Vitreoretinal surgery outcomes: results of a patient satisfaction/functional status survey.

OBJECTIVE: This study aimed to assess patient satisfaction and change in functional status after surgery for epiretinal membrane (ERM), rhegmatogenous retinal detachment (RRD), and complex retinal detachment (CRD). This study also aimed to determine whether objective measures of vision are predictive of subjective improvement after surgery. DESIGN: The study design included patient interviews and retrospective chart review. PARTICIPANTS: Participants were those patients who underwent surgery for ERM, RRD, or CRD by one surgeon at the Bascom Palmer Eye Institute between January 1, 1993, and December 31, 1994. INTERVENTION: Patient satisfaction and patients' perceptions of the impact of surgery on their functional status were assessed by telephone interviews conducted by one interviewer at least 6 months after surgery. MAIN OUTCOME MEASURES: Responses to patient satisfaction survey and subjective change in patients' functional status were measured. RESULTS: Of 187 eligible patients, 146 (78.1%) could be contacted and all agreed to participate. Ninety patients (61.6%) reported improved functioning after surgery in 2 or more of the 5 activities investigated. Twenty-one patients (14.4%) reported worse postoperative vision than expected, but only 5 patients (3.4%) thought surgery had not been worthwhile. One hundred forty-three patients (97.9%) reported adequate explanation of surgery and its expected results. Patients with preoperative study eye visual acuity between 20/40 and 20/200 were most likely to improve in two or more activities. Lower preoperative worse eye vision and better final study eye vision were associated with a greater likelihood of satisfaction after surgery. Diagnostic category was not predictive of change in functional status or patient satisfaction. CONCLUSIONS: There is a high rate of patient satisfaction and improved functional status after surgery for ERM, RRD, and CRD, even among patients with good fellow eye vision.

Vitreoretinal surgery outcomes. Impact on bilateral visual function.

PURPOSE: The authors evaluated the impact of vitreoretinal surgery for epiretinal membrane (ERM), rhegmatogenous retinal detachment (RRD), and complex retinal detachment (CRD) on bilateral visual function. METHODS: Anatomic and visual acuity outcomes were reviewed by the authors for all patients who underwent surgery for ERM, RRD, or CRD during a 2-year period. Several outcome measures of bilateral visual function were applied to quantitate the impact of surgery on bilateral visual function. Data were also analyzed by subdividing patients into two cohorts based on whether vision in the fellow eye was normal (visual acuity > or = 20/40) or abnormal (visual acuity < or = 20/50) at baseline. RESULTS: Anatomic and visual acuity outcomes of 187 study eyes were similar to previous studies. Postoperatively, the study eye was the eye with better vision in 30.9%, 26.8%, and 16.7% of patients with ERM, RRD, and CRD, respectively. The mean bilateral visual impairment according to American Medical Association Guidelines for Disability decreased postoperatively by 8.7% points, 6.8% points, and 3.6% points, respectively, and decreased most when vision in the fellow eye was abnormal. A higher bilateral visual system functional level resulted postoperatively in 10.7% of all patients, including 28.6% of patients with abnormal vision in the fellow eye (by definition, the visual system functional level of patients with normal vision in the fellow eye could not be improved). CONCLUSIONS: Surgery was associated with a reduction in bilateral visual disability among patients with ERM, RRD, and CRD, and 28.6% of patients with abnormal vision in the fellow eye achieved a higher bilateral visual functional level.

[Sodium benzoate in portal-systemic-encephalopathy-induced blood ammonia normalization and clinical improvement. Interim report of a double-blind multicenter trial]. / Derivación metabólica del amonio plasmático con benzoato de sodio, como método de tratamiento en pacientes con cirrosis y encefalopatía portosistémica. Informe interino de un estudio multicéntrico, doble ciego.

To investigate the therapeutic efficacy of sodium benzoate (SB) in a cirrotic population with chronic portal systemic encepalopathy (PSE), we performed a double blind, randomised, multicentric, clinical trial, comparing SB versus a standard therapy of lactitol (LA). To perform the study blind, syrups containing the two drugs were prepared. To date 27 patients have been studied. Of these, 12 received SB (5.6 g/day) and 15 received LA (29 g/day). Standard PSE parameters were assessed and hippurate urinary excretion was measured before and after the trial. For the SB group, basal and final PSE index were 0.39 +/- 0.16 and 0.17 +/- 0.1 respectively (p < 0.001). The Group on LA had a PSE index of 0.40 + 0.1 and 0.23 +/- 0.18 (basal and final respectively) (p < 0.001). The final hippurate excretion for SB group was 2498.9 mg/24 h. The hippurate excretion for the LA group suffer no changes (traces). No serious side effects were observed with either therapy. We suggested that SB is a safe, efficacious and comfortable alternate treatment for PSE.