Long-Term Mental Health after High-Density Polyethylene-Based Porous Orbital Implant in Enucleated and Eviscerated Patients

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is a written prospective study that focuses on the mental health of patients who have focused on both self esteem and anxiety and depression through two questionnaires.  They were administered at baseline and 3 or 4 times post treatment.   The study adequately demonstrates that placing an orbital prosthesis will either maintain or improve to mental health in these select group of patients.   The also supports what is in the literature.   It is on a smaller scale than some cited references and perhaps the numbrs could be expanded in a follow up study.

Author Response

Response to reviewers is uploaded as a PDF document.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The research addresses an important and underexplored aspect of patient care in ophthalmology, particularly the long-term mental health outcomes following orbital implant procedures. I commend you for the comprehensive approach and the significant contributions this study can make to the field. However, there are a few areas where the manuscript could benefit from revisions to enhance its clarity, rigor, and overall impact.
While the introduction provides a solid overview of the topic, it would be beneficial to further contextualize the importance of mental health outcomes in ophthalmologic surgery. Expanding on why mental health is a critical factor in the overall quality of life for these patients could strengthen the rationale for the study.

Consider highlighting specific gaps in the existing literature that your study aims to address. This will help to clearly define the unique contribution of your research. The criteria for participant selection, particularly how patients were chosen for the enucleation or evisceration procedures, need to be detailed further. Clarifying this process will enhance the transparency of your study and help readers understand the applicability of the findings.

Although you mention the use of validated questionnaires (SF-12, Rosemberg Self-Esteem Scale, PHQ-4), providing a brief explanation of their relevance and previous validation in similar studies could be beneficial. Additionally, discussing any potential limitations of these tools in the specific context of your study would add depth to your methodological approach.

The results section would benefit from a more detailed presentation of the data. Consider including additional tables or figures that break down the results by demographic variables, such as age, gender, or type of surgery. This could offer more nuanced insights into the mental health outcomes of different patient subgroups.

While the findings are promising, a more thorough discussion of the statistical methods used, particularly in handling potential confounders, would strengthen the credibility of the results. It may also be useful to discuss the power of the study and any limitations related to sample size.
The discussion would benefit from a deeper exploration of the implications of your findings. For instance, how do these results compare with the outcomes of other types of implants, or with patients who did not receive implants? Discussing these comparisons could provide a broader perspective on the significance of your work. Emphasizing the clinical relevance of your findings and how they can be integrated into current practice would enhance the impact of your study. Suggestions for how practitioners might use this information in decision-making processes for ocular surgery would be particularly useful.

The conclusion could be strengthened by clearly summarizing the key findings and their implications for future research and clinical practice. Reiterating the importance of addressing mental health in patients undergoing enucleation or evisceration can reinforce the study’s value.

There are a few minor grammatical and syntactical errors throughout the manuscript. A thorough proofread is recommended to ensure clarity and professionalism.

Ensure that all references are up-to-date and formatted according to the journal's guidelines. It may also be helpful to include recent studies that align with your findings or methodology.

Overall, this is a well-conceived and executed study that addresses an important issue in ophthalmologic surgery. With these revisions, the manuscript will be even more robust and impactful. I look forward to seeing the revised version.

Author Response

Response to reviewers is uploaded as a PDF document.

Author Response File: Author Response.pdf