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Christine Zemsky, Larissa Ghadiali, Noam Rudnick, Bryan J Winn; Dry Eye in Patients Undergoing External Levator Advancement Surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3837.
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Few studies have examined dry eye syndrome (DES) as a consequence of external levator advancement (ELA) surgery. The purpose of this retrospective study was to examine risk factors for dry eye signs and symptoms after ELA, in order to improve pre-operative planning.
A retrospective chart analysis was performed on all patients who underwent ELA from 1/1/2014 to 12/31/2014 performed by one surgeon (BJW). Margin-reflex distance-1 (MRD1) was measured pre- and post-operatively. Dry eye symptoms (DSX) and punctate corneal erosions (PE) were recorded for visits pre-operatively, post-operatively at week 1, and month 3. DSX and PE were graded 0 to 3, where 0 = none, 1 = mild, 2 = moderate, and 3 = severe. Subgroup analysis was performed on patients with a pre-existing diagnosis of DES, eyes undergoing simultaneous upper lid blepharoplasty (ULB), and eyes undergoing simultaneous lateral tarsal strip (LTS). Statistical measures included analysis of variance (ANOVA) in conjunction post hoc comparison tests at each time point.
A total of 68 eyes (39 patients) were included in the analysis. 32% were DES patients, 34% had simultaneous ULB, and 26% had simultaneous LTS. Mean pre-and post-operative MRD1 were 0.0mm and 3.5mm, respectively (p < 0.0001). DSX grade increased significantly after surgery (0.10 pre-operative, 0.34 3-months post-operative, p < 0.005), although only one patient had a DSX score greater than 1. No significant difference was observed in PE analysis. DES patients experienced worse DSX post-operatively at week 1 compared to patients without pre-existing DES (0.41 versus 0.07, p < 0.005), but this difference was no longer present at 3 months (0.36 versus 0.33, p > 0.05). Simultaneous ULB and LTS did not result in any significant increase of DSX or PE. While there was no significant difference in post-operative MRD1 between patients experiencing DSX and those who did not, there was a significant difference in the postoperative change in MRD1 between those with DSX and those without, 4.1mm vs. 3.3mm, respectively. (p = 0.0138). (Figure 1)
ELA may cause an increase in DSX 3 months post-operatively in patients with and without pre-existing DES. Greater intraoperative change in MRD1 rather than absolute post-operative MRD1 appears to be related to increased risk of DSX after surgery.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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