Patient Satisfaction Based on IOL Implantation Results

Purpose: to found the relationship between the obtained postoperative visual acuity, the increase in visual acuity in the lines and the subjective satisfaction of patients with the results of the operation.Material and methods. The study included 165 patients (186 eyes) who received cataract phacoemulsification surgery with IOL implantation (n = 170) or refractive lensectomy with IOL implantation (n = 16). The average age of the subjects was 70.23 ± 10.14 years. The group included patients without concomitant systemic or ophthalmic pathology, without previous surgical interventions in the eye for any purpose. At least 1 month after the operation, patients filled out a questionnaire in order to find out the subjective satisfaction with the treatment (scale from 0 to 4 points). The results of the questionnaire were compared with postoperative BCVA, and increased vision (postoperative BCVA — preoperative BCVA). Preoperative BCVA — Me 0.4 (Q1–Q3: 0.1–0.68), postoperative BCVA — Me 1.0 (Q1–Q3: 0.95–1.0), increased vision — Me 0.6 (Q1–Q3: 0.3–0.9) according to Snellen’s table.Results. Visual acuity in satisfaction subgroups: 0 points — Me 1.0 (Q1–Q3: 0.9–1.0) / n = 5 (2.7 %); 1 point — 1 case, postoperative BCVA 1.16 (0.5 %); 2 points — Me 0.95 (Q1–Q3: 0.84–1.0) / n = 14 (7.5 %); 3 points — Me 1.0 (Q1–Q3: 0.9–1.16) / n = 57 (30.6 %); 4 points — Me 1.0 (Q1–Q3: 0.96–1.0) / n = 109 (58.6 %). Postoperative BCVA and increased in visual acuity do not have statistically significant differences depending on satisfaction with treatment (p > 0.05). The correlation between postoperative BCVA and satisfaction is not statistically significant (p = 0.65; rxy = 0.136), as well as between vision improvement and satisfaction (p = 0.55; rxy = 0.141).Conclusion. There was a lack of a statistically significant relationship between postoperative BCVA and improved vision with subjective patient satisfaction with treatment. Identification of factors affecting subjective assessment requires a deeper analysis. Practicing ophthalmologists should remember the importance of the dialogue between the doctor and the patient at the preoperative stage, informing the patient about the expected results of the operation and the possible course after the operation period.

Speech perception and hearing effort using a new active middle ear implant audio processor

Purpose The Vibrant Soundbridge (VSB) was introduced in 1996, and the fourth generation of the audio processor recently released. This clinical study evaluates the audiological performance and subjective satisfaction of the new SAMBA 2 audio processor compared to its predecessor, SAMBA. Method Fifteen VSB users tested both audio processors for approximately 3 weeks. Air conduction and bone conduction thresholds and unaided and aided sound field thresholds were measured with both devices. Speech performance in quiet (Freiburg monosyllables) and noise (OLSA) was evaluated as well as subjective listening effort (ACALES) and questionnaire outcomes (SSQ12 and APSQ). In addition, data from 16 subjects with normal hearing were gathered on sound field tests and ACALES. Results Both audio processors showed substantial improvement compared to the unaided condition. The SAMBA and SAMBA 2 had comparable performance in sound filed thresholds, while the SAMBA 2 was significantly better in speech in quiet, speech in noise, reduced listening effort, and improved subjective satisfaction compared with the SAMBA. Conclusion The SAMBA 2 audio processor, compared to its predecessor SAMBA, offers improved performance throughout the parameters investigated in this study. Patients with a VSB implant would benefit from an upgrade to SAMBA 2.

Average 4-Year Outcomes of Distal Oblique First Metatarsal Osteotomy for Stage 1 to 3 Hallux Rigidus

Background: Hallux rigidus is the second most frequent pathology of the first ray. Surgical options for degenerative metatarsophalangeal joint disease are either joint destructive or conservative procedures. The hypothesis was that oblique distal shortening osteotomy of the first metatarsal is an effective conservative technique for the management of stage 1 to 3 hallux rigidus. Methods: We conducted a retrospective cohort study of 87 feet with Coughlin and Shurnas’s stage 1-3 hallux rigidus, operated between 2009 and 2019. The cohort consisted in 72 patients (87 feet) with an average age of 57±9 (30/79) years; 22 of 87 (25.3%) feet had the first metatarsal surgery performed in isolation; 65 of 87 (74.7%) had concomitant forefoot procedures, including 31 of 87 (35.6%) with Akin phalangeal osteotomies and 34 of 87 (39.1%) with Moberg phalangeal osteotomies. We evaluated the American Orthopaedic Foot & Ankle Society (AOFAS) Scale, subjective satisfaction, joint amplitudes, shortening rate, and occurrence of postoperative complications with a mean follow-up of 51 months (16/134). Results: The AOFAS score increased from 54.2±11.3 (25/70) preoperatively to 92.2±7.8 (62/100) postoperatively ( P < .001). Patients reported excellent or good outcome in 95.4% of cases. The 40-point self-reported pain subscale score improved from 19.6 (± 10.0) to 37.4 (± 5.4), P < .001. The overall range of motion increased from 61±21 (20/110) degrees to 69±17 (35/120) degrees ( P < .001). The mean first metatarsal shortening rate (SRpo) was 9.6%. Neither the Coughlin grade, the metatarsal index, or the SRpo influenced the AOFAS score. At 6-month follow-up, 15 patients had transfer metatarsalgia compared with 5 at last follow-up without requiring another surgical procedure. The risk was not significantly different according to Coughlin's stage, preoperative metatarsal index, or SRpo. Conclusion: Oblique distal osteotomy of the first metatarsal for stage 1-3 hallux rigidus, often in combination with other first ray procedures, performed well during our follow-up time period, with a high subjective satisfaction rate and few complications. Level of Evidence: Level III, retrospective cohort study.

Horizontal dorsal resection of a crooked septum in septoplasty

Objective: There are several types of septal deviation, including horizontal, vertical, C-shaped, S-shaped, and high deviation. One of the most difficult of these types to correct is the crooked dorsal septum, which attaches to the upper lateral cartilage and causes a high septal deviation. We propose a method for horizontal dorsal resection of a crooked septum using a mucosal through-and-through suture technique for the correction of high septal deviation. Design and setting: The medical records of 30 patients (27 men) who underwent septoplasty by one author of this study from 2019 to 2020 at our institute were reviewed prospectively. The median follow-up was 11 months (range, 4–16 months). All patients underwent a horizontal dorsal septal cartilaginous resection with mucosal through-and-through suture. Data were collected on demographics, symptoms, anatomic site of deviation, and postoperative complications. Patient self-satisfaction scores were subjectively graded using a visual analog scale ranging from 0 (excellent) to 10 (poor). Results: One surgeon performed each septoplasty using the same method; 2 (6.7%) patients underwent additional valvuloplasty. The median scores in subjective satisfaction for the 30 patients were 8.4±1.22 before surgery and 2.07±1.26 after surgery (p<0.05). Furthermore, no patient experienced a saddle deformity, septal hematoma, septal perforation, or loss of nasal tip support during follow-up. Conclusions: After horizontal dorsal resection from the upper lateral cartilage during septoplasty, the patients experienced no stability problems. This suggests that this surgical technique is a safe and effective method for correcting high deviation due to a crooked dorsal septum.

Surgery of congenital breast asymmetry—which objective parameter influences the subjective satisfaction with long-term results

Purpose Congenital breast asymmetry is a serious gynecological malformation for affected patients. The condition hits young women in puberty and is associated with socio-esthetic handicap, depression, and psychosexual problems. Surgical treatment is usually early in the patient's lifetime, so a long-term sustainable solution is important. Although postoperative outcome has been evaluated in several studies before, this study is the first to analyze which objective parameters have the greatest influence on subjective satisfaction with long-term results. Methods Thirty-four patients diagnosed with congenital breast asymmetry that underwent either lipofilling or implant therapy between the years of 2008 to 2019 were examined. On average, our collective comprised patients seven years after surgery. Data were mainly gathered through manual measurements, patient-reported outcome measures (Breast Q™), and breast volumetry based on 3D scans (Vectra® H2, Canfield Scientific). Results Among all analyzed parameters, only areolar diameter correlated significantly negatively with the subjective outcome satisfaction of the patient. Regarding the subjective assessment of postoperative satisfaction with similarity of the breasts, again the mean areolar diameter, but also the difference in areolar diameter and breast volume between the right and left breasts correlated significantly negatively. Conclusion Areolar diameter was revealed as being a significant factor influencing subjective long-term satisfaction in breast asymmetry patients. Moreover, 3D volumetry proves to be an effective tool to substantiate subjective patient assessments. Our findings may lead to further improvements to surgical planning and will be expanded in further studies.

Short-Term Outcomes after High Tibial Osteotomy Aimed at Neutral Alignment Combined with Arthroscopic Centralization of Medial Meniscus in Osteoarthritis Patients

The study aimed to improve the long-term outcomes of open-wedge high tibial osteotomy (OWHTO); procedures combining OWHTO aimed at neutral alignment and arthroscopic centralization for meniscal extrusion have been introduced. The present study evaluated short-term patient-reported outcome measures; namely, the patient subjective satisfaction scores and Numeric Rating Scale (NRS) for walking pain after OWHTO aimed at neutral alignment with and without arthroscopic centralization for an extruded medial meniscus. A retrospective review of 50 primary OWHTO patients was conducted. Thirty-nine patients were included in the analysis after applying the exclusion criteria. The centralization group included 21 patients with knee osteoarthritis patients who underwent the OWHTO with arthroscopic meniscal centralization, while the control group included 18 patients who underwent OWHTO alone. The patient subjective satisfaction scores and NRS for walking pain were recorded at outpatient visits from before surgery to 3 years after surgery. In terms of the Lysholm knee scale, International Knee Documentation Committee subjective score, and Knee Osteoarthritis Outcome Score, the latest data (at least 2 years after surgery) were reviewed. Radiographic changes in joint space width and joint line congruence angle were measured 2 years postoperatively. Patient demographic data were also reviewed. One patient in the centralization group experienced a superficial surgical site infection. The patient subjective satisfaction and NRS scores for walking pain gradually improved by 1 year after surgery and were sustained until 3 years after surgery in both groups, with no significant difference between the groups. The course of patient-reported outcome measures from before surgery to 3 years after surgery for solely OWHTO aimed at neutral alignment and OWHTO aimed at neutral alignment with arthroscopic centralization showed the similar trends.

Early Weightbearing Versus Nonweightbearing After Operative Treatment of an Ankle Fracture: A Multicenter, Noninferiority, Randomized Controlled Trial

Background: Acute ankle fractures can occur during sports activities, and unstable ankle fractures are commonly treated operatively. However, controversy exists about the optimal time to allow weightbearing. Hypothesis: Early weightbearing after the stable fixation of an ankle fracture is not inferior to nonweightbearing in terms of ankle function assessed at 12 months after injury. Study design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 258 patients were assessed for eligibility. Of these patients, 194 were randomly allocated to either the early weightbearing group (95 patients who were allowed weightbearing at 2 weeks postoperatively) or the nonweightbearing group (99 patients who were not allowed weightbearing until 6 weeks postoperatively). The primary outcome measure was the mean difference in the Olerud-Molander ankle score (OMAS) between the groups, assessed at the 12-month follow-up examination. The secondary outcome measures were the time to return to preinjury activities and patients’ subjective satisfaction. Complications such as hardware loosening or failure, fracture displacement, and nonunion were evaluated. Results: The mean difference in the OMAS for the early weightbearing group compared with the nonweightbearing group was 1.6 (95% CI, –1.9 to 5.0) in the intention-to-treat analysis. The lower limit of the 95% CI (–1.9) exceeded the noninferiority margin of –8, indicating that early weightbearing was not inferior to nonweightbearing. The difference in the proportion of patients who were satisfied or very satisfied with their treatment was not statistically significant (84.3% vs 76.2%; P = .19); however, the time taken to return to preinjury activities was shorter with early weightbearing than with nonweightbearing (9.1 ± 3.0 vs 11.0 ± 3.0 weeks; P < .001). No cases of nonunion were observed in either group. Conclusion: Early weightbearing after the operative treatment of an unstable ankle fracture was not inferior to nonweightbearing in terms of OMAS assessed at 12 months after injury. The patients’ subjective satisfaction was similar between the groups, although the time taken to return to preinjury activities was shorter in the early weightbearing group. Registration: NCT02029170 (ClinicalTrials.gov identifier).