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S. P. Verb, E. H. Black, G. J. Gladstone, A. Bradley; Lagophthalmos After Ptosis Surgery: Incidence and Predictive Factors. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5486.
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A levator muscle advancement procedure may be employed in all cases of aponeurotic ptosis. Lagophthalmos (lag) is a known complication. The purpose of this study is to (1) report the incidence of lag after levator muscle advancement for aponeurotic ptosis (2) quantify the association between intra-operative and post-operative lag, and (3) determine the relationship between pre-operative factors and post-operative lag.
Fifty-nine lids (fifty-four patients) that underwent levator muscle advancement surgery by two surgeons (EHB, GJG) were retrospectively reviewed. Unilateral and bilateral cases of aponeurotic ptosis [defined as a pre-operative measured Burke levator muscle function (BLF) of at least 10 mm] were repaired by levator muscle advancement. Data collected included pre-operative margin reflex distance (MRD1), pre-operative BLF, and lag (mm) measured intra-operatively, immediately following surgery, at 1 week, and at 1 month.
Incidence of lag was 54/59 patients (91.5%) intra-operative, 48/59 (81.4%) post-operative, 17/59 (28.8%) 1 week post-operative, and 6/59 (13.6%) 1 month post-operative. Patients with lag at 1 month after surgery had significantly more lag (p<0.01)1 week following the operation than the group who did not have lag at 1 month; no difference was found intra-operatively or post-operatively. Patients with lag at 1 month had an average pre-operative BLF significantly less than patients with no lag at 1 month (p<0.005) and had a borderline-significant smaller pre-op MRD1 when compared to patients with no lag at 1 month. A significant positive correlation existed between measured lag at 1 week and measured lag at 1 month (p<0.001, Pearson’s=0.52, y=0.476x+0.022). A significant negative correlation existed between pre-operative MRD1 and the amount of lag at 1 month (p<0.01, Pearson’s=-0.36, y=-0.11x+0.22). A significant correlation was also found between preoperative BLF and amount of lag at 1 month (p<0.001, Pearson’s=-0.5, y=-0.89x+1.49).
Intra-operative and post-operative lag should not cause the surgeon to alter lid height during levator muscle advancement. Lag at 1 week correlated with lid height at 1 month after surgery, supporting early intervention to correct post-operative lag. Smaller pre-operative MRD1 is associated with larger values of lag 1 month after surgery, indicating surgical accuracy may decrease with larger advancements. Poor levator muscle function correlated with increased lag 1 month after surgery. MRD1 and BLF measurements should be obtained pre-operatively and may be predictive of outcome.
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