Longitudinal Changes in Self-Esteem and Evaluation of Patient Satisfaction After Keratopigmentation for Unilateral...

Purpose The primary objective of this study was to evaluate longitudinal changes in self-esteem over six months following keratopigmentation (KTP) in adults with unilateral corneal opacity and poor visual prognosis. The secondary objectives were to compare baseline self-esteem between the KTP cohort and an age- and sex-matched control group with non-disfiguring visual impairment and to examine the association between baseline self-esteem and postoperative patient satisfaction domain scores. Methods This prospective study included 42 adults with unilateral corneal opacity that had remained stable for at least six months and had no potential for visual recovery. The Rosenberg Self-Esteem Scale (RSES) was administered preoperatively and at one, three, and six months postoperatively, whereas the Patient Satisfaction Questionnaire-18 (PSQ-18) was administered only at the one-month postoperative visit. An age- and sex-matched control group with visual impairment but no visible ocular disfigurement was included for comparison of baseline self-esteem. Longitudinal changes in RSES scores were analyzed using the Friedman test, followed by Wilcoxon signed-rank tests for pairwise comparisons. Baseline RSES scores and postoperative PSQ-18 domain scores were compared using the Mann-Whitney U test. For the PSQ-18 analysis, participants were categorized as having low (≤15) or normal/high (>15) baseline self-esteem. Results RSES scores differed significantly across the four assessment points (χ²(3) = 94.39, p < 0.001) and were higher at one, three, and six months than at baseline. Baseline RSES scores were lower in the KTP cohort than in controls (10 (IQR, 9-13) vs. 20 (IQR, 18-22); p < 0.001). At one month, participants with normal/high baseline self-esteem reported higher PSQ-18 technical quality scores (Bonferroni-adjusted p = 0.020); no significant differences were observed in the other domains. No intraoperative or postoperative adverse events were observed. Conclusion KTP was associated with improved self-esteem over six months in this cohort. However, without a longitudinal untreated control group, the improvement cannot be attributed exclusively to KTP.