disease that threatens patients' lives. In the past decade, there have been more and more studies on eye cancer. From the recently published eye cancer literature review, it can be seen that the two most popular research hotspots are retinoblastoma (RB) and uveal melanoma (UM) [1, 2]. Although several studies have assessed QOL in different types of eye cancer patients, a study that synthesizes the factors influencing QOL in eye cancer patients is yet to be undertaken. This study aimed to review and evaluate the literature related to the QOL of RB and UM survivors, and provide a synthesis of the current evidence on the impact of the two types of eye cancer on the overall QOL of patients. METHODS Eight databases (APA Psych Articles, CINAHL Complete, Health Source: Nursing/Academic Edition, MEDLINE Complete, Scopus, Cochrane Library, PubMed, and Registers (Clinicaltrials.gov.)) were searched between January 2012 and December 2022 for English, peer-reviewed quantitative original studies within this review. All publications were screened using the Preferred Reporting Items for Systematic Review and Meta-Analyses reporting guidelines. The methodological quality of the reviews was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. The findings were summarised and tabulated accordingly. RESULTS Seventeen articles were analysed. Among them, 14 articles on patients with UM, and three articles on patients with RB using 18 different types of measurement tools were included. Eight researchers claimed that the overall QOL of patients with eye cancer was better than or similar to that of the general healthy population. However, nine studies indicated that these patients had poorer QOL than others. Many factors affect QOL, including treatment, sex, and age. CONCLUSION This systematic review identified the QOL levels and several factors that influence the QOL of ocular cancer patients worldwide, due to the variability in quality of the studies, it also showed the need for further research to assess factors affecting long-term QOL outcomes in RB and UM survivors. Simultaneously, it clarified the necessity and importance of developing standardized and complete assessment tools to compare QOL in different countries. Early interventions can be developed to improve the survivors' QOL by identifying potential deficits in specific areas.
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Affiliation(s)
- Yonghui Huang
- Henan Provincial People's Hospital, Henan Provincial Eye Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China.
| | - Yunfei Guo
- Henan Provincial People's Hospital, Henan Provincial Eye Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
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Tiosano A, Ben-Ishai M, Cnaany Y, Markel G, Kurman N, Popovtzer A, Bar Sela G, Ben Simon G, Gershoni A, Yassur I. Primary cemiplimab treatment for orbital squamous cell carcinoma is effective and may alleviate the need for orbital exenteration. Eye (Lond) 2023; 37:2482-2487. [PMID: 36690728 PMCID: PMC10397183 DOI: 10.1038/s41433-022-02358-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/17/2022] [Accepted: 12/02/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of cemiplimab, a Programmed-cell-death-1(PD-1) protein inhibitor, for the treatment of cutaneous periocular-locally-advanced squamous-cell-carcinoma (POLA-SCC) with orbital-invasion. METHODS Multicentre real-world retrospective study. Demographic and clinical data were collected and analysed for patients with biopsy-proven POLA-SCC(AJCC-T4) with orbital-invasion who were treated with cemiplimab at one of four tertiary medical centres in 2019-2022. RESULTS The cohort included 13 patients, 8 males and 5 females, of median age 76 years (IQR65-86). The median duration of treatment was 5.0months (IQR3.5-10.5) and the median follow-up time, 15.0 months (IQR10.5-30). The overall response rate was 69.2%. Complete response was documented in seven patients (53.8%), partial response in two (15.4%), stable disease in one (7.7%), and progressive disease in two (15.4%); in one patient (7.7%), response was not evaluable. Six complete responders (46.1% of the cohort) received no further treatment and did not have a recurrence during an average follow-up of 6.14 (±6.9) months from treatment cessation. None of the patients underwent orbital-exenteration. The majority of adverse events were mild (grade-1), except for a moderate increase in creatinine level (grade-2), severe bullous dermatitis (grade-3), and myocarditis (grade-5) in one patient each. Four patients (30.7%) died during the follow-up period, all of whom had an Eastern-Cooperative-Oncology-Group score of 4 at presentation. CONCLUSIONS To our knowledge, this is the largest study to date on cemiplimab therapy for cutaneous POLA-SCC with orbital-invasion. Treatment was shown to be effective, with an overall response rate of 69.2%. Cemiplimab holds promise for the treatment of patients with tumours invading the orbit as it may alleviate the need for orbital exenteration.
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Affiliation(s)
- Alon Tiosano
- Ophthalmology Division, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meydan Ben-Ishai
- Ophthalmology Division, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaacov Cnaany
- Ophthalmology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Gal Markel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Davidoff Comprehensive Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Noga Kurman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Davidoff Comprehensive Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Aron Popovtzer
- Sharett Institute of Oncology, Hebrew University Hadassah Medical Center, Jerusalem, Israel
| | - Gil Bar Sela
- Oncology and Hematology Division, Emek Medical Center, Afula, Israel
| | - Guy Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Assaf Gershoni
- Ophthalmology Division, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iftach Yassur
- Ophthalmology Division, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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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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Kumar P, Rao UR R, Roy N, Agrawal D, Ahmad S, Bhavana K. Quality of life in patients treated for COVID-19-associated mucormycosis at a tertiary care hospital. Osong Public Health Res Perspect 2023; 14:119-128. [PMID: 37183332 PMCID: PMC10211455 DOI: 10.24171/j.phrp.2022.0307] [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: 12/04/2022] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) has emerged as a formidable infection in patients with COVID-19. The aggressive management of CAM affects quality of life (QOL); thus, this study was designed to assess the QOL in patients with CAM at a tertiary healthcare institution. METHODS This cross-sectional study of 57 patients with CAM was conducted over 6 months using a semi-structured standard questionnaire (the abbreviated World Health Organization Quality of Life questionnaire [WHO-BREF]) and a self-rated improvement (SRI) scale ranging from 0 to 9. Cut-off values of ≤52 and <7 were considered to indicate poor QOL and poor improvement, respectively. The correlations of QOL and SRI scores were evaluated using Spearman rho values. RESULTS In total, 27 patients (47.4%; 95% confidence interval [CI], 34.9%-60.1%) and 26 patients (45.6%; 95% CI, 33.4%-58.4%) had poor QOL and poor SRI scores, respectively. The overall median (interquartile range) QOL score was 52 (41-63). Headache (adjusted B, -12.3), localized facial puffiness (adjusted B , -16.4), facial discoloration (adjusted B, -23.4), loosening of teeth (adjusted B, -18.7), and facial palsy (adjusted B, -38.5) wer e significantly associated with the QOL score in patients with CAM. CONCLUSION Approximately 1 in 2 patients with CAM had poor QOL and poor improvement. Various CAM symptoms were associated with QOL in these patients. Early recognition is the key to optimal treatment, improved outcomes, and improved QOL in patients with CAM.
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Affiliation(s)
- Pragya Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| | - Rajath Rao UR
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| | - Nilanjan Roy
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| | - Deepika Agrawal
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| | - Shamshad Ahmad
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| | - Kranti Bhavana
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Patna, India
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Hellman J, Mahmood B, Lin LK. Anxiety and Depression after Traumatic Open-Globe Injury. J Emerg Trauma Shock 2023; 16:59-62. [PMID: 37583375 PMCID: PMC10424737 DOI: 10.4103/jets.jets_154_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction This cross-sectional interview-based study aimed to assess the prevalence and severity of probable anxiety and depression in patients with traumatic open-globe injury and to identify factors associated with anxiety and depression following open-globe injury. Methods Two hundred and twenty-five patients with open-globe injury were identified at the UC Davis Medical Center between 2008 and 2019. Prisoners and patients under 18 at the time of recruitment were excluded from the study. One hundred and twenty-four patients provided consent to participate in the study, which involved a phone interview and chart review. The interview consisted of a section on sociodemographic data and potential associations followed by the Hospital Anxiety and Depression Scale, a standardized 14-question survey that has been validated in previous studies as an excellent predictor of anxiety and depression. A score of 8 for anxiety or depression was considered a positive test, and patients with a positive test in either category were advised to seek further evaluation with their primary care doctors. The prevalence of probable anxiety and depression was calculated, and linear regression was used to identify factors associated with anxiety and depression. Results The average age was 50.5 ± 19.2, and 75.8% of patients were male. The anxiety score was positive in 37.9% of patients and the depression score was positive in 28.2%. The mean anxiety and depression scores were 6.3 ± 4.7 and 5.5 ± 4.8, respectively. The P value of the linear regressions for anxiety score and depression score were both < 0.001, with R2 = 0.429 and 0.363, respectively. Younger age (P = 0.002) and unemployment at the time of the interview (P = 0.038) were associated with higher anxiety scores. Patients who were bothered by the appearance of their injured eye had higher anxiety scores (P < 0.001) and depression scores (P < 0.001). Patients without a high school diploma had higher depression scores (P < 0.001). Gender, enucleation status, number of people in support network, use of a prosthetic or scleral shell, final logMAR visual acuity, marital status, months since the initial injury, and presence of an intraocular foreign body were not significantly associated with anxiety or depression scores. Conclusions Traumatic open-globe injury is associated with a high prevalence of probable anxiety and depression. Dissatisfaction with the appearance of the injured eye was associated with higher anxiety and depression scores. Younger age and unemployment were associated with increased anxiety scores, and lack of a high school diploma was associated with higher depression scores.
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Affiliation(s)
- Justin Hellman
- Pacific Eye, San Luis Obispo, Sacramento, California, USA
| | - Bilawal Mahmood
- School of Medicine, University of California Davis, Sacramento, California, USA
| | - Lily Koo Lin
- Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, California, USA
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Lou L, Sun Y, Zhang H, Shi X, Ye J. Physical Appearance Perfectionism in Blepharoplasty Patients: A Prospective Observational Study. J Plast Reconstr Aesthet Surg 2023; 80:102-106. [PMID: 37003071 DOI: 10.1016/j.bjps.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/26/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Evaluation of physical appearance perfectionism (PAP) in individuals seeking blepharoplasty would be meaningful. This study aimed to explore the relationship of demographic and psychological variables with PAP in blepharoplasty patients and further investigate the impact of blepharoplasty on PAP in these patients. METHODS This prospective observational study included 153 patients undergoing blepharoplasty between October 2017 and June 2019. Demographic and psychological variables, and PAP, were collected preoperatively. Postoperative satisfaction with eye appearance and PAP was collected with a 6-month follow-up. RESULTS Partial correlations analyses revealed that hope for perfection was positively associated with self-esteem (r = 0.246; P < 0.01) in 153 blepharoplasty patients. Worry about imperfection was positively related to facial appearance concern (r = 0.703; P < 0.001) and negatively related to satisfaction with eye appearance (r = -0.242; P < 0.01) and self-esteem (r = -0.533; P < 0.001). After blepharoplasty, the mean± standard deviation of satisfaction with eye appearance increased (preoperatively vs. postoperatively: 5.1 ± 2.2 vs. 7.4 ± 2.2; P < 0.001), and worry about imperfection decreased (17.0 ± 4.2 vs. 15.9 ± 4.6; P < 0.001). Whereas hope for perfection remained unchanged (23.9 ± 3.9 vs. 23.6 ± 3.9; P > 0.05). CONCLUSIONS Appearance perfectionism was related to psychological variables rather than demographic variables in blepharoplasty patients. Preoperative evaluation of appearance perfectionism could be helpful for oculoplastic surgeons to screen for perfectionistic patients. Although some improvement in perfectionism has been observed after blepharoplasty, long-term follow-up is needed in the future.
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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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Lou L, Wang Y, Zhang B, Jia Y, Wang W, Ye J. Cerebral processing of emotions in phantom eye pain patients: An event related potential study. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100075. [PMID: 37846286 PMCID: PMC10577829 DOI: 10.1016/j.aopr.2022.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/19/2022] [Accepted: 07/04/2022] [Indexed: 10/18/2023]
Abstract
Purpose Phantom eye pain (PEP) is a major clinical problem after eye removal with no standard treatment protocol to date. As pain is a multidimensional experience associated with emotional and cognitive components, this study aimed to explore the possible neuropsychological mechanisms of PEP in a perspective of emotional cognition, in order to provide a basis for clinical treatment. Methods Visual oddball event-related potentials (ERPs) under different external emotional stimuli (Disgust, Fear, Sadness, Happiness, Erotica and Neutral) were tested in 12 patients and 12 healthy volunteers. Participants' affective states were measured with the Mood Disorder Questionnaire (MDQ), the Hypomania Checklist-32 (HCL-32), and the Plutchik-van Praag Depression Inventory (PVP). The amplitudes and latencies of N1, P2, N2 and P3 components were analyzed by three-way ANOVA, i.e., group (2) × emotion (6) × electrode (3). Multiple comparisons were performed using Bonferroni's test. Results Longer N1 latencies, increased N1 amplitudes; shorter P2 latencies under Disgust and Happiness, decreased P2 amplitudes; shorter N2 latencies under Erotica, increased N2 amplitudes were found in patients compared with controls. There was no main effect of group or interaction effect on P3 latencies and P3 amplitudes. The MDQ and HCL-32 scores were lower, and the N1 latencies under Sadness were negatively correlated with PVP scores in patients. Conclusions PEP patients showed reversed patterns in exogenous attention allocation and enhanced involuntary attention to emotional stimuli compared with controls. This study demonstrated cortical processing of emotions in PEP patients and could provide a basis for developing emotional intervention therapy.
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Affiliation(s)
- Lixia Lou
- Eye Center, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yijie Wang
- Eye Center, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Bingren Zhang
- Department of Medical Psychology, College of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Yanli Jia
- Department of Affective Disorder, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Wei Wang
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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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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12
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Ulhaq ZS, Soraya GV, Dewi NA, Wulandari LR. The prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Ther Adv Ophthalmol 2022; 14:25158414221090100. [PMID: 35464342 PMCID: PMC9021519 DOI: 10.1177/25158414221090100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/09/2022] [Indexed: 12/26/2022] Open
Abstract
Background: Progressive and irreversible vision loss has been shown to place a patient at risk of mental health problems such as anxiety. However, the reported prevalence of anxiety symptoms and disorders among eye disease patients vary across studies. Thus, this study aims to clarify the estimated prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Methods: Relevant studies on the prevalence of anxiety symptoms and disorders among eye disease patients were collected through international databases, PubMed, Scopus, and Web of Science. A random-effects model was used to determine the pooled prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Results: The 95 included studies yielded a pooled prevalence of 31.2% patients with anxiety symptoms and 19.0% with anxiety disorders among subjects with ophthalmic disease. Pediatric patients were more anxious (58.6%) than adults (29%). Anxiety symptoms were most prevalent in uveitis (53.5%), followed by dry eye disease (DED, 37.2%), retinitis pigmentosa (RP, 36.5%), diabetic retinopathy (DR, 31.3%), glaucoma (30.7%), myopia (24.7%), age-related macular degeneration (AMD, 21.6%), and cataract (21.2%) patients. Anxiety disorders were most prevalent in thyroid eye disease (TED, 28.9%), followed by glaucoma (22.2%) and DED (11.4%). When compared with healthy controls, there was a twofold increase on the prevalence of anxiety symptoms (OR = 1.912, 95% CI 1.463–2.5, p < 0.001) and anxiety disorders (OR = 2.281, 95% CI 1.168–4.454, p = 0.016). Conclusion: Anxiety symptoms and disorders are common problems associated with ophthalmic disease patients. Thus, comprehensive and appropriate treatments are necessary for treating anxiety symptoms and disorders among ophthalmic disease patients.
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Affiliation(s)
- Zulvikar Syambani Ulhaq
- Research Center for Pre-Clinical and Clinical Medicine, National Research and Innovation Agency Republic of Indonesia, Cibinong, Indonesia
| | - Gita Vita Soraya
- Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Nadia Artha Dewi
- Department of Ophthalmology, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Lely Retno Wulandari
- Department of Ophthalmology, Faculty of Medicine, Brawijaya University, Malang, Indonesia
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13
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Rischin D, Khushalani NI, Schmults CD, Guminski A, Chang ALS, Lewis KD, Lim AM, Hernandez-Aya L, Hughes BGM, Schadendorf D, Hauschild A, Thai AA, Stankevich E, Booth J, Yoo SY, Li S, Chen Z, Okoye E, Chen CI, Mastey V, Sasane M, Lowy I, Fury MG, Migden MR. Integrated analysis of a phase 2 study of cemiplimab in advanced cutaneous squamous cell carcinoma: extended follow-up of outcomes and quality of life analysis. J Immunother Cancer 2021; 9:jitc-2021-002757. [PMID: 34413166 PMCID: PMC8382148 DOI: 10.1136/jitc-2021-002757] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background To provide pooled longer term data from three groups of a phase 2 study of cemiplimab in patients with advanced cutaneous squamous cell carcinoma (CSCC), and to determine duration of response (DOR) and impact on quality of life (QoL). Methods Patients received cemiplimab 3 mg/kg every 2 weeks (group 1, metastatic CSCC [mCSCC], n=59; group 2, locally advanced CSCC, n=78) or cemiplimab 350 mg every 3 weeks (group 3, mCSCC, n=56). Primary endpoint was objective response rate (ORR) per independent central review (ICR). QoL was repeatedly measured at day 1 of each treatment cycle (groups 1 and 2: 8 weeks; group 3: 9 weeks). Results Median duration of follow-up was 15.7 months. Overall, ORR per ICR was 46.1% (95% CI: 38.9% to 53.4%). Complete response (CR) rates were 20.3%, 12.8%, and 16.1% for groups 1, 2, and 3, respectively. Median time to CR was 11.2 months. Among patients with partial response or CR, the estimated proportion of patients with ongoing response at 12 months from the first objective response was 87.8% (95% CI: 78.5% to 93.3%), with median DOR not reached. Kaplan-Meier estimated probability of overall survival (OS) was 73.3% (95% CI: 66.1% to 79.2%) at 24 months, with median OS not reached. Global Health Status (GHS)/QoL improvements were observed as early as cycle 2 and were significantly improved and durable until last assessment. Kaplan-Meier estimate of median time to first clinically meaningful improvement for pain was 2.1 (95% CI: 2.0 to 3.7) months and was significantly improved in responders versus non-responders (p<0.0001). Conclusions This is the largest (n=193) clinical dataset for a programmed cell death-1 inhibitor against advanced CSCC, confirming the sustained substantial clinical activity of cemiplimab in these patients, including new findings of improved CR rates over time, increasing DOR, and durable pain control and GHS/QoL improvement. Trial registration number ClinicalTrials.gov Registry (NCT02760498), https://clinicaltrialsgov/ct2/show/NCT02760498.
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Affiliation(s)
- Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Guminski
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Anne Lynn S Chang
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Karl D Lewis
- Department of Medicine, Division of Medical Oncology, University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Annette M Lim
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
| | - Leonel Hernandez-Aya
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Brett G M Hughes
- Department of Cancer Care Services, Royal Brisbane and Women's Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen; German Cancer Consortium, Essen, Germany
| | - Axel Hauschild
- Department of Dermatology, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Alesha A Thai
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | | | - Siyu Li
- Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - Zhen Chen
- Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | | | - Chieh-I Chen
- Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - Vera Mastey
- Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | | | - Israel Lowy
- Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | | | - Michael R Migden
- Departments of Dermatology and Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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14
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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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15
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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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16
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Tao JP, Charlson ES, Zhu Y, Guo Z, Chen W, Zhan X, Shi H, Harris IG. A Digital Microscreen for the Enhanced Appearance of Ocular Prosthetic Motility (an American Ophthalmological Society Thesis). Am J Ophthalmol 2021; 228:35-46. [PMID: 33852909 DOI: 10.1016/j.ajo.2021.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to improve the apparent motility of ocular prosthetic devices using technology. Prevailing ocular prostheses are acrylic shells with a static eye image rendered on the convex surface. A limited range of ocular prosthetic movement and lack of natural saccadic movements commonly causes the appearance of eye misalignment that may be disfiguring. Digital screens and computational systems may obviate current limitations in eye prosthetic motility and help prosthetic wearers feel less self-conscious about their appearance. METHODS We applied convoluted neural networks (CNNs) to track pupil location in various conditions. These algorithms were coupled to a microscreen digital prosthetic eye (DPE) prototype to assess the ability of the system to capture full ocular ductions and saccadic movements in a miniaturized, portable, and wearable system. RESULTS The CNNs captured pupil location with high accuracy. Pupil location data were transmitted to a miniature screen ocular prosthetic prototype that displayed a dynamic contralateral eye image. The transmission achieved a full range of ocular ductions and with grossly undetectable latency. Lack of iris and sclera color and detail, as well as constraints in luminosity, dimensionality and image stability limited the real eye appearance. Yet, the digitally rendered eye moved in the same amplitude and velocity as the native, tracked eye. CONCLUSIONS Real-time image processing using CNNs coupled to microcameras and a miniscreen DPE may offer improvements in amplitude and velocity of apparent prosthetic eye movement. These developments, along with ocular image precision, may offer a next-generation eye prosthesis. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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17
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Al-Oulabi A, Al Rawas M, Farook TH, Rashid F, Barman A, Jamayet NB, Alam MK. The loss of an eye due to occupational injury: Two case studies of ocular prosthetic rehabilitation. Work 2021; 69:865-870. [PMID: 34180457 DOI: 10.3233/wor-213519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Two patients received ocular injuries from rusted metallic projectiles at their industrial workplaces. Said injuries resulted in the loss of their eyes by evisceration surgeries to prevent fatal infections. CASE DESCRIPTION The first case, a man in his twenties, received a stock conformer immediately after surgery and started prosthetic therapy within 2 months. The second case, a man in his forties, started prosthetic therapy after 10 years. Definitive custom ocular prostheses were fabricated and relined according to conventional protocol. RESULTS On issue of the prosthesis, there was adequate retention, aesthetics and stability to extra-ocular movements and treatment was considered successful for both cases. However, follow-ups showed noticeable prosthetic eye movements for case 1 which, to some extent mimicked the physiologic movement of its fellow natural eye. Case 1 adjusted to his prosthesis better while case 2 was still adjusting with little to no physiologic movement. CONCLUSION Prosthetic rehabilitation should be started as early as possible to obtain optimum rehabilitative results.
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Affiliation(s)
- Ayman Al-Oulabi
- Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Matheel Al Rawas
- Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Taseef Hasan Farook
- Maxillofacial Prosthetic Service, Prosthodontic Unit, School of Dental Sciences, Health campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Farah Rashid
- Maxillofacial Prosthetic Service, Prosthodontic Unit, School of Dental Sciences, Health campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Aparna Barman
- Maxillofacial Prosthetic Service, Prosthodontic Unit, School of Dental Sciences, Health campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nafij Bin Jamayet
- Division of Restorative Dentistry (Prosthodontics), School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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18
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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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19
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Kahana A, Unsworth SP, Andrews CA, Chan MP, Bresler SC, Bichakjian CK, Durham AB, Demirci H, Elner VM, Nelson CC, Kim DS, Joseph SS, Swiecicki PL, Worden FP. Vismodegib for Preservation of Visual Function in Patients with Advanced Periocular Basal Cell Carcinoma: The VISORB Trial. Oncologist 2021; 26:e1240-e1249. [PMID: 33988881 PMCID: PMC8265335 DOI: 10.1002/onco.13820] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background Basal cell carcinoma (BCC) is a common skin cancer often curable by excision; however, for patients with BCC around the eye, excision places visual organs and function at risk. In this article, we test the hypothesis that use of the hedgehog inhibitor vismodegib will improve vision‐related outcomes in patients with orbital and extensive periocular BCC (opBCC). Materials and Methods In this open‐label, nonrandomized phase IV trial, we enrolled patients with globe‐ and lacrimal drainage system–threatening opBCC. To assess visual function in the context of invasive periorbital and lacrimal disease, we used a novel Visual Assessment Weighted Score (VAWS) in addition to standard ophthalmic exams. Primary endpoint was VAWS with a score of 21/50 (or greater) considered successful, signifying globe preservation. Tumor response was evaluated using RECIST v1.1. Surgical specimens were examined histologically by dermatopathologists. Results In 34 patients with opBCC, mean VAWS was 44/50 at baseline, 46/50 at 3 months, and 47/50 at 12 months or postsurgery. In total, 100% of patients maintained successful VAWS outcome at study endpoint. Compared with baseline, 3% (95% confidence interval [CI], 0.1–15.3) experienced major score decline (5+ points), 14.7% (95% CI, 5 to 31.1) experienced a minor decline (2–4 points), and 79.4% experienced a stable or improved score (95% CI, 62.1–91.3). A total of 56% (19) of patients demonstrated complete tumor regression by physical examination, and 47% (16) had complete regression by MRI/CT. A total of 79.4% (27) of patients underwent surgery, of which 67% (18) had no histologic evidence of disease, 22% (6) had residual disease with clear margins, and 11% (3) had residual disease extending to margins. Conclusion Vismodegib treatment, primary or neoadjuvant, preserves globe and visual function in patients with opBCC. Clinical trail identification number.NCT02436408. Implications for Practice Use of the antihedgehog inhibitor vismodegib resulted in preservation of end‐organ function, specifically with regard to preservation of the eye and lacrimal apparatus when treating extensive periocular basal cell carcinoma. Vismodegib as a neoadjuvant also maximized clinical benefit while minimizing toxic side effects. This is the first prospective clinical trial to demonstrate efficacy of neoadjuvant antihedgehog therapy for locally advanced periocular basal cell carcinoma, and the first such trial to demonstrate end‐organ preservation. This article reports the results of a prospective clinical trial of vismodegib for patients with basal cell carcinoma occurring in the orbital and periocular regions to assess whether such treatment helps to preserve visual organs and function.
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Affiliation(s)
- Alon Kahana
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.,Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA.,Consultants in Ophthalmic and Facial Plastic Surgery, Southfield, Michigan, USA.,Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Shelby P Unsworth
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher A Andrews
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - May P Chan
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott C Bresler
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher K Bichakjian
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alison B Durham
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hakan Demirci
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.,Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Victor M Elner
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Christine C Nelson
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Denise S Kim
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Shannon S Joseph
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul L Swiecicki
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA.,Section on Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis P Worden
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA.,Section on Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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20
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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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Makrakis LR, de Araújo CB, Macedo AP, Silva-Lovato CH. The Impact of an Ocular Prosthesis on the Quality of Life, Perceived Stress, and Clinical Adaptation of Anophthalmic Patients: A Clinical and Longitudinal Trial. J Prosthodont 2021; 30:394-400. [PMID: 33464687 DOI: 10.1111/jopr.13332] [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] [Accepted: 01/12/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This prospective study evaluated and correlated the impact of ocular prostheses on quality of life and stress with socioeconomic level and clinical characteristics. The clinical difficulties and perceptions of patients after ocular rehabilitation were evaluated. MATERIALS AND METHODS Anophthalmic patients (at least 18 years of age) who were not users of ocular prostheses were recruited. The Medical Outcomes Short-Form Health Survey (SF-36) and Perceived Stress Scale (PSS-10) questionnaires were administered before and after 3 and 6 months of prosthesis installation. Clinical characteristics, difficulties, and perceptions were evaluated by quantitative and descriptive analysis (7 days, 3 months, 6 months). Data were analyzed by the Friedman test and Pearson Correlation test (α = 0.05). RESULTS The final sample consisted of 26 patients. Quality of life showed improvement in the "Bodily Pain" and "General Health" domains. Wearing the prosthesis did not influence perceived stress. The clinical evaluation showed clinical discharge over 6 months and presence of pain only at 7 days. A weak correlation occurred between sociodemographic characteristics and the categories "Role-Physical" (r = 0.423) and "General Health" (r = 0.494); cause of anophthalmia and "Role-Physical" (r = -0.471); and type of surgery and "General Health" (r = -0.432). CONCLUSIONS According to the results of this study, the provision of ocular prostheses showed positive influence in 2 domains of quality of life and weak correlations with socioeconomic level, type of surgery, and cause of loss. Ocular rehabilitation did not influence stress. The use and care of the prostheses did not affect tissue inflammation, but the discharge was continuous.
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Affiliation(s)
- Laís Ranieri Makrakis
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Camila Borba de Araújo
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Paula Macedo
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Cláudia Helena Silva-Lovato
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Holló G, Sándor NG, Kóthy P, Géczy A. Influence of painless one-eye blindness on depression, anxiety and quality of life in glaucoma patients with a normal fellow eye. BMC Ophthalmol 2021; 21:89. [PMID: 33596863 PMCID: PMC7891029 DOI: 10.1186/s12886-021-01845-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background For clinical practice it is important to evaluate and compare anxiety, depression and quality of life of glaucoma patients with painless one-eye blindness and a normal fellow eye to unaffected age-matched individuals from a similar environment. Methods Twenty-eight stable glaucoma patients (age, mean ± SD: 69.0 ± 13.3 years) with one normal and one painless blind eye, and 26 controls (age: 67.0 ± 14.0 years) completed the standard Hungarian adaptations of the Beck Depression Inventory, Beck Anxiety Inventory, Spielberger-Trait Anxiety Inventory, Hopelessness Scale, and Quality of Life Questionnaire SF-36 with the assistance of trained psychologist interviewers within 3 months after a detailed ophthalmological examination. Results The groups did not differ in age, gender distribution, number of children, grandchildren and people in their household (p ≥ 0.235). The best corrected visual acuity (BCVA) of the diseased eye was minimal (median: 0.00), while BCVA of their better eye (median: 1.0) did not differ from that of the control group (p ≥ 0.694). Compared to the control group, the patients’ scores were significantly higher for depression (p ≤ 0.01), cognitive and psychophysiological symptoms of anxiety (p ≤ 0.05) and hopelessness (p ≤ 0.013), and lower (worse) for physical function, vitality, general health and bodily pain (p ≤ 0.045). No difference was found between the groups for mental health, physical role functioning, emotional role functioning and social role functioning (p ≥ 0.117). Conclusion Our results show that patients with glaucoma-related one-eye blindness may require regular psychological support even when the visual performance of the fellow eye is fully maintained on the long run, and the patients’ everyday functioning is normal.
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Affiliation(s)
- Gábor Holló
- Department of Ophthalmology, Semmelweis University, Mária u. 39, Budapest, 1085, Hungary.
| | - Nikolett Gabriella Sándor
- Department of Personality and Clinical Psychology, Pázmány Péter Catholic University, Institute of Psychology, Budapest, Hungary.,Doctoral School of Psychology, University of Pécs, Pécs, Hungary
| | - Péter Kóthy
- Department of Ophthalmology, Semmelweis University, Mária u. 39, Budapest, 1085, Hungary
| | - Anna Géczy
- Department of Personality and Clinical Psychology, Pázmány Péter Catholic University, Institute of Psychology, Budapest, Hungary
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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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Heindl LM, Trester M, Guo Y, Zwiener F, Sadat N, Pine NS, Pine KR, Traweger A, Rokohl AC. Anxiety and depression in patients wearing prosthetic eyes. Graefes Arch Clin Exp Ophthalmol 2021; 259:495-503. [PMID: 32870372 PMCID: PMC7843548 DOI: 10.1007/s00417-020-04908-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To investigate anxiety and depression levels in prosthetic eye-wearing patients using standardized psychometric instruments, to define factors associated with these psychological diseases, and to identify a potential healthcare gap. METHODS A total of 295 prosthetic eye wearers were screened using the 7-item generalized anxiety disorder scale (GAD-7) and the 9-item patient health questionnaire (PHQ-9). Scores of GAD-7 and PHQ-9 were correlated with scores of general physical and mental health functioning, vision-related quality of life, appearance-related distress, appearance-related social function, and further biosocial factors. RESULTS Five patients (2%) had a pre-diagnosed anxiety disorder, and 20 patients (7%) had a pre-diagnosed depression. However, our screening revealed 26 patients (9%) with anxiety symptoms, 31 patients (11%) with depression symptoms, and 40 patients (14%) suffering from both anxiety and depression symptoms. This underdiagnosing for both anxiety and depression disorders was significant (p < 0.001, respectively). Higher GAD-7 scores were significantly associated with higher PHQ-9 scores, lower appearance-related social function, lower mental health functioning, and female gender (p ≤ 0.021, respectively). Higher PHQ-9 scores were significantly associated with lower physical and mental health functioning, higher educational degree, and non-traumatic eye loss (p ≤ 0.038, respectively). CONCLUSIONS Anxiety and depression disorders seem to be underdiagnosed in prosthetic eye wearers and to have higher incidence compared with the general population. Therefore, a psychometric screening should be routinely implemented in the clinical care. For a successful long-term rehabilitation, integrated care by a multidisciplinary team including ophthalmic plastic surgeons, ophthalmologists, ocularists, general practitioners, and psychologists is essential.
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Affiliation(s)
- Ludwig M. Heindl
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany ,Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
| | - Marc Trester
- Trester-Institute for Ocular Prosthetics and Artificial Eyes, Cologne, Germany
| | - Yongwei Guo
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany
| | - Florian Zwiener
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany
| | - Narges Sadat
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany
| | | | - Keith R. Pine
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Andreas Traweger
- Institute for Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria ,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Alexander C. Rokohl
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany
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25
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Gauthier AC, Oduyale OK, Fliotsos MJ, Zafar S, Mahoney NR, Srikumaran D, Woreta FA. Clinical Characteristics and Outcomes in Patients Undergoing Primary or Secondary Enucleation or Evisceration After Ocular Trauma. Clin Ophthalmol 2020; 14:3499-3506. [PMID: 33149543 PMCID: PMC7602916 DOI: 10.2147/opth.s273760] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the frequency of primary versus secondary eye removal, frequency of enucleation versus evisceration, and characteristics and outcomes of patients undergoing these procedures after presenting with severe ocular trauma. Patients and Methods Retrospective chart review of patients presenting to the emergency department (ED) with severe eye trauma necessitating enucleation or evisceration between 2010 and 2018. Results There were 92 eyes from 90 patients included in our study. Twenty-seven percent of eyes underwent primary removal (n=25, 14 enucleation, 11 evisceration), while 73% of eyes underwent secondary removal (n=67, 50 enucleation, 17 evisceration). The mean patient age was 45.2 years (range 4.2–92.6); primary enucleation/evisceration patients were older on average than secondary eye removal patients [53.8 years (range 15.9–91.2) versus 42.2 years (range 4.2–91.6 years), p=0.04]. A median of 34 days passed between ED presentation and secondary enucleation/evisceration. Before undergoing secondary enucleation/evisceration, patients underwent a median of one ocular procedure (range 0–14) for various complications of trauma including orbital infection, choroidal or retinal tear or detachment, and wound dehiscence. Open globe injury repairs comprised 43 of the 92 total procedures (47%) performed prior to secondary enucleation/evisceration. Secondary enucleations/eviscerations required a median of seven clinic visits compared to two clinic visits required after primary surgeries (p<0.01). 10.7% of all patients (n=10) had at least one implant-related complication following enucleation/evisceration, with all but one of these patients being in the secondary enucleation/evisceration group. Conclusion Primary enucleation or evisceration was performed in 27% of all eye removals, and enucleation was performed in 69.6% of all eye removals. Future research is warranted to determine if primary eye removal may be appropriate and when to consider enucleation versus evisceration.
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Affiliation(s)
- Angela C Gauthier
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Oluseye K Oduyale
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael J Fliotsos
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nicholas R Mahoney
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Wu H, Wang JY, Zhong XC, Shi X, Wu YH, Ye J. Ocular injury resulting in eye removal at a large tertiary care center in China. Int J Ophthalmol 2020; 13:1312-1317. [PMID: 32821687 DOI: 10.18240/ijo.2020.08.19] [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: 12/09/2019] [Accepted: 04/08/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the risk factors for eye removal following ocular trauma at a major ophthalmology department in China. METHODS A retrospective study of patients who underwent eye removal surgery following ocular trauma was completed. Clinical outcomes were consulted in detail through the hospital's computed medical data system. Patients' information including age, gender, cause of ocular trauma, affected eye, and education level was collected and recorded in a standardized database. Chi-squared test, Student's t-test, Fisher's exact test, and bivariate correlation analysis were used for statistical comparisons. RESULTS The present study included 1675 removal eyes from 1674 patients over the 20-year period. Patients included 80.5% males and 19.5% females, with mean age of 38y. The majority of the patients (70.7%) were blue-collar workers (physical laborers), and 1098 patients (65.6%) did not receive high school education. Work-related injuries were the most common reason for eye removal (n=739, 44.1%), of which 441 cases (59.7%) were related to metal/nail wounds. The most frequent injury type in males was work-related injuries (49.7%), whereas the most frequent injury type in females was home-related injuries (25.8%). CONCLUSION Work-related injuries are a leading cause of severe ocular injury resulting in eye removal. In addition, men and undereducated patients are more likely to undergo eye removal surgery following ocular trauma. This study identified multiple high-risk factors leading to eye removal following ocular trauma, which is of great importance for preventing severe eye injuries.
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Affiliation(s)
- Han Wu
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jing-Yi Wang
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Xin-Cao Zhong
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Xin Shi
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Yi-Hua Wu
- Department of Toxicology of School of Public Health, Zhejiang University School of Medicine, Hangzhou 310029, Zhejiang Province, China
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
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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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Ojuok E, Uppuluri A, Langer PD, Zarbin MA, Thangamathesvaran L, Bhagat N. Predictive factors of enucleation after open globe injuries. Graefes Arch Clin Exp Ophthalmol 2020; 259:247-255. [PMID: 32567040 DOI: 10.1007/s00417-020-04794-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/24/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Trauma is the leading cause of enucleations in the USA. Current information regarding open globe injuries (OGI) is based mainly on data from individual tertiary care centers across the country which might skew the findings towards the population served by these level-one trauma centers. The aim of this study is to evaluate the demographics, characteristics, and risk factors of traumatic enucleations in a large data sample. METHODS Descriptive cross-sectional observational study using the National Inpatient Sample (NIS) Database from 2002 to 2013. Inpatients with traumatic enucleations were identified using ICD-9 codes. Chi-square and logistic regression analyses were used to identify differences between the enucleated and non-enucleated cohorts and to evaluate the predictive factors of enucleation in OGIs. RESULTS Enucleations were performed in 3020 (6.2%) of 48,563 OGIs identified. The average age in the enucleated cohort for males vs. females was 44.7 vs. 62.2 years. In the USA, the highest number of traumatic enucleations occurred in the 21-40 group (41.8%) and the fewest in the 80+ age group (11.8%). The risk of enucleation decreased across the age groups significantly. Compared with the 21-40 age group, the risk of undergoing enucleation was 15% lower in patients 41 to 60 years of age, 35% in patients 61 to 80, and 40% lower in patients over 80. In total, 5.1% OGIs in women and 6.7% of OGIs in men were enucleated. The risk of enucleation was 29% higher in men than in women. The highest absolute number of enucleations was seen in Whites. Compared with Whites, Blacks had a 63% higher risk of enucleation following an OGI. OGIs with rupture-type injury, endophthalmitis, or phthisis were significantly higher odds to be enucleated. CONCLUSIONS The risk of enucleation following traumatic OGI significantly increased for patients who were in the 21-40 age group, of Black race, or of male gender; the risk also increased if the injury was a rupture-type or associated with endophthalmitis or phthisis. The risk of depression was 75% higher in enucleated patients versus non-enucleated patients.
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Affiliation(s)
- Effy Ojuok
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
| | - Aditya Uppuluri
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
| | - Paul D Langer
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
| | - Marco A Zarbin
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
| | - Loka Thangamathesvaran
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA
| | - Neelakshi Bhagat
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA.
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30
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Pine NS, Pine KR. Depression, Anxiety and Stress Indicators for Prosthetic Eye Wearers. Clin Ophthalmol 2020; 14:1715-1723. [PMID: 32606587 PMCID: PMC7320898 DOI: 10.2147/opth.s254910] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background This study explores the role of appearance, mucoid discharge, visual perception and functional problems as indicators for depression, anxiety and stress amongst prosthetic eye wearers. Methods A total of 217 anophthalmic patients who had worn a prosthetic eye for at least two years and were older than 16 years completed an anonymous questionnaire. Descriptive and inferential statistics were used to investigate differences and correlations between variables. Results The mean scores for depression, anxiety, and stress fell within the accepted normal ranges; however, 11% of participants experienced moderate depression, while 7% experienced severe or extremely severe levels. Ten percent were moderately anxious, and 7% were severely or extremely severely anxious. Five percent of participants were moderately stressed, while 7% were severely or extremely severely stressed. Conclusion Social settings are important predictors for depression, whereas anxiety and stress appear to derive more from appearance concerns and practical issues. Prosthetic eye wearers with employment, leisure and social functioning issues are at higher risk of depression, anxiety and stress, as well as appearance, anxiety and not feeling accepted by society. Older patients and those who feel accepted by society appear to suffer less anxiety and stress. It is recommended that psychologists be a part of an integrated team to address the needs of anophthalmic patients.
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Affiliation(s)
- Nicola S Pine
- School of Psychology, Massey University, Wellington, New Zealand
| | - Keith R Pine
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
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Conrady CD, Feist RM, Vitale AT, Shakoor A. Long-term visual outcomes of endophthalmitis and the role of systemic steroids in addition to intravitreal dexamethasone. BMC Ophthalmol 2020; 20:181. [PMID: 32375683 PMCID: PMC7201644 DOI: 10.1186/s12886-020-01449-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 04/23/2020] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of this study was to evaluate the role of systemic steroids in post-procedural endophthalmitis as the role of intravitreal steroids in treatment algorithms of endophthalmitis remain controversial. Methods This is a retrospective analysis from a single tertiary referral center of all patients older than 18 years old that developed presumed post-procedure endophthalmitis and were treated at our center from 2009 to 2018. Results Eighty-three patients were followed after being treated for post-procedural endophthalmitis that either received systemic steroids or did not around the time of diagnosis. Almost 30 % of all patients regained a final visual acuity of 20/40 or better, while 31.2% had poor visual outcomes of count fingers or worse. Non-clearing debris was the most significant long-term complication. Visual improvement plateaued in 67.7% by 1 month after diagnosis and initial treatment in both groups. There was no difference in visual outcomes when comparing the sixteen patients that received systemic steroids and the sixty-seven that did not; however, no enucleation or evisceration was required in patients receiving systemic steroids. Five patients that did not receive systemic steroids required an enucleation or evisceration due to a blind, painful eye. Conclusions The use of systemic steroids does not seem to worsen long-term outcomes of endophthalmitis compared to those patients that did not receive them and they may prove beneficial in the most severe cases by reducing the risk of losing the globe altogether.
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Affiliation(s)
- Christopher D Conrady
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA. .,Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall St, Ann Arbor, MI, 48103, USA.
| | - Richard M Feist
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Akbar Shakoor
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Unsworth SP, Heisel CJ, Kahana A. A New Paradigm in the Treatment of Advanced Periocular Basal Cell Carcinoma? Am J Ophthalmol 2019; 206:215-216. [PMID: 31957698 DOI: 10.1016/j.ajo.2019.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/18/2019] [Accepted: 06/23/2019] [Indexed: 01/17/2023]
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Enucleations and Eviscerations for Combat Ocular Trauma Performed During Operations Iraqi and Enduring Freedom: 2001 to 2011. J Craniofac Surg 2019; 30:767-770. [PMID: 30817532 DOI: 10.1097/scs.0000000000005294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To describe the demographics and clinical outcomes of patients who underwent posttraumatic enucleation or evisceration during Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) from 2001 to 2011. METHODS The Walter Reed Ocular Trauma Database is a retrospective case series of US Servicemembers and Department of Defense civilians who had combat ocular injuries in OIF and OEF. Data regarding posttraumatic enucleations and eviscerations performed during OIF and OEF were extracted. The main outcomes analyzed were the number of enucleations and eviscerations performed, location of the surgery, laterality, and graft type. The secondary outcome measures included: mechanism of injury and Ocular Trauma Score classification. RESULTS One hundred nine enucleations and eviscerations were performed on the 890 eyes (12.24%). Sixty-three (57.80%) primary enucleations, 36 (33.03%) secondary enucleations, 5 (4.59%) postretinal detachment repair enucleations, and 5 (4.59%) primary eviscerations were completed. The surgeries were completed at a combat support hospital (57; 52.3%), or Walter Reed Army Medical Center (49; 45.0%). All surgeries were unilateral except in 2 patients. The most common graft type used was silicone (n = 56; 51.38%). Improvised explosive devices caused 76 (69.72%) eye injuries. Ocular Trauma Score were recorded as 56 (51.38%) between 0 and 44, 44 (40.37%) between 45 and 65, and unknown in 9 (8.26%). CONCLUSION Posttraumatic enucleation or evisceration due to devastating ocular trauma is required in about 15% of ophthalmic patients in modern combat trauma. The psychosocial impact on veterans who have required an enucleation or evisceration from combat trauma has been poorly studied and requires further review.
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Zhang J, Wan L, Dai Y. The Demography and Etiology of Pediatric Enucleation in a Tertiary Eye Center in North China, 2001-2015. Ophthalmic Epidemiol 2018; 26:95-101. [PMID: 30325254 DOI: 10.1080/09286586.2018.1523439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To review the demography and etiology of pediatric enucleation over time. METHODS Pediatric ophthalmic inpatients recruited and recorded (aged 0-14 years) at Shandong Eye Institute from January 2001 to December 2015 were reviewed. Changes during the three periods from 2001 to 2005, 2006 to 2010, and 2011 to 2015 were compared and analyzed. RESULTS A total of 9307 pediatric inpatients were reviewed. Of these, 71 patients (71 eyes) who had been treated by enucleation were analyzed; 46 were boys (64.79%) and 25 were girls (35.21%). The mean age at enucleation was 9 (0-14) years. The pediatric enucleation rate during this 15-year period was 0.76% (71/9307), with a decreasing trend (p < 0.001). From 2001 to 2005, the figure was 3.45% (43/1245); it dropped to 0.80% (26/3231) from 2006 to 2010 and then dropped further to 0.04% (2/4831) by 2015. Trauma (52.1%, 37/71) was the leading etiology. Overall, 89.2% (33 eyes) exhibited open globe injuries; 78.4% (29/37) of these involved boys. In the cases with open injuries, the mean age at the time of trauma was 6.0 (0-14) years and the mean age at enucleation was 11 (2-14) years. Retinoblastoma (RB) (22.5%, 16/71) was the second-most common etiology; 68.8% (11/16) of these cases involved girls and the mean age at enucleation was 2 (0-5) years. CONCLUSION A decrease in pediatric enucleation in North China, especially in Shandong Province, was observed over time, possibly because of better surgical techniques, improvements in the treatment of RB, and public health interventions in children.
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Affiliation(s)
- Jing Zhang
- a Medical College , Qingdao University , Qingdao , China.,b Shandong Provincial Key Laboratory of Ophthalmology , Shandong Eye Institute, Shandong Academy of Medical Sciences , Qingdao , China
| | - Lei Wan
- a Medical College , Qingdao University , Qingdao , China.,b Shandong Provincial Key Laboratory of Ophthalmology , Shandong Eye Institute, Shandong Academy of Medical Sciences , Qingdao , China
| | - Yunhai Dai
- b Shandong Provincial Key Laboratory of Ophthalmology , Shandong Eye Institute, Shandong Academy of Medical Sciences , Qingdao , China
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Damato B, Hope-Stone L, Cooper B, Brown SL, Salmon P, Heimann H, Dunn LB. Patient-reported Outcomes and Quality of Life After Treatment of Choroidal Melanoma: A Comparison of Enucleation Versus Radiotherapy in 1596 Patients. Am J Ophthalmol 2018; 193:230-251. [PMID: 29555484 DOI: 10.1016/j.ajo.2018.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE To test the hypothesis that patients treated with radiotherapy for choroidal melanoma enjoy better quality of life (QoL) than patients who have undergone enucleation. METHODS In this nonrandomized study, patients with choroidal melanoma treated at the Royal Liverpool University Hospital, Liverpool, UK, were invited to complete QoL questionnaires approximately 6 months postoperatively and then on each anniversary of their primary treatment. These instruments consisted of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-OPT30 questionnaire, Hospital Anxiety & Depression Scale, and the Functional Assessment of Cancer Treatment questionnaire. Patient-reported outcomes were correlated with demographics, ocular treatment, social factors, presenting tumor and ocular status, self-reported general health, marital status, and employment status. RESULTS The 1596 patients were treated with radiotherapy (72.3%) or enucleation (27.7%). Enucleation was associated with male sex (χ2, P = .004), older age (t test, P < .001), larger tumor diameter (t test, P < .001), monosomy 3 (χ2, P < .001), depression (linear regression, 95% confidence interval [CI], .17 to 1.01), and reduced physical and functional well-being (linear regression, 95% CI, -1.14 to -0.12 and -1.96 to -0.47), respectively. Poor QoL was attributed to the ocular disease by 21% and 20% of enucleated and irradiated patients, respectively (χ2, P = .938). CONCLUSIONS Patient-reported outcomes and QoL were worse in patients who had undergone primary enucleation for choroidal melanoma. These outcomes may partly have been caused by factors predisposing to enucleation rather than enucleation itself, because enucleated patients tended to be older, with more advanced disease at presentation, and a worse prognosis for survival. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Sittivarakul W, Wongkot P. Anxiety and Depression among Patients with Uveitis and Ocular Inflammatory Disease at a Tertiary Center in Southern Thailand: Vision-Related Quality of Life, Sociodemographics, and Clinical Characteristics Associated. Ocul Immunol Inflamm 2018; 27:731-742. [DOI: 10.1080/09273948.2018.1484495] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Wantanee Sittivarakul
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Prapaipim Wongkot
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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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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Chan SWS, Khattak S, Yücel N, Gupta N, Yücel YH. A decade of surgical eye removals in Ontario: a clinical-pathological study. Can J Ophthalmol 2017; 52:486-493. [PMID: 28985809 DOI: 10.1016/j.jcjo.2017.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess patient demographics, clinical indications, and pathologic causes of surgically removed eyes over a decade in Ontario (Canada) and to identify areas of ocular disease management needing more attention. DESIGN Retrospective cross-sectional study. PARTICIPANTS The surgically removed eyes of 713 consecutive mainly adult patients from 2004 to 2013. METHODS Demographic, clinical, and pathologic data were collected on all eyes received by the University of Toronto Ophthalmic Pathology Laboratory from 2004 to 2013. RESULTS Of the 713 eyes removed, enucleations accounted for 60% of cases, eviscerations for 39% of cases, and exenteration for 1% of cases. The most common clinical indications for surgical eye removal were blind painful eye (37%), neoplasm (35%), and trauma (6%). The leading pathologic causes of eye removal were neoplasm (36%), glaucoma (21%), infection or inflammation (17%), and trauma (16%). Glaucoma-related findings were the most common pathologic findings observed (38%), regardless of the primary cause. CONCLUSIONS A blind painful eye and neoplasms were the most commonly documented indications prior to removal of the eye. Common pathologies included glaucoma, neoplasms, infection/inflammation, and trauma. However, regardless of the primary cause, glaucoma-related pathologies were the most common pathologic findings. Refractory eye disease and pain continue to be important reasons for removal of eyes among patients in Ontario. More effective and targeted management strategies are needed to reduce the need for this radical eye surgery of last resort.
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Affiliation(s)
- Sze Wah Samuel Chan
- Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont
| | - Shireen Khattak
- Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont
| | - Narain Yücel
- Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont
| | - Neeru Gupta
- Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ont; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ont; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Yeni H Yücel
- Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ont; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ont; Ophthalmic Pathology Laboratory, University of Toronto, Toronto, Ont.
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