Change in Lower Eyelid Position After Ptosis Repair in Patients With Unilateral Myogenic Versus Aponeurotic Blepharoptosis

Kashkouli, Mohsen Bahmani; Abdolalizadeh, Parya; Hadi, Yasaman; Amirsardari, Anahita; Jafari, Saeed; Karimi, Nasser

doi:10.1097/iop.0000000000001287

Cited by 15 publications

(23 citation statements)

References 6 publications

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“…The ΔMRD1 and ΔMRD2 values were poorly correlated in all measurement times. In accordance with our results, Kaskouli et al [29] reported that more severe…”

Section: Phenylephrine Test In Ptosissupporting

confidence: 94%

“…9, Sep.18, 2022 www.ijo.cn Tel: 8629-82245172 8629-82210956 Email: ijopress@163.com myogenic ptosis was significantly associated with more severe preoperative scleral show. Preoperative MRD2 was the only factor predicting postoperative improvement of scleral show in myogenic ptosis [29] . The main limitation of the present study is its retrospective design.…”

Section: Phenylephrine Test In Ptosismentioning

confidence: 93%

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Clinical value of phenylephrine testing in the upper and lower eyelids of patients with aponeurotic and congenital eyelid ptosis

Totuk¹,

Kanra²,

Aykan³

2022

Int J Ophthalmol

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AIM: To characterize the phenylephrine test in aponeurotic and congenital eyelid ptosis, to determine the appropriate timing of the phenylephrine test, and to assess the responses of the upper and lower eyelids. METHODS: This was a retrospective analysis of 140 eyes of 87 patients (mean age 52.29±16.45y; 22 males, 65 females) with upper eyelid ptosis. Totally 88.6% had aponeurotic and 11.4% had congenital ptosis. For the evaluation of the responses of the upper and lower eyelids to topical 2.5% phenylephrine, the scleral show height, the marginal reflex distance (MRD) between the inferior margin of the upper eyelid and pupillary light reflex (MRD1), and between the central portion of the lower eyelid and pupillary light reflex (MRD2) were measured at the 2nd, 5th, and 15th minutes. The changes of MRD1 and MRD2 with time (ΔMRD1 and ΔMRD2) were evaluated. RESULTS: The mean MRD1, MRD2, and scleral show heights increased within 5min after testing, remaining largely stable between the 5th-15th minutes. The percentage of eyes with a greater response in MRD1 increased with increased severity of ptosis (P<0.05). Eyes with aponeurotic ptosis were more responsive to phenylephrine testing than congenital ptosis. The mild ptosis group had lower scleral show measurements and higher ΔMRD2 values. The ΔMRD1 and ΔMRD2 values were poorly correlated in all measurement times. CONCLUSION: Performing the phenylephrine test 5min after instilling the reagent is adequate to assess the maximum response of the upper and lower eyelids. The upper and lower eyelid responses in phenylephrine testing are poorly correlated. However, the ΔMRD2 is related with baseline scleral show degree that may be a postoperative predictive factor. Further studies are necessary to determine the relationship between the responses of the lower eyelids to phenylephrine testing.

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“…The ΔMRD1 and ΔMRD2 values were poorly correlated in all measurement times. In accordance with our results, Kaskouli et al [29] reported that more severe…”

Section: Phenylephrine Test In Ptosissupporting

confidence: 94%

Section: Phenylephrine Test In Ptosismentioning

confidence: 93%

Clinical value of phenylephrine testing in the upper and lower eyelids of patients with aponeurotic and congenital eyelid ptosis

Totuk¹,

Kanra²,

Aykan³

2022

Int J Ophthalmol

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“… 4 5 6 7 8 9 10 11 12 Since MRD2 increases in some patients with blepharoptosis, an accurate definition of PP should be based on MRD1 rather than palpebral fissure. 13 Furthermore, the objective (eyelid measurement) definition of ptosis is more accurate than the subjective one. Since a substantial proportion of PP tends to resolve within 6 months (transient PP) after the intraocular procedures, 2 real persistent PP should be defined at least 6 months after the surgery.…”

Section: Discussionmentioning

confidence: 99%

“… 4 5 6 8 9 11 Palpebral fissure height was used for the assessment of PP in two studies which is not as accurate as the MRD1 measurement due to the confounding effect of MRD2 on the assessment of blepharoptosis. 5 6 13 Therefore, MRD1 based posttrabeculectomy persistent PP has been reported 13%, 4 17.4%, 8 19%, 9 and 12.5% 11 in the 4 previous studies. Persistent PP has not been reported after the GDD implantation.…”

Section: Introductionmentioning

confidence: 90%

Postoperative blepharoptosis after trabeculectomy versus ahmed glaucoma valve implantation

et al. 2021

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Purpose: To investigate the frequency of persistent postoperative ptosis (PP) following trabeculectomy or Ahmed glaucoma valve (AGV) implantation and to analyze the associated factors. Methods: It is a prospective observational study on glaucoma patients who underwent trabeculectomy or AGV implantation from October 2015 to June 2017 in a tertiary center. Margin reflex distance 1 and 2 (MRD1 and 2) and levator function were measured before and at least 6 months, postoperatively. Clinically significant ptosis was defined as ≥2 mm drop of MRD1. Results: One hundred and fourteen patients (124 eyelids) including 76 patients (87 eyelids) with trabeculectomy and 35 patients (37 eyelids) with AGV implantation were included. The mean age was 55.50 (standard deviation = 17.54) years. Most of the surgeries were performed under general anesthesia (87.9%, 109/124) between 30 and 60 min (53.2%, 66/124) by residents (39.5%, 49/124). Trabeculectomy and AGV groups did not differ in terms of pre, intra, and postoperative variables (0.1≤ P ≤0.9) except duration of surgery ( P = 0.01) and sex ( P = 0.04). Clinically significant persistent PP was observed in 12.9% (16/124) in total, 13.7% (12/87) in the trabeculectomy group, and 10.8% (4/37) in the AGV group ( P = 0.6). Male gender (ß coefficient = 2.56, 95% confidence interval (CI) = 4.76–0.36, P = 0.02) and a higher preoperative MRD1 (ß coefficient = 1.24, 95% CI = 0.52–1.95, P = 0.001) were the only factors affecting the frequency of clinically significant PP. Conclusions: Postoperative blepharoptosis occurred in 12.9% of eyes after glaucoma procedures. Male gender and higher preoperative MRD1 were significantly associated with a higher frequency of postglaucoma surgery blepharoptosis.

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“…Unilateral ptosis was defined as margin-reflex distance (MRD1) [20] being ˃1.5 mm lower than the contralateral eyelid [23]. Prior to ptosis repair, levator function and MRD1 were measured in both eyes of all patients.…”

Section: Patient Evaluationmentioning

confidence: 99%

Cumulative Sum Analysis of the Learning Curve of Ptosis Surgery: External Levator Advancement versus Müller Muscle-conjunctival Resection

Mangan

Çakir

İmamoğlu

2021

Korean J Ophthalmol

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Purpose: Even though it is stated that external levator advancement (ELA) has a much longer learning curve than Müller muscle-conjunctival resection (MMCR) in the treatment of aponeurotic ptosis, there is no study in the literature regarding the learning curves of these two surgical techniques. We aimed to objectively determine the length of the learning curves of ELA and MMCR using cumulative sum (CUSUM) analysis.Methods: The first 30 unilateral ELA and the first 30 unilateral MMCR consecutively performed by a single surgeon were retrospectively reviewed. The CUSUM method was used to analyze the learning curves of ELA and MMCR based on operation times of consecutive surgeries and the clinical outcomes were compared.Results: CUSUM analyses revealed that the operation time stabilized after around 11 ELA surgeries and 12 MMCR surgeries and R2 value for ELA and MMCR were 0.93 and 0.91, respectively. There was no significant difference in these stratified analyses. Mean operation time was 45.7 minutes in the ELA group and 34.1 minutes in the MMCR group (p = 0.002). Total number of intraoperative complications was 37 in the ELA group and 16 in the MMCR group (p = 0.015). Symmetry success rate was significantly higher (p < 0.0001) and reoperation rate was significantly lower in the MMCR group (p = 0.045).Conclusions: Even though ELA is more challenging than MMCR, comparable learning curves indicate that surgeons in training need to be encouraged to perform both techniques. The challenges and obstacles that the surgeons in training face in these two techniques need to be analyzed in detail.

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Change in Lower Eyelid Position After Ptosis Repair in Patients With Unilateral Myogenic Versus Aponeurotic Blepharoptosis

Cited by 15 publications

References 6 publications

Clinical value of phenylephrine testing in the upper and lower eyelids of patients with aponeurotic and congenital eyelid ptosis

Clinical value of phenylephrine testing in the upper and lower eyelids of patients with aponeurotic and congenital eyelid ptosis

Postoperative blepharoptosis after trabeculectomy versus ahmed glaucoma valve implantation

Cumulative Sum Analysis of the Learning Curve of Ptosis Surgery: External Levator Advancement versus Müller Muscle-conjunctival Resection

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