Eyelid Malposition After Cataract and Refractive Surgery

Ahuero, Audrey E.; Hatton, Mark P.

doi:10.1097/iio.0b013e3181c55150

Cited by 16 publications

(9 citation statements)

References 47 publications

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“…However, manipulation of the upper eyelid when placing postoperative eyedrops may also contribute to the development of ptosis, as when the upper eyelid is stretched when placing a contact lens. 10 A majority of the eyelids (92%) had ptosis with good or excellent levator excursion. There was no statistically significant difference between the degree of levator function compared to the amount of response to phenylephrine.…”

Section: Discussionmentioning

confidence: 96%

Response to phenylephrine testing in upper eyelids with ptosis

Lee

Lin²,

Mehta

et al. 2015

Digit J Ophthalmol

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A majority of ptotic eyelids, regardless of levator function, responded to topical phenylephrine, which has been demonstrated to be necessary for successful Müller's muscle resection ptosis repair. While the severity of ptosis was linked to eyelid response to phenylephrine, the degree of levator function did not appear to affect an eyelid's response to phenylephrine. In this study cohort, phenylephrine was shown to stimulate Müller's muscle contraction independently of levator function.

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Section: Discussionmentioning

confidence: 96%

Response to phenylephrine testing in upper eyelids with ptosis

Lee

Lin²,

Mehta

et al. 2015

Digit J Ophthalmol

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“…These include: advanced age, excessive traction on the eyelids by the eyelid speculum during surgery, retrobulbar or peribulbar local anesthesia injections, prolonged postoperative patching and postoperative lid edema. [ 18,19 ] Smith and colleagues revealed that oculoplastic procedures, including entropion, ectropion and ptosis repair, have significant patient-reported quality of life improvements. This may justify the cost-effectiveness of oculoplastic intervention even in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Oculoplastic Surgeries in Patients Older than 90 Years of Age

Abumanhal

Feldman

Leibovitch

et al. 2022

European Journal of Ophthalmology

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Purpose To report the epidemiology, indications and surgical outcomes of oculoplastic surgeries in older adults (≥ 90 years old). Methods A retrospective study was conducted reviewing the medical charts of 114 patients aged 90 years old and older who underwent oculoplastic procedures from 2010 to 2020. Data retrieved from the medical records included: past medical and ocular history, indication for surgery, type of surgery, intra and post-operative complications, pathological analysis for removed tissues, and surgical outcome in the last follow-up. Results One hundred and twenty eight surgeries were performed on 114 patients (male: female = 1:1). The mean age was 92.95 years old (± 3.12 SD). Six patients (5.2%) were older than 100 years old. The most common indication for surgery was lower lid malpositioning (32%). Mass/lesion excision was performed in 34 procedures (25%). Forty-three biopsies were analyzed and basal cell carcinoma was found to be the most common pathological diagnosis (32%). Hypertension was the most common associated systemic comorbidity (79 patients, 69%). 80% of the surgeries were performed under local anesthesia. Surgical revision was required in seven patients (5.2%). One patient had suffered from a minor stroke one day after the surgical pocedure. The same patient had orbital-skin fistulas after orbital exenteration Conclusion In our experience, oculoplastic surgeries among the elderly population are safe without significant complications and can usually be performed under local anesthesia. Advanced age should not prevent surgery, especially if the procedure may improve vision and quality of life.

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“…The risk of ptosis after any anterior segment surgery increases for many reasons, including older age, race, gender, operative time, type of anesthesia, eyelid edema, orbital inflammation, frequent use of topical steroid eye drops, anesthesia type (i.e., retrobulbar vs. topical), use of a lid speculum, use of a superior rectus bridle suture, and type of surgery. 7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]38 Recent studies have shown less surgery-related ptosis, which likely reflects the use of more modern surgical techniques. 9,10 Consistent with previous studies, 9,10 a total 7 eyelids of 7 patients underwent PK in our study, but none of the patients underwent endothelial keratoplasty (EK).…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Most of the previous studies have reported eyelid ptosis following anterior segment surgery, and especially after cataract and glaucoma surgery. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] However, a few reports have appeared regarding ptosis correction surgeries in patients after keratoplasty. 6,7 For example, Michel et al 6 reported the use of Müller muscle-conjunctival resection (MMCR) without tarsectomy to treat ptosis in patients with a prior history of corneal surgery; however, they did not investigate the use of a bandage contact lens (BCL) after MMCR to protect the corneal grafts.…”

Section: Introductionmentioning

confidence: 99%

Müller Muscle-conjunctival Resection with or without Tarsectomy and Combined with Bandage Contact Lens Use in Ptosis Patients with Corneal Graft

Mangan

Ocak

Vural

et al. 2021

Korean J Ophthalmol

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Purpose To examine the efficacy of ptosis correction with a Müller muscle-conjunctival resection with or without tarsectomy (MMCR±T), combined with bandage contact lens (BCL) use, in corneal graft patients. Methods Seven patients with corneal grafts who underwent MMCR±T for treatment of ptosis were evaluated retrospectively. A BCL was applied to the grafts at the end of the surgery. The collected data included preoperative and postoperative visual acuity, marginal reflex distance 1 (MRD-1), presence of Hering’s dependency by the phenylephrine test, symmetry outcomes, and complications after MMCR±T. Results The average duration between the penetrating keratoplasty and MMCR±T was 14 months, with a follow-up time of 10.4 months after MMCR±T. Hering’s dependency was observed in four (57.2%) patients before MMCR±T, and MRD-1 was increased in all patients based on preoperative phenylephrine tests. The mean preoperative MRD-1 was −0.14 ± 0.55 mm, and the mean postoperative MRD-1 was 2.35 ± 0.89 mm ( p < 0.0001). Symmetry outcomes of perfect (<0.5 mm), good (0.5–1 mm), and fair (≥1 mm) were noted after MMCR±T in three, three, and one patients, respectively. During the follow-up, no obvious corneal epitheliopathy, keratitis, or corneal graft rejection/failure were noted in any cases. BCL use was well tolerated by all patients. Conclusions Most patients achieved good surgical outcomes with the application of the BCL to protect the graft and with the use of the phenylephrine test and Hering’s dependency to predict the final eyelid position and symmetry. MMCR±T combined with BCL may therefore represent an alternative approach for correction of ptosis in patients with corneal graft.

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Eyelid Malposition After Cataract and Refractive Surgery

Cited by 16 publications

References 47 publications

Response to phenylephrine testing in upper eyelids with ptosis

Response to phenylephrine testing in upper eyelids with ptosis

Oculoplastic Surgeries in Patients Older than 90 Years of Age

Müller Muscle-conjunctival Resection with or without Tarsectomy and Combined with Bandage Contact Lens Use in Ptosis Patients with Corneal Graft

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