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A. R. Gohari, H. Park, M. Shah, A. M. Lessner, M. F. Smith; Changes in Eyelid Anatomy and Function After Phacoemulsification. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3575.
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To study eyelid anatomy and function before and after intraocular surgery, and evaluate variables associated with post-operative blepharoptosis.
Medical records of patients undergoing phacoemulsification from 9/06 to 12/06 were reviewed retrospectively. Eyelid parameters evaluated included horizontal fissure height (HFH), vertical fissure height (VFH), marginal reflex distance one (MRD1), marginal reflex distance two (MRD2), levator function (LF), and upper lid crease distance (ULC). These parameters were analyzed preoperatively, on postoperative day 1 (POD1), postoperative day 7 (POD7), and postoperative day 30 (POD30). The non-operative eye served as the control for the surgical eye. Operative variables included type of surgery, duration of surgery, type of eyelid speculum, type of drape, method of removal of drape, use of retrobulbar block, use of bridal suture, and use of post-operative patching. Prior eyelid surgery in either eye and absence of complete eyelid parameter data were the main exclusion criteria.
Data analysis of cases undergoing PHACO/PCIOL demonstrated a 1.1 mm average decrease in MRD1 (p=0.001), a 1.4 mm average decrease in VFH (p=0.004), and a corresponding 0.4 mm increase in ULC (p=0.004) when comparing eyelid parameters between the pre-operative and POD1 visit. There were no statistically significant eyelid parameter changes noted between POD1 and POD7. MRD1 increased by an average of 0.35 mm (p=0.005) with a corresponding average increase of 0.46 (p=0.01) in VFH between POD7 and POD30. When comparing the pre-operative and POD30 eyelid parameters, the only statistically significant change was an average decrease of 0.7 mm in MRD1 (p=0.01). The range of decrease in MRD1 was zero to 2.5 mm. Trace ptosis (< 1mm) was noted in 7 of the 23 cases (30%) and 2 patients (8%) showed mild ptosis (1mm-2.5mm) when comparing the POD30 to the preoperative visit. There was no statistically significance difference in eyelid function when comparing the Lieberman eyelid and a wire speculum.
Statistically significant decrease in MRD1 (average of 1.1 mm) was noted in this study when comparing eyelid parameters between the preoperative and POD30. Patients should be aware of the risk of mild eyelid ptosis (1mm to 2.5mm) as a possible complication of cataract surgery.
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