Relationship between the phenylephrine test and eyelid droop after aponeurotic repair with the use of an epinephrine-containing local anaesthetic

Abstract

PurposeTo analyse the relationship between the results of the phenylephrine test and postoperative eyelid droop in transcutaneous aponeurotic repair using epinephrine-containing local anaesthetic for aponeurotic blepharoptosis.Patients and methodsWe retrospectively reviewed the medical records of 66 eyelids from 40 patients who underwent transcutaneous aponeurotic repair. A positive phenylephrine test result was defined as an increase in margin reflex distance-1 (MRD-1) ≥0.5 mm after application of phenylephrine eye drops. The patients were divided into a positive phenylephrine response group (Group A, 16 patients) and a negative phenylephrine response group (Group B, 24 patients). The ΔMRD-1 was calculated by subtracting the 3-month postoperative value from the intraoperative value. Patient age, sex, pre- and intraoperative MRD-1s, levator function, and phenylephrine response were investigated as factors potentially influencing the ΔMRD-1. The relationship between these factors and ΔMRD-1 was analysed using single and multiple regression analysis.ResultsThe ΔMRD-1 in Group A (0.68±0.52 mm) was significantly greater than that in Group B (0.17±0.56 mm; P=0.004). A moderate correlation was found between phenylephrine response and ΔMRD-1 in the total patient group (Y=0.441 X+0.358; r=0.462; r=0.213; P=0.002).ConclusionsAlthough the ΔMRD-1 in Group B was quite small, the ΔMRD-1 in Group A was considerable, and there was a moderate positive correlation between phenylephrine response and the ΔMRD-1 overall. This indicates that the degree of postoperative eyelid droop can be estimated by the phenylephrine test results in transcutaneous aponeurotic repair.

Influence of fatty deposits in the levator aponeurosis/levator palpebrae superioris muscle on outcomes of aponeurotic repair in a Japanese population

“…We previously showed the occurrence of postoperative upper eyelid droop in patients with greater changes in the MRD-1 during the phenylephrine test [9]. This result was similar to that of the present study, showing that the degree of response to phenylephrine eye drops significantly influenced surgical success.…”

“…MRD-1 was measured before and 3 months after surgery. A 5% phenylephrine test was performed preoperatively on the surgical side [9]. Any changes in MRD-1 were recorded 20 min after application of the phenylephrine eye drops.…”

Assessing the Clinical Requirement of 2.5% Phenylephrine for Diagnostic Pupil Examination

“…There may be a ''washout'' effect from administering multiple drops in the triple regimen group, which could decrease the mydriatic power of each agent. 23 Our priority was to evaluate efficacy under typical clinical conditions to determine the utility of the third agent in a clinical setting. This includes the use of proparacaine which has been shown to enhance the rate and magnitude of pupillary dilation if instilled before mydriatic agents.…”

How far we have come: A review of the evolution of posterior approach ptosis surgery

“…The average time to lid elevation was 9 minutes, but some patients took up to 30 minutes to respond. Preoperative phenylephrine testing has been shown to correlate with higher MRD1 change after anterior approach ptosis repair …”

“…Preoperative phenylephrine testing has been shown to correlate with higher MRD1 change after anterior approach ptosis repair. 50 In the United Kingdom, 77% of surgeons use phenylephrine testing to demonstrate an idea of surgical outcome to the patient, whereas 62% use it to detect subclinical contralateral ptosis. 51 About 65% of surgeons used phenylephrine testing to determine their surgical approach, utilizing a posterior approach for >2 mm lid elevation with phenylephrine testing and an anterior approach for <2 mm lid elevation.…”