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Rika Shirakawa, Tetsuya Toyono, Reina Akiyama, Mika Noda, Reiko Arita, Junko Yoshida, Takashi Miyai, Tomohiko Usui; Impact of aponeurotic blepharoptosis surgery to the tarsal plate and the Meibomian gland. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4928.
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© ARVO (1962-2015); The Authors (2016-present)
In the aponeurotic blepharoptosis surgery, permanent sutures were placed in the tarsal plate. The aim of this study is to investigate influence of the blepharoptosis surgery to the tarsal plate and the Meibomian gland.
Subjects are patients who had undergone aponeurotic ptosis surgery. The levator aponeurosis was exposed and advanced by the anterior approach. Three 6-0 nylon monofilament sutures (6-0 Prolene) were placed to the upper one third of the tarsal plate.Preoperative levator function (LF), preoperative (Pre) and 6 month postoperative (POM6) Margin reflex distance (MRD),tear meniscus height (TMH) measured by Keratograph 5M (OCULUS Inc.), fluorescein staining score (FS: 0-9), and Schirmer test (ST) were obtained. Pre and POM6 Meibography and meiboscore (0-3) of the upper and lower eyelids were also obtained by non-contact meibography (Topcon Corp.).
Thirty nine eyes of 29 patients (7 male and 22 female, age 73.4±9.1 years) were enrolled. Preoperative levator function was 10.7±2.3mm. Pre and POM6 MRD were 0.3 ± 0.5mm and 2.2 ± 1.2mm, respectively (p<0.0001). TMH, FS and ST at Pre/ POM6 were 0.4 ± 0.3/ 0.4 ± 0.3mm (p=0.39), 0.9 ± 0.8/ 0.8 ± 0.8 (p=0.24) and 10.6 ± 8.3/ 10.3 ± 9.0 mm (p=0.44), respectively.Nine upper eyelids of 7 patients were impossible to be everted. Among 30 upper eyelids which can be everted, distortion of the upper tarsal plate were observed in 17 tarsal plates of 14 patients when everted. Among 29 eyelids in which both pre and post operative meibography could be obtained, prepoperative Meiboscore of the upper/ lower eyelids were 2.1 ±0.5 / 1.7 ±0.9, which was identical to the postoperative meiboscore in each eye.
Placement of suture in the tarsal plate does not lead to morphological change of the Meibomian gland. It is necessary to be aware that eversion of the postoperative upper eyelid could be difficult in some cases.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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