June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Glaucoma drainage device and trabeculectomy surgery is associated with a higher rate of post-operative blepharoptosis compared to cataract extraction in a prospective cohort
Author Affiliations & Notes
  • Gavin W Roddy
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Chengbo Feng
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Zhao Bingying
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Jasmina Bajric
    Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Cheryl Khanna
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Footnotes
    Commercial Relationships   Gavin Roddy, None; Chengbo Feng, None; Zhao Bingying, None; Jasmina Bajric, None; Cheryl Khanna, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4969. doi:
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      Gavin W Roddy, Chengbo Feng, Zhao Bingying, Jasmina Bajric, Cheryl Khanna; Glaucoma drainage device and trabeculectomy surgery is associated with a higher rate of post-operative blepharoptosis compared to cataract extraction in a prospective cohort. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4969.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Blepharoptosis (or ptosis) is a complication following cataract extraction (CE) and trabeculectomy occurring as frequently as 4 – 21% and 10%, respectively, while its incidence glaucoma drainage device (GDD) placement is unknown. We sought to determine the rate of post-operative ptosis in patients who underwent, trabeculectomy, GDD placement, and/or CE.

Methods : 48 patients were prospectively and consecutively enrolled who underwent GDD placement, trabeculectomy, and/or CE by a single surgeon at Mayo Clinic, Rochester, MN and completed one month follow-up. Palpebral fissures were measured pre-operatively and one month post-operatively. Ptosis was defined as a decrease in palpebral fissure of ≥2 mm when compared pre and post-operatively. A student’s t-test was used for statistical analysis.

Results : Twenty patients underwent trabeculectomy surgery (5 of these were combined trabeculectomy and CE), 16 patients who underwent GDD placement (one underwent combined GDD placement and cataract extraction), and 12 patients who underwent CE by phacoemulsification alone. Patients undergoing CE had change in palpebral fissures of 0 ± 0.9 mm and a rate of ptosis of 8%. Patients undergoing trabeculectomy had a decrease in palpebral fissure length of 1 ± 1.3 mm and a rate of ptosis of 25% (p=0.3 vs. cataract extraction alone). Patients undergoing GDD placement had a decrease in palpebral fissure length of 1 ± 1.2 mm (p=0.07 vs CE alone) and a rate of ptosis of 25%.

Conclusions : In our prospective single surgeon study, patients undergoing glaucoma surgery including trabeculectomy or GDD placement had a higher incidence of post-operative ptosis than patients who underwent CE alone. In our study, one out of every four patients who underwent glaucoma surgery developed post-operative ptosis. This is significant for patients as ptosis may further limit their already restricted visual field. We hypothesize that the greater incidence of ptosis with glaucoma surgery is secondary to greater conjunctival dissection, manipulation of the extraocular muscles, and duration of surgery compared to CE alone. Glaucoma surgeons may elect to discuss the high risk of post-operative ptosis in the pre-operative setting for patients undergoing trabeculectomy and GDD placement.

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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