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

Abstract

Purpose: To compare preoperative and postoperative lower eyelid scleral show in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis, analyze the factors correlated with them, and assess the rate of postoperative lower eyelid symmetry in both groups. Methods: Patients (older than 5 years old) with unilateral MP (58) and AP (20) were included from June 2015 to April 2017. Excluded were patients with previous eyelid surgery, strabismus, levator function of ≤3, and associated procedures. Margin reflex distance (MRD) 1 and 2 and levator function were measured by the same observer before and at least 6 months after the ptosis repair. Results: Lower scleral show was observed in 56.8% and 80% of MP and AP, respectively. Margin reflex distance 2 was significantly (r = −0.37, p = 0.002) associated with MRD1 in the MP group (multiple regression analysis). Both groups showed a significant improvement of MRD2, postoperatively resulting in symmetric MRD2 in 91.4% of MP and 80% of AP group. It was not changed in 43% of MP and 25% of AP group. Multiple regression analysis showed that preoperative MRD2 was the only significant factor associated with postoperative improvement of scleral show in the MP group. Conclusions: Lower scleral show was significantly improved after ptosis repair in both MP and AP. The more severe MP was significantly associated with more severe preoperative scleral show. Preoperative MRD2 was the only factor predicting postoperative improvement of scleral show in the MP. No factor was significantly associated with MRD2 in the AP group.

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

“…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…”

“…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.…”

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

“…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.…”

Postoperative Blepharoptosis after Trabeculectomy Versus Ahmed Glaucoma Valve Implantation

“… 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.…”

“… 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.…”