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T.N. Garvin, C.C. Nelson, D.C. Musch, G.J. Lelli, Jr., E.C. Lillard; A Standardized Method to Evaluate Cosmetic Outcomes Following Ptosis Repair . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3971.
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© ARVO (1962-2015); The Authors (2016-present)
To design a standardized method to systematically evaluate cosmetic outcomes following silicone rod frontalis sling suspension for correction of ptosis.
We obtained the post–operative photographs of 33 patients who underwent frontalis silicone rod sling suspension at our center. In order to rate the cosmetic outcome of the procedure, we designed a scale to systematically evaluate multiple eyelid parameters. Two masked and unbiased observers were chosen to evaluate the photographs using this scale. After reviewing a learning set of 17 randomly selected photographs, they evaluated the post–operative photographs of the 33 study patients. Several revisions were made to the scale, and the two reviewers reevaluated the 33 post–operative photographs using the final refined scale. Lid contour, lid height, symmetry of lid height, symmetry of lid crease, and overall cosmesis could be rated as good, acceptable, or poor. Lash ptosis and lid crease were rated as either present or absent. Disagreement was arbitrated by a third expert evaluator. For all parameters, the percent agreement between the two observers was determined. Kappa statistics were calculated to determine the level of agreement beyond chance.
Interobserver agreement as assessed by kappa values ranged from 0.58 for overall cosmesis to 0.29 for lid crease symmetry, with intermediate values for lid height symmetry (0.54) and lid contour (0.42). Kappa values from 0.41 to 0.60 reflect moderate agreement beyond chance. The two observers agreed well (94%) on the presence a lid crease, and somewhat less on the presence of lash ptosis (79%). Picture quality did not significantly impact interobserver agreement.
The scale we developed is a useful tool to provide a more objective evaluation of subjective outcomes. It showed good interobserver agreement, and in the future, it could be used by both physicians and patients to rate cosmetic outcomes following various oculoplastic procedures.
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