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Gan L, Wang L, Chen J, Tang L. Complications of XEN gel stent implantation for the treatment of glaucoma: a systematic review. Front Med (Lausanne) 2024; 11:1360051. [PMID: 38770050 PMCID: PMC11102958 DOI: 10.3389/fmed.2024.1360051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
Aim This study was aimed to summarize the complications and their management associated with XEN gel stent implantation. Methods A systematic review of literature was conducted using Medline (via PubMed), EMBASE, the Cochrane Library databases, and China National Knowledge Infrastructure, from their inception to February 1, 2024. Results A total of 48 studies published between 2017 and 2024 were identified and included in the systematic review, including 16 original studies (retrospective or prospective clinical studies), 28 case reports, and 4 case series, which followed patients for up to 5 years. Early postoperative complications of XEN gel stent implantation include hypotony maculopathy (1.9-4.6%), occlusion (3.9-8.8%), suprachoroidal hemorrhage (SCH), choroidal detachment (0-15%), conjunctival erosion, and exposure of the XEN gel stent (1.1-2.3%), wound and bleb leaks (2.1%) and malignant glaucoma (MG) (2.2%). Mid-postoperative complications of XEN gel stent implantation included migration of XEN (1.5%), ptosis (1.2%), endophthalmitis (0.4-3%), macular edema (1.5-4.3%), hypertrophic bleb (8.8%) and subconjunctival XEN gel stent fragmentation (reported in 2 cases). Late postoperative complications reported in cases included spontaneous dislocation and intraocular degradation. Conclusion XEN gel stent implantation is a minimally invasive glaucoma surgery (MIGS) procedure for glaucoma, known for its potential to minimize tissue damage and reduce surgical duration. However, it is crucial to note that despite these advantages, there remains a risk of severe complications, including endophthalmitis, SCH, and MG. Therefore, postoperative follow-up and early recognition of severe complications are essential for surgical management.
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Affiliation(s)
- Lu Gan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Department of Ophthalmology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lixiang Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
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Aydemir E, Aksoy Aydemir G. Ptosis effects on intraocular lens power calculation. J Cataract Refract Surg 2023; 49:171-176. [PMID: 36148816 DOI: 10.1097/j.jcrs.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate quantitatively ocular biometric parameters and intraocular lens (IOL) power measurements after ptosis surgery. SETTING Adiyaman University Hospital, Adiyaman, Turkey. DESIGN Comparative prospective clinical study. METHODS This study comprised involutional ptosis patients divided into droopy eyelid severity groups: Group 1: >4 mm, Group 2: 3 to 4 mm, and Group 3: 1 to 2 mm. The patients underwent anterior levator resection, and preoperative and postoperative biometry measurements at 3 months postoperatively were obtained. RESULTS The Group 1 sample size was 19, Group 2 was 22, and Group 3 was 16. The mean flattest keratometry (K 1 ), steepest keratometry (K 2 ), and mean keratometry (K m ) values significantly decreased at 3 months postoperatively in Group 1 ( P < .001 for all). The mean K 1 , K 2 , and K m values nonsignificantly decreased at 3 months postoperatively in Groups 2 and 3 ( P > .05 for all). The mean corneal astigmatism magnitude decreased at 3 months postoperatively in Group 1 ( P < .01), Group 2 ( P = .186), and Group 3 ( P = .952). The mean recommended IOL powers targeting emmetropia increased postoperatively in Group 1 and were similar preoperatively and postoperatively in Groups 2 and 3. In Group 1, the mean changes after ptosis surgery by the formula were 0.47 diopters (D) for SRK/T, 0.52 D for Hoffer Q, 0.55 D for Haigis, 0.50 D for Barrett Universal II, and 0.55 D for Holladay 2. CONCLUSIONS Ptosis >4 mm significantly affects corneal curvature values and IOL power calculations when cataract surgery is planned. Surgeons might consider altering their lens power choice accordingly if cataract surgery is to be sequentially followed by ptosis repair.
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Affiliation(s)
- Emre Aydemir
- From the Department of Ophthalmology, Adıyaman University Research and Training Hospital, Adıyaman, Turkey
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Abumanhal M, Feldman I, Leibovitch I, Cnaan RB. Oculoplastic Surgeries in Patients Older than 90 Years of Age. Eur J Ophthalmol 2022; 32:2067-2071. [PMID: 35377245 DOI: 10.1177/11206721221086153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Muhammad Abumanhal
- Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, 26738Tel Aviv Ichilov Sourasky Medical Center, Tel Aviv, Israel
| | - Ilan Feldman
- Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, 26738Tel Aviv Ichilov Sourasky Medical Center, Tel Aviv, Israel
| | - Igal Leibovitch
- Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, 26738Tel Aviv Ichilov Sourasky Medical Center, Tel Aviv, Israel
| | - Ran Ben Cnaan
- Oculoplastic, Orbital and Lacrimal Institute, Division of Ophthalmology, 26738Tel Aviv Ichilov Sourasky Medical Center, Tel Aviv, Israel
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Pongsachareonnont P, Hemarat K, Panjaphongse R, Liu W, Vagefi MR, Stewart JM. Factors associated with the development of blepharoptosis after pars plana vitrectomy surgery. Semin Ophthalmol 2021; 37:509-514. [PMID: 34957908 DOI: 10.1080/08820538.2021.2006240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the incidence and risk factors for developing blepharoptosis after vitrectomy surgery. METHODS This prospective observational study conducted in patients who had vitrectomy surgery at the University of California, San Francisco. The patients' eyelids were photographed before, surgery and follow-up visits at 1 day, 1 week, 1 month, 3 months, and 6 months after surgery. Levator excursion (LE), palpebral fissure (PF) height and marginal reflex distance 1 (MRD1) changes from baseline were evaluated. Operative parameters associated with lid parameter changes were analyzed. RESULTS Thirty-eight eyes were enrolled in the study. Multivariate analysis performed for PF changes from pre-operative were -0.47 mm, 0.33 mm, and 0.09 mm at 1 week, 1 month and 6 months after surgery, respectively (p-value 0.1, 0.2, and 0.8). The mean change of LE from preoperative was -0.44 mm, -0.15 mm, and 0.35 mm at 1 week, 1 month and 6 months after surgery, respectively (p-value 0.3, 0.7 and 0.4). The reduction of MRD1 at 1 week, 1 month and 6 months after surgery were -0.08 mm, -0.13 mm and -0.01 mm, respectively (p = .003, p = .6 and 0.9). Triamcinolone usage was associated with reduction of MRD1 and LE. CONCLUSION Blepharoptosis presents most during the first week after surgery. The possibility of developing transient changes in eyelid position after vitrectomy surgery should be discussed with patients.
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Affiliation(s)
- Pear Pongsachareonnont
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Vitreoretinal Research Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kornwipa Hemarat
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Ronakorn Panjaphongse
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Department of Ophthalmology, Royal Thai Air Force, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Weifeng Liu
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, China
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Jay M Stewart
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
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Salvá-Palomeque T, Muñoz-Ramón P, Rebolleda G, Aguado-Casanova V, Ye-Zhu C, Muñoz-Negrete FJ. Changes in eyelid position after glaucoma filtering surgery. Eur J Ophthalmol 2021; 32:2886-2892. [PMID: 34812089 DOI: 10.1177/11206721211063723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While ptosis is a well-known consequence of glaucoma surgery, some isolated case reports point to the possibility of upper eyelid retraction occurring after glaucoma surgery. This study aims to analyze the occurrence of ptosis and eyelid retraction after glaucoma surgery and to evaluate factors contributing to these palpebral fissure changes. METHODS Cross-sectional study including 100 eyes of 100 patients that had undergone unilateral glaucoma surgery. Upper eyelid height in the operated eye was measured by digital photography and compared with the fellow, non-operated eye. The main outcome was to determine if ptosis or retraction occurred in the operated eye in comparison with the fellow eye. The secondary outcome was to determine if any variable was associated with ptosis or retraction. A clinically significant difference (either toward ptosis or retraction) was defined as a difference ≥1 mm between both eyes. RESULTS Of 100 eyes included 81 (81%) showed no change in eyelid height (-0.133 mm ± 0.496), 11 (11%) showed ptosis (-1.348 mm ± 0.387) and 8 eyes (8%) showed retraction (1.705 ± 0.634). A statistically significant relation was found between ptosis and pseudoexfoliation glaucoma (p = 0.003). A trend toward lower postoperative IOP and higher conjunctival blebs was found in eyes with postoperative eyelid retraction. CONCLUSIONS Eyelid retraction was present in 8% of patients and ptosis in 11%. Patients with eyelid retraction showed around a 3 mmHg lower postoperative IOP than eyes without retraction. The presence of pseudoexfoliation may be a risk factor for this complication. A prospective study with a large number of patients would be required to confirm these results.
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Affiliation(s)
| | - Pablo Muñoz-Ramón
- Ophthalmology Department, IRYCIS, 16507Ramon y Cajal University Hospital, Madrid, Spain
| | - Gema Rebolleda
- Ophthalmology Department, IRYCIS, 16507Ramon y Cajal University Hospital, Madrid, Spain
| | | | - Cristina Ye-Zhu
- Ophthalmology Department, IRYCIS, 16507Ramon y Cajal University Hospital, Madrid, Spain
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Song AJ, Khanna CL, Jamali S, Roddy GW, Wagner LH. Efficacy and safety of blepharoptosis repair after incisional glaucoma surgery. Eur J Ophthalmol 2021; 32:122-128. [PMID: 33779340 DOI: 10.1177/11206721211006643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE There is an increased risk for development of blepharoptosis after incisional glaucoma surgery. Data on safety and efficacy of ptosis repair in this group of patients in limited. The goal of this study is to evaluate outcomes and identify potential risk factors for failure of ptosis repair in eyes with history of incisional glaucoma surgery. METHODS A retrospective chart review was performed of all patients who underwent incisional glaucoma surgery, specifically trabeculectomy or implantation of glaucoma drainage device (GDD), and subsequent ptosis repair at a single institution from 2009 to 2019. Ptosis surgery outcomes were compared to a control group who underwent ptosis repair after cataract surgery. RESULTS Seventy-eight eyes of 64 patients were included in the glaucoma surgery group. The rate of severe ptosis (margin reflex distance 1 ⩽ 0 mm) among glaucoma surgery patients was higher compared to control (35 of 78 (44.9%) vs 23 of 82 (28.6%). Ptosis repair was successful in 59 of 78 eyes (75.6%), which was similar to control. Risk for revision surgery was increased more than five-fold in the GDD group compared to control. There were no cases of early or late bleb-related complications. CONCLUSIONS Ptosis repair can be performed safely in patients after incisional glaucoma surgery. Müller muscle conjunctival resection and external levator advancement are equally effective. Patients with history of GDD should be advised about the potentially increased risk of need for revision surgery.
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Affiliation(s)
- Allisa J Song
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Cheryl L Khanna
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Sepideh Jamali
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Gavin W Roddy
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Lilly H Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
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Erdinest N, London N. Letter to the Editor: "Dry Eye Disease after Cataract Surgery: Study of its Determinants and Risk Factors". Turk J Ophthalmol 2021; 50:390-391. [PMID: 33389942 PMCID: PMC7802105 DOI: 10.4274/tjo.galenos.2020.83893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Nir Erdinest
- Hadassah-Hebrew University Medical Center, Department of Ophthalmology
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Lee CC, Feng IJ, Lai HT, Huang SH, Kuo YR, Lai CS. The Epidemiology and Clinical Features of Blepharoptosis in Taiwanese Population. Aesthetic Plast Surg 2019; 43:964-972. [PMID: 30877447 DOI: 10.1007/s00266-019-01344-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Blepharoptosis describes a condition of low-lying upper eyelid that may affect individuals of all ages under various etiologies. It may be of congenital or acquired form by the timing of onset or be divided into myogenic, neurogenic, aponeurotic, or mechanical types according to the mechanism. Our goal was to report the characteristics of age-specific blepharoptosis and to analyze the association between levator function (LF) and ptosis severity of each ptosis subtype. MATERIALS AND METHODS The retrospective, single-center, cross-sectional study consisted of patients diagnosed with blepharoptosis in the plastic surgery practice at a medical center between September 2009 and May 2017. We reported patients' age at presentation, sex, laterality of ptosis, etiology, classification, and evaluation of ptosis including levator function and ptosis severity. RESULTS During a nine-year span of study, a total of 1975 eyelids of 1164 Taiwanese patients aged between 2 and 88 years were enrolled in the research (mean = 57.73 ± 13.41 years). The female-to-male ratio was 2.72 (95% confidence interval [CI]: p < 0.0001). Acquired blepharoptosis and bilateral blepharoptosis were more frequently observed (55.85%, p < 0.0001 and 69.67%, p < 0.0001, respectively). In age-specific relative incidence of blepharoptosis, myogenic ptosis was the majority in patients younger than 40 years. Early onset of aponeurotic ptosis was observed in young contact lenses wearers. Aponeurotic blepharoptosis was the predominant type of ptosis in the senior population older than 40 years (p < 0.0001). Among the subtypes, mechanical ptosis had the most preserved LF (p < 0.0001). LF and MRD1 had statistically positive correlations in all subtypes of blepharoptosis, in which neurogenic ptosis demonstrated the severest levator dysfunction for each millimeter in MRD1 reduction. CONCLUSIONS Of the 1164 Taiwanese patients, blepharoptosis had a higher propensity for female gender and the age between the second to fourth decades. Bilateral involvement of blepharoptosis with acquired type was frequently diagnosed. Myogenic ptosis had a preponderance in age younger than 40 years, while aponeurotic ptosis usually affects senile population. Many mild degree myogenic ptosis was simultaneously recognized in young-aged adults seeking aesthetic double eyelid surgery. Early onset of acquired aponeurotic ptosis was also observed in contact lens wearers given the trend of decorative contact lens use. Levator dysfunction was implicated in the pathology of not only myogenic ptosis but aponeurotic, mechanical, and neurogenic ptosis. Moreover, levator function of neurogenic ptosis was most severely impacted in each MRD1 reduction among all subtypes of blepharoptosis. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Chia-Chen Lee
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Jung Feng
- Department of Healthcare Administration and Medical Informatics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hsin-Ti Lai
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan
| | - Shu-Hung Huang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan
| | - Yur-Ren Kuo
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan
| | - Chung-Sheng Lai
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan.
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Marqués-Fernández V, Garcia-Zamora M, Calabuig-Goena M, Diez-Montero C, Schellini SA, Khandekar R, Galindo-Ferreiro A. An Objective Evaluation of the Upper Eyelid Position after Phacoemulsification Cataract Surgery. Semin Ophthalmol 2019; 34:442-445. [PMID: 31314625 DOI: 10.1080/08820538.2019.1643379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To objectively measure the upper eyelid position following phacoemulsification cataract surgery and to identify the determinants of postoperative transient ptosis. Methods: This is a single arm prospective study of patients who underwent cataract surgery from January to May 2017 at a tertiary Eye Hospital in Spain. Data comprised of: the type of anesthesia, the duration that the speculum remained in place and the total surgical time (duration of the procedure). The total surgical time was defined as, the time from the beginning of the paracentesis to the closure of the wounds (incision time). Digital photographs were obtained of: the face with the eye in primary gaze, looking inferiorly and superiorly, preoperatively, and 1, 30, 90 and 180 days postoperatively. Measurements for eyelid crease, levator function, and marginal reflex distance 1 (MRD1) were performed using ImageJ. Statistical analysis was performed of the difference between the preoperative and postoperative measurements. Results: The study consisted of 112 patients. The median lid crease was 9.0 mm [IQR (interquartile range) 7.5; 10.0] both preoperatively and at 180 days postoperatively (IQR 8.0; 10.8). No statistical difference was determined in the lid crease measurements between these two times (P = .17). The median levator function differed significantly preoperatively, at day 1 and 30, 60 and 180 days postoperatively (P < .01). MRD1 decreased significantly from a median of 3.01 mm preoperatively to 2.7 mm at 30 days postoperatively (P = .05) but was similar at preoperative and after 180 days (P = .7). The correlation of MRD1 to the duration of the speculum in place (P = .2) and the incision time (P = .57) was not significant. Conclusions: Ptosis, following phacoemulsification cataract surgery, is mild and transient, occurring only in the early postoperative period.
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Affiliation(s)
| | - Maria Garcia-Zamora
- a Department of Ophthalmology, Rio Hortega University Hospital , Valladolid , Spain
| | - Maria Calabuig-Goena
- a Department of Ophthalmology, Rio Hortega University Hospital , Valladolid , Spain
| | - Cecilia Diez-Montero
- a Department of Ophthalmology, Rio Hortega University Hospital , Valladolid , Spain
| | - Silvana A Schellini
- b Oculoplastic Division, King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia.,c Department of Ophthalmology Faculdade de Medicina de Botucatu, UNESP , Botucatu , Brazil
| | - Rajiv Khandekar
- b Oculoplastic Division, King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia
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Wang Y, Lou L, Liu Z, Ye J. Incidence and risk of ptosis following ocular surgery: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2018; 257:397-404. [PMID: 30203103 DOI: 10.1007/s00417-018-4130-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/27/2018] [Accepted: 07/12/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to evaluate the incidence and risk factors of ptosis following ocular surgery. METHODS PubMed, Embase, and Cochrane Library were searched for articles that assessed the incidence or risk factors of ptosis following ocular surgery up to October 2017. We used a fixed effects model to calculate a pooled estimate of incidence, with subgroup analyses to evaluate the effect of different variables. The relative risks (RRs) or odds ratios (ORs) and 95% confidence intervals (CIs) for all available factors were calculated using the fixed effects models. RESULTS A total of 16 studies on 2856 eyes were analyzed, including 3 randomized controlled trials (RCTs) and 13 cohort studies. The overall incidence of ptosis following ocular surgery was 11.4% (95% CI 10.1-12.8%). Subgroup analyses showed that the region and the surgery type were significantly associated with the incidence of postoperative ptosis. Men were less likely to get postoperative ptosis than women (OR 0.62; 95% CI 0.43-0.89). However, age (OR 0.77; 95% CI 0.48-1.23), side (OR 1.37; 95% CI 0.84-2.25), type of anesthesia (OR 0.57; 95% CI 0.16-2.05), prior surgery (OR 1.09; 95% CI 0.64-1.83), bridle suture (OR 2.04; 95% CI 0.94-4.42), or combined surgery (OR 0.95; 95% CI 0.58-1.57) did not significantly change the risk of ptosis following ocular surgery. CONCLUSION More than one in ten patients who undergo ocular surgery will develop ptosis. Different regions and surgery types may influence the occurrence of this abnormality. Female gender is a risk factor for development of postoperative ptosis.
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Affiliation(s)
- Yijie Wang
- Department of Ophthalmology, College of Medicine, The Second Affiliated Hospital of Zhejiang University, Jiefang Road 88, Hangzhou, 310009, Zhejiang, China
| | - Lixia Lou
- Department of Ophthalmology, College of Medicine, The Second Affiliated Hospital of Zhejiang University, Jiefang Road 88, Hangzhou, 310009, Zhejiang, China
| | - Zhifang Liu
- Department of Ophthalmology, College of Medicine, The Second Affiliated Hospital of Zhejiang University, Jiefang Road 88, Hangzhou, 310009, Zhejiang, China
| | - Juan Ye
- Department of Ophthalmology, College of Medicine, The Second Affiliated Hospital of Zhejiang University, Jiefang Road 88, Hangzhou, 310009, Zhejiang, China.
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Postsurgical ptosis associated with intraoperative eyelid dilatability. SPEKTRUM DER AUGENHEILKUNDE 2017. [DOI: 10.1007/s00717-017-0340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE Evaluate factors contributing to ptosis after glaucoma surgery. METHODS Three-year retrospective chart review from January 1, 2012, to January 1, 2015, 157 eyes, 3 surgeons, at Boston Medical Center, to determine the incidence of ptosis and the effects of each variable contributing to ptosis at 3 months after surgery. Each variable was analyzed using the chi-square or independent samples t-test analysis to determine statistical significance of ptosis compared with above variables. RESULTS The t-test or chi-square analysis showed that gender, steroid duration, use of mitomycin C, duration of surgery, and prior surgeries were not statistically significant factors for ptosis. There was a statistically significant association between those <70 years of age and ptosis (P<0.05), non-combined surgery and ptosis (P<0.05), shunting surgery and ptosis (P<0.05). CONCLUSION Ptotic changes occurred more often in those who have shunting (Ahmed and Baerveldt) surgeries compared with filtering (trabeculectomy and Express) surgeries.
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Affiliation(s)
| | | | - Manishi A Desai
- Boston Medical Center, Department of Ophthalmology, Boston, MA, USA
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Tamaki R, Gosho M, Mizumoto K, Kato N, Zako M. Influence of upper and temporal transconjunctival sclerocorneal incision on marginal reflex distance after cataract surgery. BMC Ophthalmol 2016; 16:95. [PMID: 27387207 PMCID: PMC4937608 DOI: 10.1186/s12886-016-0286-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 06/22/2016] [Indexed: 11/16/2022] Open
Abstract
Background Ptosis incidence following cataract surgery is reduced with a recently developed phacoemulsification technique using a small incision. However, it remains uncertain whether an upper transconjunctival sclerocorneal incision can cause minor blepharoptosis. In the present prospective study, patients underwent cataract surgery with either an upper or temporal 2.4-mm transconjunctival sclerocorneal incision. We measured the marginal reflex distance 1 (MRD1) preoperatively and postoperatively, and compared these measurements between the two different incision types. Further we explored the risk factors of the postoperative MRD1 reduction. Methods The study population included patients who underwent cataract surgery on both eyes at Aichi Medical University between October 2013 and September 2015. In each patient, one eye was operated using an upper 2.4-mm transconjunctival sclerocorneal incision, and the other with a temporal incision. We prespecified that an MRD1 difference of ≥0.5 mm between the pre- and post-surgical measurements indicated postoperative ptosis, which was a strict criterion. MRD1 was measured using digital photography, and we calculated the difference between the preoperative and postoperative MRD1 values. This change in MRD1 was compared between the groups with different incision locations. The change in MRD1 was analyzed by using the multivariate regression model including incision position (temporal or upper), preoperative MRD1, and preoperative distance between medial and lateral canthi. Results We assessed data from a total of 34 patients. The mean change in MRD1 from pre-operation to post-operation measurements was −0.26 ± 0.93 with the temporal incision and −0.24 ± 0.86 with the upper incision. The mean difference in the change in MRD1 between the different two incision types was −0.02, with a 95 % CI of −0.24 to 0.20, establishing equivalence between these incision types. The multivariate regression analysis showed that the preoperative MRD1 was significantly associated with the reduction of MRD1 after surgery (p = 0.034). Conclusions Cataract surgery using upper and temporal 2.4-mm transconjunctival sclerocorneal incisions are clinically equivalent with regards to change in MRD1, and neither incision type caused critical postoperative ptosis. The longer preoperative MRD1 was significantly associated with the reduction of MRD1 after surgery. Trial registration Current Controlled Trials UMIN000022310. Retrospectively registered 14 May 2016. Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0286-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rikiya Tamaki
- Department of Ophthalmology, Aichi Medical University, Nagakute, 480-1195, Aichi, Japan
| | - Masahiko Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, 305-8575, Ibaraki, Japan
| | - Kyoichi Mizumoto
- Department of Ophthalmology, Aichi Medical University, Nagakute, 480-1195, Aichi, Japan
| | - Nahoko Kato
- Department of Ophthalmology, Aichi Medical University, Nagakute, 480-1195, Aichi, Japan
| | - Masahiro Zako
- Department of Ophthalmology, Aichi Medical University, Nagakute, 480-1195, Aichi, Japan.
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A Vector Force Model of Upper Eyelid Position in the Setting of a Trabeculectomy Bleb. Ophthalmic Plast Reconstr Surg 2016; 32:127-32. [DOI: 10.1097/iop.0000000000000444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Crosby NJ, Shepherd D, Murray A. Mechanical testing of lid speculae and relationship to postoperative ptosis. Eye (Lond) 2013; 27:1098-101. [PMID: 23788211 DOI: 10.1038/eye.2013.133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/14/2013] [Indexed: 11/10/2022] Open
Abstract
AIMS Postoperative lid malpositions are known complications of routine intraocular surgery and were previously attributed to the use of a bridle suture or the myotoxic effect of retrobulbar or peribulbar anaesthetics. However, lid malpositions are still seen under topical anaesthesia. Recent studies have implicated the lid speculum as a factor. Patients with narrower vertical palpebral apertures have been shown to develop postoperative ptosis more frequently, but the reason is unknown. This is the first study to determine the forces exerted by lid speculae over a range of palpebral apertures. METHODS Mechanical testing was undertaken using a Bose 3200 materials testing machine. Tests were undertaken on four disposable and four reusable speculae. The force used to compress each speculum was compared over a range of displacements. A two-sample t-test was used to compare the stiffness of the two types of speculum. RESULTS The stiffness of the reusable speculum was significantly greater than the disposable speculum (P=0.002). The stiffness of each speculum was greatest at the range of displacement corresponding to the narrower palpebral apertures. CONCLUSIONS Different speculae exert significantly different forces on patients' eyelids during surgery. The patients who experience the greatest compression from the speculae are those with the smallest palpebral apertures. This may explain why these patients are more likely to develop postoperative lid malpositions.
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Affiliation(s)
- N J Crosby
- Birmingham and Midland Eye Centre, City Hospital, Birmingham, UK
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Kim YJ, Lim HW, Kang MH, Seong MC, Cho HY. A Prospective Study of Blepharoptosis after Panretinal Photocoagulation Using Ophthalmoscopic Contact Lens. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.7.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yu Jeong Kim
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Han Woong Lim
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Min Ho Kang
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Min Cheol Seong
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hee Yoon Cho
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Oh HY, Park ES, Kim YB. Iatrogenic Blepharoptosis after Cataract Surgery. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2013. [DOI: 10.14730/aaps.2013.19.3.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hwa Young Oh
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
| | - Yong Bae Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
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Mehat MS, Sood V, Madge S. Blepharoptosis following anterior segment surgery: a new theory for an old problem. Orbit 2012; 31:274-278. [PMID: 22642903 DOI: 10.3109/01676830.2012.681750] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Blepharoptosis is a well-known complication following anterior segment surgery. However, its precise aetiology remains elusive. There are currently two widely held views on the pathogenesis of persistent postoperative ptosis, namely the speculum and bridle suture theories. However, both suggested explanations fail to address important anatomical and epidemiological features of this condition. Until now, the majority of published literature describing persistent postoperative ptosis following anterior segment surgery has largely concentrated on dehiscence of the levator aponeurosis as the common mechanism underlying this postoperative complication. However, numerous studies have failed to show any correlation between pre or postoperative skin crease positions in such patients. This review article discusses previously proposed mechanisms responsible for both transient and persistent ptosis. Furthermore, we propose an alternative mechanism for the development of ptosis following anterior segment surgery, namely horizontal stretch of the upper eyelid induced by the use of the speculum. This mechanism also provides a plausible explanation for less commonly described oculoplastic complications, such as lower lid malpositions, following anterior segment surgery. Postoperative ptosis may also act as a paradigm for the development of involutional ptosis in general. In view of the frequency with which ophthalmologists perform anterior segment procedures such as cataract surgery, postoperative ptosis represents a significant concern for all ocular surgeons. Identifying the underlying mechanism is imperative, not only to identify those patients at greatest risk, but also to perhaps provide novel surgical approaches to the management of this complication.
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Puvanachandra N, Hustler A, Seah LL, Tyers AG. The incidence of ptosis following extracapsular and phacoemulsification surgery: comparison of two prospective studies and review of the literature. Orbit 2010; 29:321-323. [PMID: 21158573 DOI: 10.3109/01676830.2010.522297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We prospectively compared 120 patients who underwent either phacoemulsification or extracapsular cataract (ECCE) surgery to establish the incidence of postoperative ptosis between the two techniques. Of the 120 patients, 60 underwent ECCE (unpublished data 1989) and 60 had phacoemulsification. Data was collected prospectively on upper and lower margin reflex distance, upper lid skin crease and levator function, preoperatively and 6 weeks postoperatively. Photographs were taken pre and postoperatively and examined by a blinded observer. At 6 weeks, ptosis was present in 18% of ECCE patients compared with 0% in the phacoemulsification group. By changing from ECCE to phacoemulsification the incidence of postoperative ptosis has reduced. The possibility to induce postoperative ptosis remains, potential mechanisms are discussed.
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Affiliation(s)
- Narman Puvanachandra
- Department of Ophthalmology, Norfolk and Norwich Universtiy Hospital, Norwich, UK
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Affiliation(s)
- Audrey E Ahuero
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
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23
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Canadian Ophthalmological Society evidence-based clinical practice guidelines for cataract surgery in the adult eye. CANADIAN JOURNAL OF OPHTHALMOLOGY 2008. [DOI: 10.3129/i08-133] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Guide de pratique clinique factuelle de la Société canadienne d’ophtalmologie pour la chirurgie de la cataracte de l’œil adulte. CANADIAN JOURNAL OF OPHTHALMOLOGY 2008. [DOI: 10.1016/s0008-4182(08)80002-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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