Study to the Effect of Involutional Blepharoptosis Surgery Using Objective and Subjective Parameters

Asamura, Shinichi; Wada, Yoshitaka; Tanaka, Sai-ichi; Saika, Shizuya

doi:10.1055/s-0042-1751101

Cited by 4 publications

(7 citation statements)

References 36 publications

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“…SPK is known to mainly occur below the cornea after BP surgery. Asamura et al 6 reported that postoperative MRD-1 should be less than 3 mm because of the possible appearance of SPK due to BP surgery. In this study, SPK area and density scores were found to increase when the MRD-1 increase was more than 2.5 mm with surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The condition for SPK worsens, resulting in patient complaints. 3 6 20 21 BP surgery in elderly people must therefore be considered to be a very delicate procedure. There have been no previous reports of a scale evaluation method for SPK by surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Blepharoptosis (BP) surgery is commonly performed in both young and elderly patients with the goal of broadening the visual fields. 1 2 3 4 5 6 The majority of BP surgery is performed for dehiscence or stretching of the aponeurosis to the tarsus. It is achieved by nondelivery of contractile power to the upper eyelid, which requires resection of redundant skin and/or shortening of the levator aponeurosis.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Pitfalls of Blepharoptosis Surgery in Elderly People

Shirakawa,

Uemura,

Kumegawa

et al. 2023

Arch Plast Surg

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Background Elderly patients often have complications of blepharoptosis surgery that can result in the appearance or exacerbation of superficial punctate keratopathy (SPK). However, postoperative changes to SPK status have not been previously reported. We used subjective assessment of symptoms and measurement of SPK scale classification to investigate the safety and efficacy of blepharoptosis surgery in elderly patients. Methods Included in this prospective study were 22 patients (44 eyes) with bilateral blepharoptosis that underwent surgery. Patients comprised 8 males and 14 females with a mean (±standard deviation) age of 75.7 ± 8.2 years (range: 61–89). Blepharoptosis surgery consisted of transcutaneous levator advancement and blepharoplasty including resection of soft tissue (skin, subcutaneous tissue, and the orbicularis oculi muscle). Margin reflex distance-1 (MRD-1) measurement, a questionnaire survey of symptoms and SPK scale classification, was administered preoperatively and 3 months postoperatively for evaluation. Results The median MRD-1 was 1 mm preoperatively and 2.5 mm postoperatively, representing a significant postoperative improvement. SPK area and density scores were found to increase when the MRD-1 increase was more than 2.5 mm with surgery. All 10 items on the questionnaire tended have increased scores after surgery, and significant differences were observed in 7 items (poor visibility, ocular fatigue, heavy eyelid, foreign body sensation, difficulty in focusing, headaches, and stiff shoulders). Conclusion Blepharoptosis surgery was found to be a safe and effective way to maintain the increase in MRD-1 within 2.0 mm. Despite the benefits, surgeons must nonetheless be aware that blepharoptosis surgery is a delicate procedure in elderly people.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety and Pitfalls of Blepharoptosis Surgery in Elderly People

Shirakawa,

Uemura,

Kumegawa

et al. 2023

Arch Plast Surg

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“…In another study conducted on patients with symptomatic scores and TBUT values indicating dry eye disease before involutional ptosis surgery, improvement was found in symptom scores and TBUT values at 6 months postoperatively ( 18 ). It could be suggested that the initial dry eye symptom status might influence changes in postoperative dry eye scores, a notion supported by the results of our study.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Blepharoptosis Surgery on Meibomian Gland, Tear Film, and Corneal Topography

Yesilkaya

2023

Beyoglu Eye J

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Objectives: The objective of this study was to evaluate the Meibomian gland (MG), tear film, and corneal changes in the post-operative period following ptosis surgery using corneal topography. Methods: This non-comparative, case series study analyzed 30 eyes of 23 patients undergoing blepharoptosis surgery with an external approach. Ocular surface and tear film evaluation was performed at baseline and post-operative 3rd month. The corneal topography was used to assess the MG, the noninvasive tear film break-up time (NI-TBUT), K values, astigmatism, and corneal aberrations. For the examination of dry eyes, the I-TBUT, Schirmer, and ocular surface disease index (OSDI) questionnaires were also performed. Results: The study involved patients with a mean age of 55.1±18.11 years. Postoperatively, marginal reflex distance 1 is significantly increased (1.23±1.09 vs. 3.65±0.65; p=0.001). Results revealed no significant changes in Kmean (43.65±1.15 vs. 43.67±1.14; p=0.727), astigmatism (−1±0.74 vs. −0.99±0.68; p=0.910), and corrected distance visual acuity logMAR (0.09±0.1 vs. 0.07±0.11; p=0.497). There was a significant increase in MG loss area postoperatively (5.02±5.04–7.75±6.75; p=0.047), while the degree of MG loss did not significantly change (0.2±0.48 vs. 0.37±0.56; p=0.132). However, no significant differences were detected in Schirmer I test (17.4±4.7 vs. 16.1±5.5; p=0.711), I-TBUT (12.4±3.1 vs. 11.9±4.7; p=0.483), and OSDI questionnaire score (16.7±9.4 vs. 17.9±10.3; p=0.176) between baseline and post-operative measurements. Similarly, no significant changes were found in NI-TBUT (5.73±3.72 vs. 6.58 4.71; p=0.535) and NIAvg-TBUT (6.06±4.8 vs. 7.51±4.43; p=0.322) values. Conclusion: Surgical correction of blepharoptosis affects MG morphology without causing dry eye at the 3rd month. Post-operative corneal topography is useful in demonstrating changes in the MG.

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“…2 Although the presence and exacerbation of SPK is well known to surgeons involved in IB surgery, the exact cause of SPK has not been fully investigated. 3 Upper lid wiper epitheliopathy (LWE) and superior limbic keratoconjunctivitis (SLK) are the most common causes of upper SPK, while inferior conjunctivochalasis (CCh) and dry eye are the most common causes of lower SPK. 4 Dry eye and lagophthalmos have been extensively studied, 5,6 but the role of friction-related diseases, such as LWE, SLK, and CCh, has been underexplored.…”

mentioning

confidence: 99%

Conjunctival Chalasis Should Not be Overlooked: Investigation Into Postoperative Ocular Surface Changes in Involutional Blepharoptosis

Uemura,

Hiroki,

Saika

et al. 2024

Journal of Craniofacial Surgery

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Background: Involutional blepharoptosis is common among elderly people. The tightening of eyelids postptosis surgery could potentially increase friction between the eyelid and the ocular surface, but this hypothesis has not yet been substantiated by research. The authors explored the relationship between involutional blepharoptosis surgery and friction-related diseases, namely conjunctivochalasis, lid wiper epitheliopathy, and superior limbic keratoconjunctivitis. Methods: We conducted a prospective study involving 31 patients who underwent levator advancement for involutional blepharoptosis. Both preoperatively and 6 weeks postoperatively, the authors assessed a range of outcome measures, including margin reflex distance-1, 2, tear film break-up time, superficial punctate keratopathy, inferior conjunctivochalasis, upper lid wiper epitheliopathy, and superior limbic keratoconjunctivitis Results: Conjunctivochalasis was detected in 18 eyes preoperatively and 20 eyes postoperatively. Lid wiper epitheliopathy was detected in 2 eyes preoperatively and in no eyes postoperatively. Superior limbic keratoconjunctivitis was detected in 2 eyes preoperatively and 1 eye postoperatively. From preoperative to postoperative assessments, conjunctivochalasis worsened in 11 eyes (17.2%), and there were no eyes with worsening lid wiper epitheliopathy or superior limbic keratoconjunctivitis. There was a significant worsening of superficial punctate keratopathy in the group with exacerbated conjunctivochalasis compared with the unchanged group (0.72 vs. 0.12, P=0.0222). The superficial petechial keratopathy in the 6 cases in which there was worsening of both conjunctivochalasis and superficial petechial keratopathy were all located inferiorly in the cornea. Conclusions: Conjunctivochalasis can worsen following ptosis surgery, potentially leading to an increase in inferior superficial punctate keratopathy. When performing involutional blepharoptosis surgery, surgeons should be mindful of the potential implications of friction-related diseases, particularly conjunctivochalasis.

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Study to the Effect of Involutional Blepharoptosis Surgery Using Objective and Subjective Parameters

Cited by 4 publications

References 36 publications

Safety and Pitfalls of Blepharoptosis Surgery in Elderly People

Safety and Pitfalls of Blepharoptosis Surgery in Elderly People

The Effects of Blepharoptosis Surgery on Meibomian Gland, Tear Film, and Corneal Topography

Conjunctival Chalasis Should Not be Overlooked: Investigation Into Postoperative Ocular Surface Changes in Involutional Blepharoptosis

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