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DH Kim, EH Black, GJ Gladstone; Lagophthalmos in Repeat Ptosis Surgery . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1470.
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Purpose: The purpose of this study is to analyze the relationship between measured intra-operative lagophthalmos and immediate post-operative lagophthalmos with one week and one month post-operative lagophthalmos following levator advancement surgery in patients having reoperations for ptosis. Methods: Patients that were included in the study were all persons of any age, race and either sex, with recurrent ptosis following previous ptosis surgery. The study evaluated twenty-three eyelids in twenty-two patients during a two-year period. Patients were examined pre-operatively, intra-operatively, immediately post-operatively, at 1 week, and at 1 month post-operatively. Measurements included a pre-operative MRD1, pre-operative levator function, intra-operative lagophthalmos, immediate post-operative lagophthalmos, one week post-operative lagophthalmos, and one month post-operative lagophthalmos. Correlation analysis was performed between intra-operative lagophthalmos and the one week and one month lagophthalmos. Also, correlation analysis between the immediate post-operative lagophthalmos and one week and one month lagophthalmos was calculated. Results: There was a significant correlation (R) between the intra-operative lagophthalmos and one week lagophthalmos of 0.436 with a p-value 0.026. The intra-operative lagophthalmos and one month lagophthalmos is 0.426 with a p-value of 0.0299. The immediate post-operative lagophthalmos and one week lagophthalmos had a correlation of 0.470 with a p-value of 0.0155. The correlation between the immediate post-operative lagophthalmos and one month lagophthalmos was 0.414 with a p-value of 0.357. All comparisons showed a significant correlation between the variables. Conclusion: The concept of lagophthalmos in ptosis surgery is important because it can have a significant impact on the overall health of the eye and the success of the procedure. Previous studies have shown no correlation between intra-operative and post-operative lagophthalmos compared with later lagophthalmos (1 week and 1 month post-operative) in primary ptosis surgery. This lack of correlation is felt to be due to local anesthetic paralysis of the orbicularis. However, the condition of the tissue (skin, muscle and levator) is different in repeat ptosis cases, therefore this situation warranted separate analysis. The results of this study confirm that there is a lagophthalmos correlation in cases of repeat ptosis surgery and this must be considered when performing this surgery. This correlation is likely due to scarring and fibrosis of the anterior lamella and/or levator complex, and associated loss of elasticity.
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