Death Anxiety and COVID-19 Anxiety. The Mediating Role of Religious Relational Identification and the Impact of Emotional Regulation Strategies.

Management theory of terror (TMT) explains the way disease and death anxiety (DA) are managed through religion during crisis (i.e., COVID-19 pandemic). 344 women students completed self-reported questionnaires regarding death and COVID-19 anxiety, religious relational identification, and emotional regulation. Results show positive relation between religious relational identification and death anxiety, and COVID-19 anxiety. The interaction between death anxiety and emotional regulation shows that both cognitive reappraisal and expressive suppression are dysfunctional for COVID-19 anxiety. A moderated mediation effect is significant, showing that COVID-19 anxiety is not decreasing due to usual and natural ways of coping (i.e., religious relational identification and cognitive reappraisal).

The efficiency of online cognitive-behavioral therapy for postpartum depressive symptomatology: a systematic review and meta-analysis.

Postpartum depression (PD) is a frequently occurring disorder that affects the cognitive, emotional and social development of a mother after childbirth. Online cognitive-behavioral therapy (OCBT) is used as therapy for PD symptomatology, but no clear evidence is available about its effectiveness. The goal of this meta-analysis was to identify, synthesize and analyze the empiric studies regarding the OCBT effectiveness for PD. A search for indexed articles and unpublished theses between 2000 and 2017 was made in Google Scholar, Proquest, ScienceDirect, APA PsycNet, Cochrane, SpringerLink, Medline, PubMed and Dissertations Abstract International. Six studies were selected based on the following eligibility criteria: (1) papers published in English, (2) papers about PD, (3) papers that empirically investigated the effectiveness of OCBT for PD, and (4) papers comparing an experimental group with a control group. Exclusion criteria included investigations of PD for: (1) mothers diagnosed with another severe disorder and (2) mothers with deceased children and (3) women with an age below 18 years old. This meta-analytic study identified a moderate significant size-effect (d = - 0.54, 95% CI [-0.716; -0.423]) of the OCBTs in reducing PD, and practical implications and limitations are discussed.

Which environmental factors are associated with lived health when controlling for biological health? - a multilevel analysis.

BACKGROUND: Lived health and biological health are two different perspectives of health introduced by the International Classification of Functioning, Disability and Health (ICF). Since in the concept of lived health the impact of the environment on biological health is inherently included, it seems intuitive that when identifying the environmental determinants of health, lived health is the appropriate outcome. The Multilevel Item Response Theory (MLIRT) model has proven to be a successful method when dealing with the relation between a latent variable and observed variables. The objective of this study was to identify environmental factors associated with lived health when controlling for biological health by using the MLIRT framework. METHODS: We performed a psychometric study using cross-sectional data from the Spanish Survey on Disability, Independence and Dependency Situation. Data were collected from 17,303 adults living in 15,263 dwellings. The MLIRT model was used for each of the two steps of the analysis to: (1) calculate people's biological health abilities and (2) estimate the association between lived health and environmental factors when controlling for biological health. The hierarchical structure of individuals in dwellings was considered in both models. RESULTS: Social support, being able to maintain one's job, the extent to which one's health needs are addressed and being discriminated against due to one's health problems were the environmental factors identified as associated with lived health. Biological health also had a strong positive association with lived health. CONCLUSIONS: This study identified environmental factors associated with people's lived health differences within and between dwellings according to the MLIRT-model approach. This study paves the way for the future implementation of the MLIRT model when analysing ICF-based data.

Biological health or lived health: which predicts self-reported general health better?

BACKGROUND: Lived health is a person's level of functioning in his or her current environment and depends both on the person's environment and biological health. Our study addresses the question whether biological health or lived health is more predictive of self-reported general health (SRGH). METHODS: This is a psychometric study using cross-sectional data from the Spanish Survey on Disability, Independence and Dependency Situation. Data was collected from 17,739 people in the community and 9,707 from an institutionalized population. The following analysis steps were performed: (1) a biological health and a lived health score were calculated for each person by constructing a biological health scale and a lived health scale using Samejima's Graded Response Model; and (2) variable importance measures were calculated for each study population using Random Forest, with SRGH as the dependent variable and the biological health and the lived health scores as independent variables. RESULTS: The levels of biological health were higher for the community-dwelling population than for the institutionalized population. When technical assistance, personal assistance or both were received, the difference in lived health between the community-dwelling population and institutionalized population was smaller. According to Random Forest's variable importance measures, for both study populations, lived health is a more important predictor of SRGH than biological health. CONCLUSIONS: In general, people base their evaluation of their own health on their lived health experience rather than their experience of biological health. This study also sheds light on the challenges of assessing biological health and lived health at the general population level.

Work Rehabilitation Questionnaire (WORQ): development and preliminary psychometric evidence of an ICF-based questionnaire for vocational rehabilitation.

PURPOSE: The International Classification of Functioning, Disability and Health (ICF) has proven to be a valuable framework for vocational rehabilitation (VR). No reliable and valid ICF-based instruments to capture work functioning is known, hence, the aims of this study were: (1) to outline the process for developing an ICF-based questionnaire, the Work Rehabilitation Questionnaire (WORQ) to assess functioning in VR and (2) to report preliminary psychometric evidence. METHODS: ICF categories were selected from the ICF Core Sets for VR using explorative Rasch-analysis and VR literature review. Questions were worded to assess identified ICF categories. WORQ was translated from English to German. Psychometrics for the German version of WORQ was examined in one VR centre in Switzerland. RESULTS: 44 ICF categories were selected which resulted in 36 questions related to functioning. The psychometric evaluation of WORQ showed high test-retest reliability (Spearman correlation 0.79) (n = 53) and good internal consistency (Cronbachs Alpha 0.88) (n = 74) WORQ showed moderate correlation with Beck Depression Inventory II (Spearman correlation 0.511) and low correlation (Spearman correlation -0.353) with SF-36. CONCLUSIONS: WORQ appears to be a reliable, ICF-based questionnaire to evaluate functioning in VR, easy to administer by health or vocational professionals. The additional information gained when using WORQ would contribute to improving interdisciplinary understanding of the patient's situation and therefore support the integrative planning of the return-to-work process or engagement in gainful employment. However, further studies are needed to further examine its use in clinical practice and research, when validated in other patient populations and settings.

Unilateral Granular Type 2 Corneal Dystrophy With Exacerbation After LASIK.

PURPOSE: The aim of this study was to report a case of unilateral granular corneal dystrophy type 2 (GCD2) with exacerbation after bilateral laser in situ keratomileusis (LASIK). METHODS: Clinical evaluation, Scheimpflug imaging, anterior segment optical coherence tomography (AS-OCT), cytology, and genetic testing were used to confirm the diagnosis of unilateral GCD2 with exacerbation after bilateral LASIK. Detailed literature review for possible unilateral GCD2 presentations was performed. RESULTS: A 54-year-old White woman presented with blurred vision in her left eye and a history of bilateral LASIK performed 8 years before. Examination revealed dense opacities in the left cornea only, which were confirmed to be confined to the LASIK interface and adjacent corneal stromal tissue, as determined by AS-OCT. The patient underwent flap lift, interface debris removal, and stromal bed phototherapeutic keratectomy. Cytological analysis showed eosinophilic corneal stromal deposits that stained with trichrome stain and were congophilic on Congo red stain. Genetic testing was positive for heterozygous GCD2 transforming growth factor ß-induced gene ( TGFBI ), c.371G>A, p.R124H mutation. There were no opacities identifiable in the right eye on serial slit-lamp examination, Scheimpflug imaging, or OCT imaging at 4 or 8 years after bilateral LASIK. Literature review failed to identify any previous reports of unilateral GCD2. CONCLUSIONS: This is the first known reported case of unilateral granular corneal dystrophy type 2. LASIK is contraindicated in eyes with corneal stromal dystrophies related to mutations in TGFBI as both flap creation and laser ablation can exacerbate visually significant opacity formation. Scheimpflug and AS-OCT imaging are useful to identify opacities in GCD2.

The psychosocial difficulties in brain disorders that explain short term changes in health outcomes.

BACKGROUND: This study identifies a set of psychosocial difficulties that are associated with short term changes in health outcomes across a heterogeneous set of brain disorders, neurological and psychiatric. METHODS: Longitudinal observational study over approximately 12 weeks with three time points of assessment and 741 patients with bipolar disorders, depression, migraine, multiple sclerosis, parkinson's disease, stroke and traumatic brain injury. The data on disability was collected with the checklist of the International Classification of Functioning, Disability and Health. The selected health outcomes were the Short Form 36 and the World Health Organization Disability Assessment Schedule. Multilevel models for change were applied controlling for age, gender and disease severity. RESULTS: The psychosocial difficulties that explain the variability and change over time of the selected health outcomes were energy and drive, sleep, and emotional functions, and a broad range of activities and participation domains, such as solving problems, conversation, areas of mobility and self-care, relationships, community life and recreation and leisure. CONCLUSIONS: Our findings are of interest to researchers and clinicians for interventions and health systems planning as they show that in addition to difficulties that are diagnostic criteria of these disorders, there are other difficulties that explain small changes in health outcomes over short periods of time.

Intracameral Fibrinous Reaction During Descemet's Membrane Endothelial Keratoplasty.

PURPOSE: To determine the outcomes and predisposing factors of Descemet's membrane endothelial keratoplasty (DMEK) complicated by intraoperative fibrinous reaction. METHODS: Retrospective cohort study of 346 DMEKs. Medical charts were reviewed for recipient demographics, surgical indications, donor characteristics, and potential predisposing ocular and systemic factors. For DMEKs complicated by fibrin, surgeons' notes on events leading to fibrin formation and on its intraoperative management, occurrence of graft detachment, primary failure, re-bubbling or regrafting, time to graft clearing, and endothelial cell density were additionally collected. RESULTS: Fifteen (4.3%) DMEKs were complicated by fibrin, which interfered with and protracted graft unfolding in all cases. Median surgical time was longer than for uncomplicated DMEKs (p = 0.001). Graft positioning at the end of surgery was suboptimal in seven eyes (47%) and failed in three (20%). Re-bubbling, primary failure, and regraft rates were of 40%, 33% and 53%, respectively. The corneas that cleared did so in three to eight weeks, with median endothelial cell loss of 53% at 12 months. Use of anticoagulants was a preoperative risk factor (p = 0.01). Surgeon-identified intraoperative factors included beginner surgeons (87%), prolonged AC shallowing (47%) and graft manipulations (33%), intraocular bleeding (27%), new injector (20%), tight donor scroll (13%), and floppy iris (13%). CONCLUSION: Fibrinous reaction is a rare intraoperative complication of DMEK that interferes with graft unfolding and results in poor outcomes. Anticoagulant use appears to be a risk factor and may be compounded by surgical trauma to vascular tissues and prolonged surgical maneuvers.

Culture of human corneal endothelial cells isolated from corneas with Fuchs endothelial corneal dystrophy.

The purpose of this study was to assess the feasibility of initiating primary cultures of corneal endothelial cells from patients suffering from Fuchs endothelial corneal dystrophy (FECD; MIM# 1036800). We also evaluated which conditions yielded the best results for culture. Twenty-nine patients undergoing Descemet stripping automated endothelial keratoplasty consented to the use of their excised Descemet's membrane for this study. Out of the 29 specimens, 18 successfully initiated a culture. Cell morphology varied between endothelial (rounded, slightly elongated cells, n = 12) and fibroblastic-like (thin and very elongated cells, n = 6). These differences in cell morphology were also observed with the normal human corneal endothelial cell cultures. The cultures that initially presented an endothelial morphology maintained their shape in subcultures. Clusterin expression was similar in FECD and normal endothelial cells. Transmission electron microscopy of FECD Descemet's membranes showed a high degree of various abnormalities generally found in this disease, such as a thickened Descemet's membrane, presence of a posterior banded layer, presence of a fibrillar layer and striated bodies of various sizes and periodicities. Patient's age was predictive of culture success, all younger FECD donors generating cultures of endothelial morphology. The absence of a fibrillar layer was also a factor associated with greater success. Culture success was not dependent on specimen size, specimen pigmentation, or patient's preoperative central corneal thickness. In conclusion, this paper shows for the first time that central Descemet's membranes of patients suffering from FECD possess proliferative endothelial cells that can be isolated and cultured without viral transduction, opening the way for new in vitro studies of this disease.

Generic patient-reported outcomes in child health research: a review of conceptual content using World Health Organization definitions.

AIM: Our aims were to (1) describe the conceptual basis of popular generic instruments according to World Health Organization (WHO) definitions of functioning, disability, and health (FDH), and quality of life (QOL) with health-related quality of life (HRQOL) as a subcomponent of QOL; (2) map the instruments to the International Classification of Functioning, Disability and Health (ICF); and (3) provide information on how the analyzed instruments were used in the literature. This should enable users to make valid choices about which instruments have the desired content for a specific context or purpose. METHOD: Child health-based literature over a 5-year period was reviewed to find research employing health status and QOL/HRQOL instruments. WHO definitions of FDH and QOL were applied to each item of the 15 most used instruments to differentiate measures of FDH and QOL/HRQOL. The ICF was used to describe the health and health-related content (if any) in those instruments. Additional aspects of instrument use were extracted from these articles. RESULTS: Many instruments that were used to measure QOL/HRQOL did not reflect WHO definitions of QOL. The ICF domains within instruments were highly variable with respect to whether body functions, activities and participation, or environment were emphasized. INTERPRETATION: There is inconsistency among researchers about how to measure HRQOL and QOL. Moreover, when an ICF content analysis is applied, there is variability among instruments in the health components included and emphasized. Reviewing content is important for matching instruments to their intended purpose.

Long-term outcomes following primary versus secondary Boston keratoprosthesis type 1 implantation.

BACKGROUND/AIMS: To compare long-term outcomes of primary versus secondary (postgraft failure) Boston keratoprosthesis type 1 (KPro) implantation. METHODS: Medical records of patients at the Centre hospitalier de l'Université de Montréal having undergone KPro implantation between 2008 and 2017 were reviewed and included if they had a preoperative Snellen best-corrected visual acuity (BCVA) of 20/100 or worse and a minimum of 5 years of follow-up. Eighty-two eyes were separated into two cohorts (40 primary, 42 secondary KPro) and BCVA, complications and device retention were evaluated between groups. RESULTS: BCVA improved from baseline in both groups at each year; this was significant at all five postoperative years in the primary group and the first 3 years in the secondary group (p<0.05). Mean BCVA was similar between groups at 5 years (logarithm of minimal angle resolution 1.3±0.8 in the primary group vs 1.5±0.8 p<0.05). Idiopathic vitritis, choroidal detachment and new glaucoma occurred more after primary KPro (n=7, 17.5% vs n=1, 2.4%; n=11, 27.5% vs n=3, 7.14% and n=14, 35% vs n=6, 14%, respectively; p<0.05). Primary KPro had lower retention (n=28, 70% vs n=38, 91%, p<0.05) at final follow-up. There was more aniridia in the primary group (n=19, 48% vs n=6, 14%, p<0.01). Within each group, 50% of removals occurred in aniridic eyes. CONCLUSION: Primary KPro yielded favourable long-term visual outcomes but had more complications and lower retention rates than secondary KPro, likely explained by preoperative indications. Primary device implantation represents a favourable option for patients for whom grafts are likely to fail.

Type of goals and perceived control for goal achievement over time. The mediating role of motivational persistence.

This study tested how type of goals (i.e., performance and mastery goals) influence perceived control for goal achievement over time (i.e., after 12 months) while controlling for motivational persistence, gender, self-efficacy, initial perceived control, emotional involvement, and perceived difficulty. Goals and self-reported data from 1220 students were analyzed. Comparative test indicated that students describing a mastery goal display more motivational persistence and more perceived control for goal achievement, compared to those describing a performance goal. Type of goals directly and significantly predict perceived control of goal achievement at 12 months. Motivational persistence directly, positively, and significantly predicts perceived control of goal achievement at 12 months. In addition, motivational persistence positively and significantly mediates the relation between type of goals and perceived control of goal achievement at 12 months. Results support a partial mediation model.

Idiopathic Vitritis after Boston Type 1 Keratoprosthesis Implantation: Incidence, Risk Factors and Outcomes in a Multicentric Cohort.

PURPOSE: To determine incidence, risks factors for, and outcomes of idiopathic vitritis (IV) after Boston type 1 keratoprosthesis (KPro) implantation. METHODS: Retrospective, consecutive case series. Risk factors were analyzed between IV group and No IV group. RESULTS: IV occurred in 32/350 procedures (9.1%), for an average incidence of 0.02 cases per procedure-year. Presumed infectious keratitis was the only risk factor identified (HR = 7.65) Corneal necrosis and retinal detachment occurred significantly more frequently in IV group (all P < .05). By last follow-up, the cumulative proportion of eyes that maintained a visual acuity >20/200 was significantly lower in IV group (P = .01), as was the KPro retention rate (HR = 0.26). CONCLUSIONS: IV is associated with infectious keratitis, indicating that the vitritis may not be a sterile process. The increased incidence of subsequent complications leads to significantly decreased visual acuity and KPro retention in affected eyes.

Health status and QOL instruments used in childhood cancer research: deciphering conceptual content using World Health Organization definitions.

PURPOSE: The impact of cancer on children can be assessed through various concepts including mental and physical health status and most significantly quality of life (QOL). It has been difficult to compare data collected through these instruments due to a lack of continuity or understanding of overlaps and gaps between them. To delineate the content of the most commonly used instruments in childhood cancer on an item-by-item basis, this study used standardized methods to link health information to the International Classification of Functioning, Disability, and Health (ICF) as well as World Health Organization (WHO) standard definitions of health and quality of life. METHOD: MEDLINE, CINAHL, EMBASE, PsycINFO, Cancerlit, and Sociological Abstracts were searched from the inception of each database to June 15th, 2009 for health status and quality of life instruments. The six most common cancer-specific and generic instruments employed in primary research in childhood cancer were analyzed on an item-by-item basis by two content assessors specializing in ICF linking and WHO definitions of health and QOL, using a standardized iterative technique developed at the ICF Research Branch. RESULTS: We report the extent to which health status and QOL are represented in each instrument. Most measures emphasize a majority health status perspective according to WHO definitions of health. The generic instruments stress activities and participation domains over body functions or environment factors according to the ICF while cancer-specific instruments vary in their emphasis. Initial phase of coding agreement between assessors was in the substantial range (0.6-0.8 using Cohen's kappa). CONCLUSION: A comprehensive and systematic content analysis of the most commonly employed health status and QOL instruments was conducted for this review. Two criteria were described as follows: the perspectives of the instruments (i.e., health vs. QOL) and the health content (according to ICF components). No single instrument demonstrated an ideal balance of content characteristics according to these criteria, and thus, each must be considered carefully relative to one's particular research or clinical evaluative purpose.

A multidisciplinary cross-cultural measurement of functioning after stroke: Rasch analysis of the brief ICF Core Set for stroke.

PURPOSE: To investigate the possibility of constructing a multiprofessional cross-cultural measure of functioning after stroke across categories of the International Classification of Functioning, Disability and Health (ICF). METHOD: Data on 757 stroke survivors from China, Germany, Italy, and Sweden, including ratings of 15 categories from the Brief ICF Core Set for stroke, were analyzed using the Rasch model. Unidimensionality, reliability, fit of the ICF categories to the model, ordering of response options of the ICF qualifier, and presence of differential item functioning (DIF) were studied. RESULTS: Of the 15 ICF categories, response options for 7 categories were collapsed, 5 categories were deleted due to misfit, and 4 ICF categories showed DIF for country and were accordingly split into country-specific categories. The proposed final clinical measure consists of 20 ICF categories (6 categories were country-common) with an overall fit statistic of χ2180 = 184.87, P = .386, and a person separation index of r = 0.72, which indicates good reliability. Based on an individual's functioning after stroke, the ratings across the different ICF categories can be summed on an interval scale ranging from 0 to 100. CONCLUSION: A construction of a cross-cultural clinical measure after stroke based on ICF categories across body functions, structures, and activities and participation was possible. With this kind of clinical measure, stroke survivors' functional levels can be compared even across countries. Despite the promising results, further studies are necessary to develop definitive measures based on ICF categories.

Endophthalmitis in Eyes With the Boston Type I Keratoprosthesis: Incidence, Recurrence, Risk Factors, and Outcomes.

PURPOSE: To determine the incidence and recurrence of Boston type I keratoprosthesis (KPro)-associated endophthalmitis, and its microbiological profile, risk factors, and outcomes. METHODS: This is a retrospective study of 158 consecutive KPro procedures with a median follow-up of 78.4 months. Medical charts were reviewed for ocular history, contact lens and topical antibiotic use, visual acuity, and complications. For eyes with endophthalmitis, time to infection, culture results, and recurrences were collected. Cox regression analyses identified risk factors for endophthalmitis and compared the risk for visual failure, KPro retention, and globe loss between eyes with and without endophthalmitis. RESULTS: The incidence and recurrence rates of endophthalmitis were of 1.7% and 6.0% per procedure-year, respectively. First episodes occurred at a median of 18.6 months. Eight of 18 episodes (44%) were culture positive, isolating mainly Gram-positive bacteria (7 [88%]). Previous ocular burn (hazard ratio: 7.34, 95% confidence interval: 1.91-28.15), infectious keratitis (5.09, 1.70-15.22), corneal melt (4.55, 1.50-13.83), and postoperative contact lens wear (4.19, 1.17-15.04) were risk factors. Eyes with endophthalmitis did not have a higher risk for visual failure (1.74, 0.78-3.91) but were more likely to not retain the KPro (2.81, 1.15-6.88) and undergo evisceration (2.81, 1.15-6.88). All eyes lost ≥ 2 lines of vision during the endophthalmitis episode. CONCLUSIONS: Endophthalmitis is rare but vision and globe threatening in eyes with KPro. Given the increased associated risk, corneal melts and infectious keratitis must be promptly treated, postoperative contact lenses should be considered on a case-by-case basis, and patients with ocular burns might require more aggressive antimicrobial prophylaxis.

Infectious Keratitis After Boston Type 1 Keratoprosthesis Implantation.

PURPOSE: To identify the incidence, risk factors, and outcomes of infectious keratitis after Boston type 1 keratoprosthesis (kpro) implantation. METHODS: Retrospective case series of kpro procedures at the Stein Eye Institute and the Centre Hospitalier de l'Université de Montréal between May 1, 2004, and December 31, 2018. Data were collected regarding ocular history, operative details, postoperative management, microbiologic profile, treatment, and outcomes. Log-rank test and Cox proportional hazard ratio (HR) were used to evaluate for an association between risk factors and outcomes. RESULTS: A total of 349 kpro procedures were performed in 295 eyes of 268 patients. Fifty-seven cases of presumed infectious keratitis were identified after 53 procedures (15.2%) in 50 eyes (16.9%) of 49 patients (18.3%). The incidences of culture-positive bacterial and fungal keratitis were 0.014 and 0.004 per eye-year, respectively. Persistent corneal epithelial defect formation (P < 0.001) and cicatricial disease (HR: 1.98, 95% confidence interval, 1.02-3.83) were associated with a significantly higher incidence of infectious keratitis. For the 53 cases with a known outcome, medical therapy achieved resolution of infection in 34 cases (64.2%), whereas kpro explantation was required in 19 cases (35.8%). Infectious keratitis was associated with an increased risk for kpro explantation (HR: 3.09, 95% confidence interval, 1.92-4.79). CONCLUSIONS: Infectious keratitis develops in approximately 17% of eyes after kpro implantation, with a higher rate of culture-positive bacterial than fungal keratitis. The observed rate of microbial keratitis suggests the need for additional topical antimicrobial prophylaxis in eyes at higher risk, such as those with preexisting cicatricial disease or postoperative persistent corneal epithelial defect formation.

Patient-Reported Vision-Related Quality of Life After Boston Type I Keratoprosthesis.

PURPOSE: To determine patient-reported vision-related quality of life (VR-QoL) after Boston type I keratoprosthesis (BKPro) and its determinants. METHODS: A cross-sectional study including consecutive consenting BKPro patients was conducted. The French National Eye Institute Visual Function Questionnaire-25 measured postoperative VR-QoL. Medical charts were retrospectively reviewed for demographics, ocular comorbidities, indication for surgery, postoperative visual acuity (VA), and complications. Univariate analyses were used to identify VR-QoL determinants. Multivariate linear regression was additionally performed for patients operated unilaterally, using VR-QoL as the dependent variable and age, sex, and postoperative VA as covariates. P < 0.05 indicated statistical significance. RESULTS: Sixty-three patients, aged 63 ± 13 years, with a mean follow-up of 54 ± 19 months, were included. VR-QoL was measured 53 ± 18 months postoperatively. "Composite" VR-QoL scores in patients with unilateral (n = 51) and bilateral (n = 12) BKPro were 65 ± 23 and 63 ± 19, respectively, and did not significantly differ between the 2 groups (P = 0.71). In patients with unilateral BKPro, VR-QoL was determined by postoperative VA in the better eye, which was the contralateral nonoperated eye in most cases. Achieved vision in the operated eye contributed to VR-QoL when vision in the contralateral nonoperated eye was poorer. In the bilateral BKPro group, VR-QoL was determined by postoperative VA in the better eye and the number of ongoing complications. CONCLUSIONS: Five-year VR-QoL scores were lower in BKPro patients compared with healthy cohorts reported in the literature and were similar after unilateral and bilateral BKPro surgery. The main determinant of postoperative VR-QoL was postoperative vision in the better eye.

Long-term visual outcomes of the Boston type I keratoprosthesis in Canada.

BACKGROUND/AIMS: To evaluate long-term visual outcomes of Boston type I keratoprosthesis (KPro) surgery and identify risk factors for visual failure. METHODS: Single surgeon retrospective cohort study including 85 eyes of 74 patients who underwent KPro implantation to treat severe ocular surface disease, including limbal stem cell deficiency, postinfectious keratitis, aniridia and chemical burns. Procedures were performed at the Centre hospitalier de l'Université de Montréal from October 2008 to May 2012. All patients with at least 5 years of follow-up were included in the analysis, including eyes with repeated KPro. Main outcome measures were visual acuity (VA), visual failure, defined as a sustained worse than preoperative VA, postoperative complications, and device retention. RESULTS: Mean follow-up was 7.2±1.3 years (±SD). Mean VA was 2.1±0.7 (logarithm of minimal angle resolution) preoperatively and 1.9±1.2 at last follow-up. There were 2.4% of patients with VA better than 20/200 preoperatively and 36.5% at last follow-up. Maintenance of improved postoperative VA was seen in 61.8% of eyes at 7 years. Preoperative factors associated with visual failure were known history of glaucoma (HR=2.7 (1.2 to 5.9), p=0.02) and Stevens-Johnson syndrome (HR=7.3 (2.5 to 21.4) p<0.01). Cumulative 8-year complication rates were 38.8% retroprosthetic membrane formation, 25.9% hypotony, 23.5% new onset glaucoma, 17.6% retinal detachment, 8.2% device extrusion and 5.9% endophthalmitis. The majority (91.8%) of eyes retained the device 8 years after implantation. CONCLUSION: Almost two-thirds of patients had improved VA 7 years after KPro implantation. Preoperative risk factors for visual failure were known glaucoma and Stevens-Johnson syndrome.