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Maria M Choudhary, Tal Joshua Rubinstein, Bryan R Costin, Julian D Perry; Effect of Conjunctival-Müllerectomy with or without Tarsectomy for Blepharoptosis Repair on Eyelid Contour. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3111.
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While eyelid height has been used as the gold standard outcome measure for blepharoptosis repair, eyelid contour represents an important outcome that has not been previously studied. We sought to quantitatively determine the effect of conjunctival-müllerectomy with or without tarsectomy for blepharoptosis repair on upper eyelid contour.
We retrospectively reviewed the charts of consecutive patients undergoing unilateral conjunctival-müllerectomy with or without tarsectomy (CM+-T) for blepharoptosis repair at the Cole Eye Institute between June 2012 and October 2013. Exclusion criteria included concurrent or prior eyelid or eyebrow surgery, lack of appropriate photographs, and known history of systemic disease affecting the eyelid. A consecutive series of patients without a history of upper eyelid surgery or complaints who had undergone lower eyelid ectropion repair during the study period were used as controls. Institutional Review Board approval was obtained for this study. Preoperative and postoperative digital images of the palpebral fissure in primary gaze of patients were studied. Measurements were performed similar to a previously published study evaluating upper eyelid contour in patients with dysthyroid upper eyelid retraction. Radial mid-pupil to eyelid distances were calculated by digitally rendering vertical lines 15 degrees apart (from 0 to 180 degrees) using NIH ImageJ64 software (Bethesda, MD). Eyelid contour was computed as a ratio of the sum of lateral to the sum of the medial mid-pupil eyelid heights. Eyelid contours were compared using the student t tests.
Nine of 67 patients met inclusion criteria. Mean patient age was 58 years (range: 32-85 years) for the study population and 68 years (range: 48-78 years) for controls. The mean lateral/medial ratio of the affected eye was 1.25 (SD: 0.33) pre-operatively and 1.26 (SD: 0.27) postoperatively (p = 0.92). The mean ratio for un-operated fellow eyes was 1.23 (SD: 0.21, p = 0.50). The mean ratio for the un-operated control eyes was 1.23 (SD: 0.25, p = 0.89).
There is no statistically significant difference in eyelid contour following CM+-T compared to preoperative contour, fellow eye contour or to the contour of normal controls. This method of measuring eyelid contour can be used to compare the outcomes of different blepharoptosis repair techniques.
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