Postoperative Blepharoptosis after Trabeculectomy Versus Ahmed Glaucoma Valve Implantation

Abstract

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.

Incidence of Blepharoptosis After Pars Plana Baerveldt 350 Glaucoma Implant Surgery by a Single Surgeon

“…The risk of blepharoptosis after filtration surgery has been reported to be 8% to 19%. [10][11][12][13][14] Chronic inflammation of the conjunctiva after filtration surgery, mitomycin C, needling, and ocular massage have been associated with a high risk of ptosis. [11][12][13] As many patients have a history of filtration surgery, notable caution is required about the occurrence of blepharoptosis after pars plana BGI.…”

“…The incidence of blepharoptosis has been reported to be 8% to 19% with glaucoma filtration surgery. [10][11][12][13][14] In addition, recent reports indicate that blepharoptosis develops in 23% to 32% of cases after the placement of a glaucoma drainage device (GDD), such as Ahmed and Baerveldt. 15,16 However, the risk of blepharoptosis due to GDD placement has not been fully assessed.…”