Biologic Augmentation of Tibiotalocalcaneal Arthrodesis with Autologous Bone Block is Associated with High Rates of Fusion

Category: Ankle; Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis is an established salvage procedure for severe deformities of the hindfoot. Despite its prevalence, end-stage pathology, systemic comorbidities, and the physical demands of surgery often precipitate unsuccessful outcomes, with nonunion rates as high as 85% in medically complex patients. Given the considerable morbidity associated with TTC arthrodesis, there has been recent interest in maximizing the physiologic potential of fusion by means of surgical technique, osteoinductive and osteoconductive biological agents, and vascularized bone flaps. Here, we present a novel approach to TTC arthrodesis using femoral head allograft bone block, bone marrow aspirate, and demineralized bone matrix (DBM) in the absence of tourniquet. Additionally, we explore the role of the medial femoral condyle (MFC) free flap as a reconstructive adjunct to arthrodesis. Methods: The sample consisted of 14 patients presenting to a tertiary care facility for reconstructive limb salvage. TTC arthrodesis was performed without tourniquet and biologically augmented with fresh-frozen femoral head allograft, pelvic bone marrow aspirate, and DBM. Three patients with severe soft tissue defects also underwent vascularized osseous reconstruction with MFC free flap. Recovery protocol included three months of prolonged non-weightbearing mechanical stabilization followed by conversion to weightbearing AFO boot for one year. Post-operative plain radiographs and computed tomography (CT) scans were assessed for fusion at regular follow-up. After fusion, participants completed a survey on patient-reported outcomes, which included the modified Foot Function Index (FFI) and Patient-Reported Outcomes Measurement Information System (PROMIS) scales for pain and physical function. Results: Successful TTC fusion was documented on plain radiograph in 13 patients (92.9%) and confirmed via CT in 10 patients (90.9%). The mean time-to-fusion was 183.2 +- 83.2 days. One patient (7.1%) failed to achieve fusion and underwent amputation secondary to infectious wound complications. Patients who underwent vascularized bone grafting had more robust healing and significantly shorter time-to-fusion (112.3 +- 31.7 days vs. 204.4 +- 82.7 days, p = 0.05). The mean patient-reported FFI score was found to be 40.96% +- 23.08%, indicating mild-to-moderate impairment in foot function. Similarly, PROMIS data revealed that patients who underwent TTC arthrodesis had a pain T-score of 58.34 (z = 0.83) and a physical function T-score of 39.00 (z = - 1.10), corresponding to mild pain and moderate impairment, respectively. Conclusion: We sought to biologically optimize the osteoinductive and osteoconductive potential of TTC arthrodesis using femoral head allograft bone block, bone marrow aspirate, and DBM in the absence of tourniquet. This approach resulted in excellent rates of fusion with minimal pain and preserved function of the lower extremity. Osseous healing was significantly enhanced by MFC flap in patients with soft tissue defects. We, therefore, recommend biologic augmentation of TTC arthrodesis as a viable salvage option for patients facing amputation or other undesirable outcomes.

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Outcomes Following the Treatment of Talar Osteochondral Lesions with BioCartilage and Bone Marrow Aspirate Concentrate Mixture

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00049 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0004

Author(s):

Ashraf Fansa ◽

Mark Drakos ◽

Taylor Cabe ◽

Peter Fabricant

Keyword(s):

Bone Marrow ◽

Patient Reported Outcomes ◽

Bone Marrow Aspirate ◽

Statistical Significance ◽

Osteochondral Lesions ◽

Foot And Ankle ◽

Bone Marrow Aspirate Concentrate ◽

Patient Reported ◽

The Mean

Category: Arthroscopy Introduction/Purpose: With reported incidence rates ranging from 40% to 70% post ankle sprains and fractures, osteochondral lesions of the talus (OLT) are not uncommon. However, management of such defects remains challenging. Microfracturing is considered the standard treatment for symptomatic OLTs.Larger lesions however typically require more invasive restorative procedures such as autologous osteochondral transplantation. Microfracture results are variable due to the fact that the resulting reparative fibrocartilage is weaker and biomechanically inferior to native hyaline cartilage. In this study, we examine the functional and radiological outcomes following use of a new arthroscopic technique utilizing a mixture of micronized allograft cartilage matrix (BioCartilage) (Arthrex, Naples, FL) soaked in Bone Marrow Aspirate Concentrate (BMAC) to fill OLTs. Methods: Eighty-six consecutive patients treated for OLT using arthroscopic debridement and BioCartilage matrix soaked in BMAC were identified. All patients were treated by a single fellowship-trained sports medicine and foot and ankle surgeon. Functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS). This information was obtained from a prospective registry at the authors’ institution. Wilcoxon signed rank tests were used to determine statistical significance between pre and postoperative clinical scores. Additionally, an attending radiologist assessed the reparative cartilage morphology on postoperative MRI scans. This was evaluated and scored using a modified magnetic resonance observation of cartilage tissue (MOCART) scoring system. Results: Thirty-one patients (19 Females; 12 Males) with a mean age of 37.8 years (Range 15–54) had a minimum follow-up duration of 12 months and were thus included in this review. Mean follow-up duration was 15.8 months (Range 12 –25.7). The mean patient BMI was 27.4 (Range 19.6 – 39.4), while the average osteochondral lesion size was 85.9 mm2 (Range 35 – 220). The Physical Function domain of the PROMIS score, demonstrated statistically significant change, improving from 40.63 ±8.31 to 48.31 ±10.07 (p=0.02). The Pain Intensity domain also improved significantly from 49.06 ±9.32 to 42.14 ±9.38 (p=0.03). The Pain Interference domain and FAOS scores did improve but not reaching statistical significance. The mean MRI MOCART score was 69 ±13.34 with 13.3 months average follow-up duration. Conclusion: Achieving the longest duration possible of symptom-free functioning postoperatively is the main goal of any cartilage repair procedure. Augmentation of an articular lesion’s infill with BioCartilage and BMAC may help enhance the biomechanical properties of the reparative fibrocartilage construct and its longevity. Our initial findings demonstrate favorable patient-reported outcomes. Moreover, postoperative MRIs demonstrate the majority of the lesions showed either complete or hypertrophic infill, complete or hypertrophic integration, homogenous repair tissue, and isointense signals. Long-term studies prospectively assessing the effectiveness of this technique in maintaining pain-free-function of the ankle joint are warranted.

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Matching Patient Expectations after Ankle Fusion Based on Patient Reported Outcome Measures

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00253 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0025

Author(s):

Jessica M. Kohring ◽

Jeffrey R. Houck ◽

Sam Flemister ◽

John P. Ketz ◽

Irvin Oh ◽

...

Keyword(s):

Physical Function ◽

Patient Reported Outcomes ◽

Surgical Intervention ◽

Threshold Value ◽

Ankle Arthrodesis ◽

Patient Expectations ◽

T Score ◽

Ankle Fusion ◽

Patient Reported ◽

The Mean

Category: Ankle Arthritis Introduction/Purpose: Much research on outcomes after ankle fusion focuses on gait changes, progression of adjacent joint arthritis, and other clinical measures, but little has been reported on the patient’s perspective. The purpose of this study was to determine the change in physical function and pain after undergoing ankle arthrodesis as determined by patient reported outcomes (PROs). Methods: This was a retrospective review of prospectively collected patient reported outcomes data in 88 consecutive ankle arthrodesis procedures performed from May 2015 to March 2018. Patient reported physical function (PF) and pain interference (PI) were measured as part of the routine care via the PROMIS computerized adaptive test at 6 months and 1 year post- operatively. Descriptive data and Spearman correlations were determined for PF and pain at 6 months and 1 year. Results: The mean pre-operative PF T-score was 37, less than the pre-determined threshold value of 42, indicating that this cohort was impaired physically and would respond positively to surgical intervention. The mean pre-operative PI T-score was 63 indicating moderate to high baseline pain and greater than the threshold value of 60, indicating that this patient cohort would have decreased pain after surgical intervention. The meaningful clinically important difference (MCID) was achieved for PI at 6 months and 1 year post-operatively (T-score of 4 and 6, respectively). At 6 months and 1 year, there was a moderate inverse correlation between PF and PI (r=-0.49, r=-0.61 respectively) suggesting less pain and more function. Demographic data, mean follow-up time, and mean PROMIS T-scores are seen in Table 1. Conclusion: The results of this study indicate that patients can expect to have a clinically meaningful improvement in pain after undergoing ankle fusion. Although patients do improve marginally in physical function, it is most likely the improvement in pain that is the greatest benefit to these patients at one year after ankle arthrodesis. This information is important to share with patients to align patient expectations with surgical results.

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Bone Marrow Aspirate Concentrate for the Treatment of Knee Osteoarthritis: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/03635465211018837 ◽

2021 ◽

pp. 036354652110188

Author(s):

Laura E. Keeling ◽

John W. Belk ◽

Matthew J. Kraeutler ◽

Alexandra C. Kallner ◽

Adam Lindsay ◽

...

Keyword(s):

Systematic Review ◽

Bone Marrow ◽

Knee Osteoarthritis ◽

Patient Reported Outcomes ◽

Bone Marrow Aspirate ◽

Cochrane Library ◽

Bone Marrow Aspirate Concentrate ◽

Knee Oa ◽

Patient Reported

Background: Bone marrow aspirate concentrate (BMAC) has emerged as a therapeutic option for symptomatic knee osteoarthritis (OA). Purpose: To systematically review the literature to evaluate the efficacy of isolated BMAC injection in the treatment of OA of the knee joint. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by searching the PubMed, Embase, and Cochrane Library databases up to July 2020 to identify human studies that assessed the clinical outcomes of isolated BMAC injection for the treatment of knee OA. The electronic search strategy used was “bone marrow aspirate concentrate knee osteoarthritis.” Results: Eight studies met the inclusion criteria, including a total of 299 knees with a mean follow-up of 12.9 months (range, 6-30 months). Of all patient-reported outcomes assessed across studies, 34 of 36 (94.4%) demonstrated significant improvement from baseline to latest follow-up ( P < .05). Five studies evaluating numerical pain scores (visual analog scale and Numeric Rating Scale) reported significant improvements in pain level at final follow-up ( P < .01). However, 3 comparative studies evaluating BMAC in relation to other therapeutic injections failed to demonstrate the clinical superiority of BMAC. Conclusion: The BMAC injection is effective in improving pain and patient-reported outcomes in patients with knee OA at short- to midterm follow-up. Nevertheless, BMAC has not demonstrated clinical superiority in relation to other biologic therapies commonly used in the treatment of OA, including platelet-rich plasma and microfragmented adipose tissue, or in relation to placebo. The high cost of the BMAC injection in comparison with other biologic and nonoperative treatment modalities may limit its utility despite demonstrable clinical benefit.

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Patient-Reported Outcomes in Systemic Light-Chain Amyloidosis

Blood ◽

10.1182/blood-2018-99-111570 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 4832-4832

Author(s):

Rajshekhar Chakraborty ◽

Lisa Rybicki ◽

Christy J. Samaras ◽

Beth M. Faiman ◽

Jason Valent ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Well Being ◽

Al Amyloidosis ◽

First Line ◽

T Score ◽

First Line Therapy ◽

Outpatient Visits ◽

Line Therapy ◽

Patient Reported ◽

The Mean

Abstract Background: Patients with systemic light-chain (AL) amyloidosis have a high symptom burden which can negatively impact their health-related quality of life (HRQoL). However, there is a lack of data on patient-reported outcomes (PROs) in this population in the current era of effective plasma cell directed therapies. The primary objectives of our study were to assess baseline HRQoL using FACT-G (Functional Assessment of Cancer Therapy-General) and PROMIS-GH (Patient Reported Outcomes Measurement Information System-Global Health), evaluate the degree of correlation between FACT-G and PROMIS-GH, and compare HRQoL by hematologic response to first-line therapy in systemic AL amyloidosis. Method: This was an observational study using the Cleveland Clinic Knowledge Program database, which contains HRQoL data captured at outpatient visits. FACT-G was administered every 90 days since its implementation on September 2012. PROMIS-GH was implemented in October 2015, initially administered every 30 days and subsequently every 90 days since July 2017. Results: A total of 81 patients with systemic AL amyloidosis diagnosed between September 2012 and December 2017 and ≥1 HRQoL measurement were included in our analysis. The median age at diagnosis was 64 years. Cardiac involvement at diagnosis was present in 49% of patients. The most common induction therapy was Bortezomib-Cyclophosphamide-Dexamethasone (86%). Autologous stem cell transplantation was performed in 38% of patients. Data on HRQoL at baseline (≤2 months from diagnosis) using FACT-G was available for 43 patients. The mean FACT-G total score at baseline was 74 (standard deviation [S.D.] ±15). In comparison, the mean FACT-G total score for general US population is 80.1 (±18.1) and that of US cancer patients is 79.3 (±17.0) [Normative data from Pearman et al; Cancer. 2014]. Maximal HRQoL deficit was seen in the functional well-being (FWB) domain of FACT-G, with the mean score being >0.5 S.D. below that of the general population (Table 1). Data on HRQoL at baseline using PROMIS-GH was available for 18 patients. There was a significant deficit in global physical health (GPH) compared to the general population, with a mean T-score of 37.7 (±7.8) [Mean T-score in general US population being 50±10]. The mean T-score for global mental health (GMH) was 44.4 (±6.7). A total of 72 patients had 128 outpatient visits where FACT-G and PROMIS-GH were captured concurrently (range, 1-4 visits per patient). Using Cohen's criterion, GPH domain of PROMIS-GH had a large and statistically significant correlation with FACT-G total (r=0.66), physical well being (PWB) (r=0.77) and FWB (r=0.66) scores. PROMIS GMH domain also had a strong and statistically significant correlation with FACT-G total (r=0.73), PWB (r=0.60), emotional well-being (EWB) (r=0.64) and FWB (r=0.73) scores. The scatterplots for correlation between PROMIS-GH domains and FACT-G total score is shown in Figure I. At follow-up, a total of 50 patients had data on best hematologic response and HRQoL assessment. Patients achieving a complete response (CR) to first-line therapy had a significantly superior FACT-G score at all domains compared to those with less than CR or no response. Maximal benefit in complete responders was noted in the FWB domain of FACT-G (Mean score ≥2 S.D. higher than patients with less than CR or no response; P=0.002). Conclusion: Patients with AL amyloidosis have a worse HRQoL at diagnosis compared to US cancer and general adult population. Deficit in HRQoL was most prominent in the FWB domain of FACT-G and GPH domain of PROMIS-GH. Most domains of FACT-G and PROMIS-GH had strong and significant correlation. Patients achieving a CR to first-line therapy had significantly superior HRQoL at all FACT-G domains. Clinical trials in AL amyloidosis should include patient-reported HRQoL as a key endpoint and focus on the domains of physical health and functioning to assess meaningful benefit of novel therapies. Psychometric validation of FACT-G and PROMIS-GH in AL amyloidosis would be helpful in generating robust PRO data in future studies. Disclosures Majhail: Anthem, Inc.: Consultancy; Incyte: Honoraria; Atara: Honoraria.

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Long-Term Efficacy, Visual Performance and Patient Reported Outcomes with a Trifocal Intraocular Lens: A Six-Year Follow-up

Journal of Clinical Medicine ◽

10.3390/jcm10092009 ◽

2021 ◽

Vol 10 (9) ◽

pp. 2009

Author(s):

Joaquín Fernández ◽

Manuel Rodríguez-Vallejo ◽

Javier Martinez ◽

Noemi Burguera ◽

David P. Piñero

Keyword(s):

Intraocular Lens ◽

Patient Reported Outcomes ◽

Phone Call ◽

Distortion Analysis ◽

Patient Reported ◽

Visual Function Questionnaire ◽

Secondary Objective ◽

Defocus Curve ◽

The Mean

(1) Background: To evaluate the efficacy at 6 years postoperative after the implantation of a trifocal intraocular lens (IOL) AT Lisa Tri 839MP. The secondary objective was to evaluate the contrast sensitivity defocus curve (CSDC), light distortion analysis (LDA), and patient reported outcomes (PROs). (2) Methods: Sixty-two subjects participated in phone call interviews to collect data regarding a visual function questionnaire (VF-14), a patient reported spectacle independence questionnaire (PRSIQ), and questions related to satisfaction and decision to be implanted with the same IOL. Thirty-seven of these subjects were consecutively invited to a study visit for measurement of their visual acuity (VA), CSDC, and LDA. (3) Results: The mean monocular distance corrected VA was −0.05, 0.08, and 0.05 logMAR at far and distances of 67 cm and 40 cm, respectively. These VAs were significantly superior to those reported in previous literature (p < 0.05). The total area under the CSDC was 2.29 logCS/m−1 and the light distortion index 18.82%. The mean VF-14 score was 94.73, with 19.4% of subjects requiring spectacles occasionally for near distances, and 88.9% considering the decision of being operated again; (4) Conclusions: Long-term AT LISA Tri 839MP IOL efficacy results were equal or better than those reported 12 months postoperatively in previous studies. The spectacle independence and satisfaction rates were comparable to those reported in short-term studies.

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No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts

Cartilage ◽

10.1177/19476035211021911 ◽

2021 ◽

pp. 194760352110219

Author(s):

Danielle H. Markus ◽

Anna M. Blaeser ◽

Eoghan T. Hurley ◽

Brian J. Mannino ◽

Kirk A. Campbell ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Knee Injury ◽

Lesion Size ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Radiographic Outcomes ◽

Significant Difference ◽

Patient Reported ◽

The Mean

Objective The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. Design A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. Results Overall, 52 total patients who underwent OCA with either fresh precut OCA cores ( n = 26) and hemi-condylar OCA ( n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar ( P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle ( P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner ( P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). Conclusions This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.

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Salvage Arthrodesis with Femoral Head Allograft for Failed Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00323 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0032

Author(s):

Hong S. Lee ◽

Kiwon Young ◽

Tae-Hoon Park ◽

Hong Seop Lee

Keyword(s):

Femoral Head ◽

Subjective Assessment ◽

Total Ankle Arthroplasty ◽

Bone Block ◽

Ankle Arthroplasty ◽

Pain Scores ◽

Walking Aids ◽

The Mean ◽

Final Followup

Category: Ankle Introduction/Purpose: Failed total ankle arthroplasty (TAA) often results in significant bone loss and requires salvage arthrodesis. The aim of this study was to investigate the outcomes of Salvage arthrodesis with allo-bone block for failed TAA. Methods: This study included 8 patients who underwent salvage arthrodesis with femoral head allograft for failed TAA from August 2012 to March 2018 because of loosing of TAA implant. The mean age of the patients was 71 years (range, 54-81 years), and the mean follow-up period was 32 months (range, 12 to 84 months). Allograft problem and alignment of joint were evaluated radiographically. American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and visual analogue scale (VAS) pain scores were recorded preoperatively and at the time of final followup. Functional questionnaires were used to assess the duration for which the patient could walk continuously, use of walking aids, consumption of pain medication, and the patient’s subjective assessment of the percentage of overall improvement compared with before the salvage arthrodesis. Results: The allograft was retained without collapse for a mean of 24 months (range, 12 to 36 months) in four patients. Collapse of the allograft was observed in four patients at a mean of 11 months (range, 9 to 16 months), 1 of 4 patients were conserved to retrograde intramedullary nail at postoperative 12 months because of with implant failure and nonunion. The mean AOFAS and VAS pain scores improved from 12 (range, 8 to 40) preoperatively to 63 (range, 38 to 75) postoperatively (p = 0.001) and from 7 (range, 6 to 10 to 3 (range, 2 to 8) (p = 0.001), respectively. At the final follow-up evaluation, 6 of 8 patients were able to walk continuously at least 30 minutes with walking aid. Conclusion: The successful rate of salvage arthrodesis with femoral head allograft was 75% (Six of total 8 patients). The incidence rate of allograft collapse was 50% (Four of total 8 patients).

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Establishing a common metric for patient-reported outcomes in cancer patients: linking patient reported outcomes measurement information system (PROMIS), numerical rating scale, and patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE)

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-020-00271-0 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Minji K. Lee ◽

Benjamin D. Schalet ◽

David Cella ◽

Kathleen J. Yost ◽

Amy C. Dueck ◽

...

Keyword(s):

Information System ◽

Adverse Events ◽

Patient Reported Outcomes ◽

Rating Scale ◽

Measurement Information ◽

Outcomes Measurement ◽

T Score ◽

Patient Reported ◽

Measurement Information System ◽

The Common

Abstract Background Researchers and clinicians studying symptoms experienced by people with cancer must choose from various scales. It would be useful to know how the scores on one measure translate to another. Methods Using item response theory (IRT) with the single-group design, in which the same sample answers all measures, we produced crosswalk tables linking five 0–10 numeric rating scale (NRS) and 15 items from Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE, scored on a 1–5 scale) to the T-Score metric of six different scales from the NIH Patient reported Outcomes Measurement Information System (PROMIS®). The constructs, for which we conducted linking, include emotional distress-anxiety, emotional distress-depression, fatigue, sleep disturbance, pain intensity, and pain interference. We tested the IRT linking assumption of construct similarity between measures by comparing item content and testing unidimensionality of item sets comprising each construct. We also investigated the correlation of the measures to be linked and, by inspecting standardized mean differences, whether the linkage is invariant across age and gender subgroups. For measures that satisfied the assumptions, we conducted linking. Results In general, an NRS score of 0 corresponded to about 38.2 on the PROMIS T-Score scale (mean = 50; SD = 10); whereas an NRS score of 10 corresponded to a PROMIS T-Score of approximately 72.7. Similarly, the lowest/best score of 1 on PRO-CTCAE corresponded to 39.8 on T-score scale and the highest/worst score of 5 corresponded to 72.0. Conclusion We produced robust linking between single item symptom measures and PROMIS short forms.

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Comparison of Patient-Reported Outcomes in 5-Year Survivors Who Received Bone Marrow vs Peripheral Blood Unrelated Donor Transplantation

JAMA Oncology ◽

10.1001/jamaoncol.2016.2520 ◽

2016 ◽

Vol 2 (12) ◽

pp. 1583 ◽

Cited By ~ 51

Author(s):

Stephanie J. Lee ◽

Brent Logan ◽

Peter Westervelt ◽

Corey Cutler ◽

Ann Woolfrey ◽

...

Keyword(s):

Bone Marrow ◽

Peripheral Blood ◽

Patient Reported Outcomes ◽

Unrelated Donor ◽

Patient Reported

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Visual Outcomes, Quality of Life and Satisfaction After Phacoemulsification in Patients With Type 2 Diabetes Mellitus and Patients Without Diabetes

10.21203/rs.3.rs-108487/v1 ◽

2020 ◽

Author(s):

Joao Beato ◽

Sonia Torres-Costa ◽

Joao Esteves-Leandro ◽

Manuel Falcão ◽

Vitor Rosas ◽

...

Keyword(s):

Quality Of Life ◽

Visual Acuity ◽

Patient Reported Outcomes ◽

Diabetic Patients ◽

Patient Reported ◽

Visual Function Questionnaire ◽

The Mean ◽

Type 2 Diabetic

Abstract BackgroundDiabetic retinopathy (DR) and cataract are major complications that lead to significant visual impairment of diabetic patients. This study aims to compare the changes in visual acuity, quality of life and satisfaction after phacoemulsification between type 2 diabetic and nondiabetic patients.MethodsFifty-seven diabetic patients (37 with no diabetic retinopathy [DR], 11 with mild/moderate nonproliferative DR and 9 with severe nonproliferative/proliferative DR) and 45 controls were submitted to first-eye cataract surgery by phacoemulsification alone or with co-adjuvant intravitreal injection of bevacizumab or triamcinolone. National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was recorded preoperatively and 6 months after surgery; and satisfaction evaluated at 1-month. ResultsCorrected distance visual acuity (CDVA) of the operated eye at 1 and 6-months (p<0.001) was significantly higher than preoperative value in the controls and all diabetic subgroups. The final CDVA in the severe nonproliferative/proliferative DR subgroup was significantly lower compared to the controls and the remaining diabetic subgroups (p<0.05). The mean NEI VFQ-25 composite score significantly improved in both control (15.413.2 points) and diabetic (15.413.0 points) groups, without differences among the diabetic subgroups (p>0.05). Overall patient satisfaction was 93% in both control and diabetic groups. ConclusionThis study provides vision-related patient-reported outcomes that support the benefit from phacoemulsification in all stages of DR, as long as there is adequate monitoring and treatment of retinopathy.

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