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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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Talens-Estarelles C, Díez-Ajenjo MA, Pons ÁM, Peris-Martínez C, García-Lázaro S. Effects of cataract surgery on blinking. J Cataract Refract Surg 2023; 49:177-183. [PMID: 36255227 DOI: 10.1097/j.jcrs.0000000000001081] [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: 05/17/2022] [Accepted: 10/10/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the effects of cataract surgery on the spontaneous blinking pattern and blinking kinematics. SETTING FISABIO Oftalmología Médica Eye Hospital, Valencia, Spain. DESIGN Observational descriptive clinical study. METHOD Patients with senile cataract were evaluated before (visit 1) and at 1 month (visit 2) and 3 months (visit 3) after undergoing phacoemulsification cataract surgery. The blinking of patients was recorded for 90 seconds using an eye-tracking device. Blinks were analyzed by means of image analysis to obtain a noninvasive detailed description of blinking including blink rate, number of complete and incomplete blinks, percentage of incomplete blinks, and kinematic parameters, including amplitude, closing, contact, opening, and total durations and closing and opening speeds. RESULTS 50 patients were included in this study. The blink rate was significantly smaller at visit 3 compared with baseline ( P = .03) and visit 2 ( P = .001). Likewise, the number of complete blinks was significantly smaller, and the percentage of incomplete blinks was significantly higher at 3 months postoperatively compared with baseline ( P = .02 and P = .01, respectively), although no differences were observed at 1 month postoperatively ( P > .05). Conversely, no differences in the number of incomplete blinks or any kinematic parameter were observed between visits ( P = .12). CONCLUSIONS Cataract surgery significantly altered the blinking pattern at 3 months postoperatively, although kinematic parameters remained unvaried. Clinicians should be aware of potential alterations in blinking after phacoemulsification cataract surgery and the implications this may have on the ocular surface of patients.
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Affiliation(s)
- Cristian Talens-Estarelles
- From the Department of Optics & Optometry & Vision Sciences, University of Valencia, Valencia, Spain (Talens-Estarelles, Díez-Ajenjo, Pons, García-Lázaro); Cornea and Anterior Segment Disease Unit, FISABIO Medical Ophthalmology (FOM), Valencia, Spain (Peris-Martínez); Department of Surgery, Ophthalmology, University of Valencia, Valencia, Spain (Peris-Martínez)
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Mangan MS, Ocak SY, Vural ET, Yildiz E. Müller Muscle-conjunctival Resection with or without Tarsectomy and Combined with Bandage Contact Lens Use in Ptosis Patients with Corneal Graft. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 35:10-17. [PMID: 33307624 PMCID: PMC7904405 DOI: 10.3341/kjo.2020.0119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/29/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To examine the efficacy of ptosis correction with a Müller muscle-conjunctival resection with or without tarsectomy (MMCR±T), combined with bandage contact lens (BCL) use, in corneal graft patients. METHODS Seven patients with corneal grafts who underwent MMCR±T for treatment of ptosis were evaluated retrospectively. A BCL was applied to the grafts at the end of the surgery. The collected data included preoperative and postoperative visual acuity, marginal reflex distance 1 (MRD-1), presence of Hering's dependency by the phenylephrine test, symmetry outcomes, and complications after MMCR±T. RESULTS The average duration between the penetrating keratoplasty and MMCR±T was 14 months, with a follow-up time of 10.4 months after MMCR±T. Hering's dependency was observed in four (57.2%) patients before MMCR±T, and MRD-1 was increased in all patients based on preoperative phenylephrine tests. The mean preoperative MRD-1 was -0.14 ± 0.55 mm, and the mean postoperative MRD-1 was 2.35 ± 0.89 mm (p < 0.0001). Symmetry outcomes of perfect (<0.5 mm), good (0.5-1 mm), and fair (≥1 mm) were noted after MMCR±T in three, three, and one patients, respectively. During the follow-up, no obvious corneal epitheliopathy, keratitis, or corneal graft rejection/failure were noted in any cases. BCL use was well tolerated by all patients. CONCLUSIONS Most patients achieved good surgical outcomes with the application of the BCL to protect the graft and with the use of the phenylephrine test and Hering's dependency to predict the final eyelid position and symmetry. MMCR±T combined with BCL may therefore represent an alternative approach for correction of ptosis in patients with corneal graft.
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Affiliation(s)
- Mehmet Serhat Mangan
- Division of Ophthalmic Plastic and Reconstructive Surgery, Sadik Eratik Eye Clinic, Haydarpasa Numune Education and Research Hospital, University of Health Sciences, Istanbul,
Turkey
| | - Serap Yurttaser Ocak
- Division of Cornea, Department of Ophthalmology, Okmeydani Education and Research Hospital, University of Health Sciences, Istanbul,
Turkey
| | - Ece Turan Vural
- Division of Cornea, Sadik Eratik Eye Clinic, Haydarpasa Numune Education and Research Hospital, University of Health Sciences, Istanbul,
Turkey
| | - Elvin Yildiz
- Division of Cornea, Sadik Eratik Eye Clinic, Haydarpasa Numune Education and Research Hospital, University of Health Sciences, Istanbul,
Turkey
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Eom Y, Na KS, Hwang HS, Cho KJ, Chung TY, Jun RM, Ko BY, Chun YS, Kim HS, Song JS. Clinical efficacy of eyelid hygiene in blepharitis and meibomian gland dysfunction after cataract surgery: a randomized controlled pilot trial. Sci Rep 2020; 10:11796. [PMID: 32678131 PMCID: PMC7366917 DOI: 10.1038/s41598-020-67888-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/08/2020] [Indexed: 11/17/2022] Open
Abstract
The purpose of this randomized clinical trial is to evaluate the effect of eyelid hygiene on subjective symptoms, anterior blepharitis, and meibomian gland dysfunction (MGD) after cataract surgery. Subjects with obstructive MGD who underwent cataract surgery were randomly divided into two groups. In the eyelid hygiene group, eyelid hygiene was performed twice a day for 10 days from 3 days before to 1 week after cataract surgery. The control group did not perform eyelid hygiene. A subjective symptom questionnaire of SPEED, anterior blepharitis grade, and meibum quality and quantity was evaluated at baseline and at postoperative 1 and 4 weeks. The eyelid hygiene group (n = 36) showed decreased SPEED score after cataract surgery and the control group (n = 33) did not. Anterior blepharitis grade was worse 1 week after surgery in the control group but not in the eyelid hygiene group. The control group had significantly decreased meibum quality and quantity in both the upper and lower eyelids after cataract surgery, but the eyelid hygiene group did not. Eyelid hygiene before/after cataract surgery improved postoperative subjective symptoms and prevented postoperative exacerbation of anterior blepharitis and MGD. Thus, perioperative eyelid hygiene is recommended for patients with obstructive MGD who undergo cataract surgery.
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Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea.,Korean Meibomian gland & Ocular Surface study group, Seoul, South Korea
| | - Kyung Sun Na
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Korean Meibomian gland & Ocular Surface study group, Seoul, South Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Korean Meibomian gland & Ocular Surface study group, Seoul, South Korea
| | - Kyong Jin Cho
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, South Korea.,Korean Meibomian gland & Ocular Surface study group, Seoul, South Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korean Meibomian gland & Ocular Surface study group, Seoul, South Korea
| | - Roo Min Jun
- Department of Ophthalmology, Ewha Woman's University School of Medicine, Seoul, South Korea.,Korean Meibomian gland & Ocular Surface study group, Seoul, South Korea
| | - Byung Yi Ko
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea.,Korean Meibomian gland & Ocular Surface study group, Seoul, South Korea
| | - Yeoun Sook Chun
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.,Korean Meibomian gland & Ocular Surface study group, Seoul, South Korea
| | - Hyun Seung Kim
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Korean Meibomian gland & Ocular Surface study group, Seoul, South Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea. .,Korean Meibomian gland & Ocular Surface study group, Seoul, South Korea.
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Kashkouli MB, Abdolalizadeh P, Es'haghi A, Nilforushan N, Aghaei H, Karimi N. Postoperative Blepharoptosis After Modern Phacoemulsification Procedure. Am J Ophthalmol 2020; 213:17-23. [PMID: 31926884 DOI: 10.1016/j.ajo.2019.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the frequency of transient (1 month) and persistent (at least 6 months) postoperative ptosis following clear corneal sutureless phacoemulsification and to analyze the factors affecting them. DESIGN Cohort study. METHODS Patients who underwent phacoemulsification cataract surgery from October 2016 to June 2018 in a tertiary center were enrolled. Margin reflex distance 1 (MRD1), MRD2, and levator function were measured and facial photography was taken before, 1 month, and at least 6 months after the surgery. Clinical ptosis was defined as any postoperative drop of MRD1 and clinically significant ptosis as MRD1 drop of ≥2 mm. Photo-based ptosis was assessed by a masked oculofacial plastic surgeon at the end of the study. RESULTS A total of 234 patients (313 eyelids) were included. The majority of surgeries were performed by senior residents (65.5%, 205/313) and under topical anesthesia (78.0%, 244/313). Persistent clinical, clinically significant, and photo-based ptosis were 25.4% (71/279), 3.2% (9/279), and 3.3% (9/276). Eyelids with persistent postoperative ptosis showed a significantly (P = .03) lower preoperative levator function (13.9 vs 15.8 mm). No other factor was significantly different between the eyelids with and without postoperative ptosis. CONCLUSION Persistent clinically significant ptosis was observed in more than 3% of patients undergoing clear corneal sutureless phacoemulsification cataract surgery. It should be counseled preoperatively. Lower preoperative levator function was significantly associated with a higher frequency of postoperative ptosis. Duration of surgery, level of surgeons, and other variables did not have any significant effect on the frequency of postoperative ptosis.
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