This investigation reported the psychological impact of FCVB implantation in patients with impending eye atrophy caused by ocular trauma and recurrent retinal detachment. The HADS and interpersonal sensitivity of the SCL-90 were used to assess and follow-up the patient's psychological status and to prove that the FCVB implantation operation was conducive to the improvement of patients' mental health.
Ocular trauma and severe retinal detachment are usually acute conditions for which surgery cannot prevent severe and permanent visual loss. FCVB implantation was used to prevent atrophic bulbi and impending eye atrophy. Before FCVB implantation, nearly half of the patients with ocular trauma and recurrent retinal detachment experienced probable levels of depression (44.23%) and anxiety (48.08%). Some experienced interpersonal sensitivity (19.23%) prior to FCVB implantation, less than the ratio of anxiety or depression. After FCVB implantation, 17.31% were depressed, 15.38% were anxious, and 9.62% were sensitive to interpersonal relationships. Compared with levels before FCVB implantation, all scores after FCVB implantation were significantly reduced. This is the first study to show that FCVB could recover patients' depression, anxiety, and interpersonal sensitivity, and to demonstrate that patients’ worsened psychological symptoms were consistently associated with ocular trauma and severe retinal detachment.
Severe retinal detachment and accidental ocular trauma causes visual impairment and inconveniences to life and social activities, resulting in a a negative impact on the quality of life, social interaction, and psychological function. Most patients said they preferred to stay at home rather than go out. In addition, all patients had undergone several previous surgeries such as vitreoretinal surgery or silicone oil filling before FCVB implantation, which also had a certain psychological impact, especially after discovering that these operations could not improve their vision and even aggravated their pain. Among all possible negative emotions, we used depression, anxiety, and interpersonal sensitivity as representative measures, since they directly or indirectly affect treatment and recovery.
Although vision could not be repaired after FCVB implantation, the patients’ long-term discomfort was reduced and their appearance was improved, making it easier for patients to adapt to life after visual impairment. A study showed that 6 months after surgery, the eyes kept symmetrical and normal, thereby reducing their depression, anxiety, and interpersonal sensitivity, all conducive to their psychological improvement. The decrease in scores proved that FCVB implantation was beneficial to patients’ psychological reconstruction.
We also investigated possible demographic influencing factors. Intuitively, factors such as economic status, surgical satisfaction, and postoperative time may influence anxiety, depression, and interpersonal sensitivity levels before and after surgery. However, our study found no significant relation between psychological scores and factors such as age, gender, occupation, finance, pre-FCVB-implantation vision, number of surgeries before FCVB implantation, postoperative period length, and surgical satisfaction (P> 0.05).
In addition, our survey showed that for most patients' families, the cost of FCVB implantation was affordable, because almost all patients had medical insurance or compensation for work-related injuries. The economic pressure was more due to job changes caused by visual disability after onset of the disease, since some patients were unable to work in their previous industry.
Our findings also support previous studies that identified links between severe retinal detachment and mental health and between severe ocular trauma and mental health. Ophthalmic operations and other ophthalmic diseases, such as diabetic retinopathy and age-related macular degeneration, have also been proven to damage patients’ mental health[26-31][1, 32-34]. Compared with previous studies, the anxiety and depression of patients with traditional retinal detachment surgery (vitrectomy or buckling) were more serious after surgery, whereas FCVB improved patient psychology.
We believe that doctors should pay more attention to patients’ mental health. The median age of our sample was 41-50 years, and male patients were more common. Since the vast majority of participants (90.38%) were < 60 years old, probably economically active, and the main source of family income, FCVB contributed to their psychological wellbeing, which would have a positive effect on the whole family or society.
There are some limitations to our research. First, this was a retrospective study. Preoperative psychological scores of patients were biased to a certain extent, which may lead to recall bias. Another major limitation of this study was the relatively small number of patient responses. The inclusion and exclusion criteria of our study were very strict, which limited the sample size. In future studies, we want to collaborate with more hospitals to obtain larger sample sizes. In addition, we lacked a control group of patients with silicone oil tamponade for a long time or patients with artificial eyes. Larger samples and control groups are needed to further study the psychological effects of FCVB implantation.
For patients with impending eye atrophy unable to improve their vision, the improvement of their mental health is worthy of attention since it helps patients partially restore their daily lives and social functions and improve their quality of life. Further research should evaluate various psychosocial aspects of patients with FCVB implantation to provide patients with suitable therapeutic interventions.