Corneal topographic and aberrometric changes in patients with acquired blepharoptosis after levator resection surgery

Abstract

Objective: To evaluate changes in corneal topography and aberrometry in patients with acquired blepharoptosis after levator resection surgery.

Methods: This prospective, interventional study evaluated 30 eyelids of 19 patients who underwent levator resection surgery for acquired blepharoptosis with fair and good levator function (LF). Patients underwent corneal topography before and 3 months after surgery.

Results: Eleven patients had bilateral, and 8 patients had unilateral surgery. There were significant decreases in steep keratometry (K2) (preoperative: 46.21±5.02, postoperative: 44.58±2.11, P=0.046) and corneal astigmatism (preoperative: 2.98±0.61, postoperative: 1.59±1.50, P=0.034). There were no statistically significant differences between the preoperative and postoperative values of flat keratometry (K1) (P=0.585), mean keratometry (Kmean) (P=0.122), axis of corneal astigmatism (P=0.548), central corneal thickness (P=0.350), anterior chamber depth (P=0.747) and anterior chamber volume (P=0.679). The root mean square (RMS)-higher order aberrations (HOA) (P<0.001), RMS-Coma (Z₃¹) (P<0.001), and RMS-Trefoil (Z₃³) (P=0.005) decreased significantly. Preoperative and postoperative values of the seconder astigmatism (P=0.345), RMS-spherical aberration (Z₄⁰) (P=0.255), and RMS-Quadrafoil (Z₄⁴) values were found similar.

Conclusions: Levator resection for acquired blepharoptosis can improve the topography and aberrometry measurements of the cornea 3 months after surgery.

Keywords

• Blepharoptosis
• levator resection surgery
• corneal topography
• corneal higher-order aberrations
• RMS-HOA
• dry eye

References

1. 1. Yadegari S. Approach to a patient with blepharoptosis. Neurol Sci. 2016;37(10):1589-1596. doi: 10.1007/s10072-016-2633-7.
2. 2. Díaz-Manera J, Luna S, Roig C. Ocular ptosis: differential diagnosis and treatment. Curr Opin Neurol. 2018;31(5):618-627. doi: 10.1097/WCO.0000000000000600.
3. 3. Sridharan GV, Tallis RC, Leatherbarrow B, Forman WM. A community survey of ptosis of the eyelid and pupil size of elderly people. Age Ageing. 1995;24(1):21-24. doi: 10.1093/ageing/24.1.21.
4. 4. Hashemi H, Khabazkhoob M, Emamian MH, et al. The prevalence of ptosis in an Iranian adult population. J Curr Ophthalmol. 2016;28(3):142-145. doi: 10.1016/j.joco.2016.04.005.
5. 5. Kim MH, Cho J, Zhao D, et al. Prevalence and associated factors of blepharoptosis in Korean adult population: the Korea National Health and Nutrition Examination Survey. Eye (Lond). 2017;31(6):940-946. doi: 10.1038/eye.2017.43.
6. 6. Richards HS, Jenkinson E, Rumsey N, et al. The psychological well-being and appearance concerns of patients presenting with ptosis. Eye (Lond). 2014;28(3):296-302. doi: 10.1038/eye.2013.264.
7. 7. Fowler BT, Pegram TA, Cutler-Peck C, et al. Contrast sensitivity testing in functional ptosis and dermatochalasis surgery. Ophthalmic Plast Reconstr Surg. 2015;31(4):272-274. doi: 10.1097/IOP.0000000000000307.
8. 8. Cahill KV, Bradley EA, Meyer DR, et al. Functional indication for upper eyelid ptosis and blepharoplasty surgery: a report by the American Academy of Ophthalmology. Ophthalmology. 2011;118(12):2510-2517. doi: 10.1016/j. ophtha.2011.09.029.

9. 9. Savino G, Battendieri R, Riso M, et al. Corneal topographic changes after eyelid ptosis surgery. Cornea. 2016;35(4):501–505. doi: 10.1097/ICO.0000000000000729.
10. 10. Kim JW, Lee H, Chang M, et al. What causes increased contrast sensitivity and improved functional visual acuity after upper eyelid blepharoplasty? J Craniofac Surg. 2013;24(5):1582-1585. doi: 10.1097/SCS.0b013e318292c5ac.
11. 11. Crawford JS. Repair of ptosis using frontalis muscle and fascia lata: a 20-year review. Ophthalmic Surg. 1977;8(4):31-40.
12. 12. Pak J, Shields M, Putterman AM. Superior tarsectomy augments super-maximum levator resection in correction of severe blepharoptosis with poor levator function. Ophthalmology. 2006;113(7):120-188. doi: 10.1016/j.ophtha.2006.01.032.
13. 13. Tyers AG, Collin JR. Muller’s muscle shortening. In: Tyers AG, Collin JR, eds. Colour atlas of ophthalmic plastic surgery. 3rd ed. Oxford, Butterworth-Heinemann; 2008: pp. 190-195.
14. 14. Keyhani K, Ashenhurst ME. Modified technique and ptosis clamp for surgical correction of congenital pediatric ptosis by anterior levator resection. Facial Plast Surg. 2007;23(3):156-161. doi: 10.1055/s-2007-984554.
15. 15. Zinkernagel MS, Ebneter A, Ammann-Rauch D. Effect of upper eyelid surgery on corneal topography. Arch Ophthalmol. 2007;125(12):1610-1612. doi: 10.1001/archopht.125.12.1610.
16. 16. Brown MS, Siegel IM, Lisman RD. Prospective analysis of changes in corneal topography after upper eyelid surgery. Ophthal Plast Reconstr Surg. 1999;15(6):378-383. doi: 10.1097/00002341-199911000-00002.
17. 17. Chiang B, Asbell PA, Franklin B. Phenol red thread test and Schirmer test for tear production in normal and dry eye patients. Invest Ophthalmol Vis Sci. 1988;29(Suppl):337.
18. 18. Elhusseiny AM, Khalil AA, El Sheikh RH, Bakr MA, Eissa MG, El Sayed YM. New approaches for diagnosis of dry eye disease. Int J Ophthalmol. 2019;12(10):1618-1628. doi: 10.18240/ijo.2019.10.15.
19. 19. Albert DM. Albert and Jakobiec’s principles and practice of ophthalmology. In: Miller JW, Azar DT, Blodi BA, Cohan JE, Perkins T, eds. Philadelphia; 2008.
20. 20. Skaat A, Fabian D, Spierer A, Rosen N, Rosner M, Ben Simon GJ. Congenital ptosis repair-surgical, cosmetic, and functional outcome: a report of 162 cases. Can J Ophthalmol. 2013;48(2):93-98. doi: 10.1016/j.jcjo.2012.09.010.
21. 21. Cadera W, Orton RB, Hakim O. Changes in astigmatism after surgery for congenital ptosis. J Pediatr Ophthalmol Strabismus. 1992;29(2):85-88. doi: 10.3928/0191-3913-19920301-06.
22. 22. Agrawal G, Ravani S. Astigmatic changes following ptosis correction surgery in 30 consecutive children seen in a regional institute of ophthalmology. Int J Curr Res Rev. 2016;8(6):1-4.
23. 23. Kao SC, Tsai CC, Lee SM, Liu JH. Astigmatic change following congenital ptosis surgery. Zhonghua Yi Xue Za Zhi (Taipei). 1998;61(12):689-693.
24. 24. Ismail ZF, Addul Rahman IH, Shaat AA, Sh Elredy A. Corneal Topographic Changes after Correction of Ptosis by Levator Muscle Resection Measured by Scheimpflug Imaging. Med J Cairo Univ. 2022;90(6):747-753. doi: 10.21608/mjcu.2022.253169.
25. 25. Youssef YA, Abo-Eleinin MA, Salama OH. Corneal Topographic Changes After Eyelid Ptosis Surgery. Al-Azhar Int Med J. 2020;1(9):236-241. doi: 10.21608/aimj.2020.38021.1291.
26. 26. Altin Ekin M, Karadeniz Ugurlu S. Prospective analysis of visual function changes in patients with dermatochalasis after upper eyelid blepharoplasty. Eur J Ophthalmol. 2019;30(5):978-984. doi: 10.1177/1120672119857501.
27. 27. Shen J, Cui H, Tang X, Zhu M, Han W. Optical Quality Assessment in Patients with Unilateral Congenital Ptosis: A Matched Case-Control Study. J Ophthalmol. 2020;(1):2653250. doi: 10.1155/2020/2653250.
28. 28. Sharifi M, Es'haghi A, Kiarudi MY. The effect of ptosis surgery on corneal topography and aberrometry. Saudi J Ophthalmol. 2023 24;37(3):233-236. doi: 10.4103/sjopt.sjopt_220_22.
29. 29. Han DJ, Lee DH, Seo JW, Yum JH, Lee JH. Changes in Corneal Higher-order Aberrations and Astigmatism after Upper Eyelid Surgery. J Korean Ophthalmol Soc. 2022;63(10):814-822. doi.org/10.3341/jkos.2022.63.10.814
30. 30. Kim HH, DePavia CS, Yen MT. Effects of upper eyelid blepharoplasty on ocular surface sensation and tear production. Can J Ophthalmol. 2007;42(5):739-742. doi: 10.3129/i07-141.