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DOI: 10.1055/s-0042-1751101
Study to the Effect of Involutional Blepharoptosis Surgery Using Objective and Subjective Parameters
Funding None.
Abstract
Background We investigate the effect of involutional blepharoptosis (IB) surgery based on dry eye symptoms by analysis using objective and subjective measures.
Methods We recorded various parameters from patients that underwent levator advancement surgery for IB, totaling 125 eyes (total 65 patients, 5 unilateral, 60 bilateral). Subjective assessment comprised a questionnaire on dry eye-related quality of life score (DEQS), a summary score calculated from DEQS, and six-grade evaluation, the patient's own measure of eye comfort. Objective assessment comprised marginal-reflex distance-1 (MRD-1), measurement of tear film breakup time, and superficial keratopathy (SPK) existence by slit lamp microscope.
Results Subjective assessments showed that IB patients had improvement of dry eye symptoms and eye comfort when surgery increased MRD-1. On the other hand, objective assessments showed that the presence of SPK is suspected when the postoperative MRD-1 level is 3 mm or higher.
Conclusion IB surgery must not only increase MRD-1 value, but also to perform maintenance of the appropriate ocular surface condition. From our parameters, we suggest postoperative MRD-1 value should be maintained at < 3 mm to safe and effective of IB surgery.
Keywords
involutional blepharoptosis - dry eye-related quality of life score questionnaire - marginal-reflex distance-1 - tear film breakup time and superficial keratopathyAuthor Contributions
Design and conceptualization of the study: S.A. and S.S. Study conduction: Y.W. and S.T. Data curation: S.A., Y.W., and S.T. Writing - original draft: S.A. Writing-review & editing: S.A. and S.S. All authors read and approved the final manuscript.
Ethical Approval
Approval was obtained from our hospital Institutional Review Board prior to initiation of this study (authorization number: 1718, IRB number: 11000505, Registration number: 5NuhaMi2Pm).
Patient Consent
The research was conducted in accordance with the Declaration of Helsinki, and prior written informed consent was obtained from all patients after receiving a detailed explanation of the study protocols and the possible consequences associated with participation.
Prior Presentation
This study was presented at the 62nd Annual Meeting of the Japan Society of Plastic and Reconstructive Surgery, May 15–17, 2019.
Ethical Approval
This study was approved by the Keio University School of Medicine Ethics Committee (approval no. 20070026).
Publication History
Article published online:
30 July 2022
© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical Publishers, Inc.
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References
- 1 Hong JP, Park CJ, Suh HP. Importance of vascularity and selecting the recipient vessels of lower extremity reconstruction. J Reconstr Microsurg 2021; 37 (01) 83-88
- 2 Huijing MA, van der Palen J, van der Lei B. The effect of upper eyelid blepharoplasty on eyebrow position. J Plast Reconstr Aesthet Surg 2014; 67 (09) 1242-1247
- 3 Kim HH, De Paiva CS, Yen MT. Effects of upper eyelid blepharoplasty on ocular surface sensation and tear production. Can J Ophthalmol 2007; 42 (05) 739-742
- 4 Noma K, Takahashi Y, Leibovitch I, Kakizaki H. Transcutaneous blepharoptosis surgery: simultaneous advancement of the levator aponeurosis and Müller's muscle (levator resection). Open Ophthalmol J 2010; 4: 71-75
- 5 Uemura K, Shirakawa U, Okuda K. et al. Essence of blepharoptosis surgery does rasises the eyelids, is not just cosmetic improvement: especially in the elderly patient. J Wakayama Med Soc 2022; 73 (01) 9-14
- 6 Bahceci Simsek I. Association of upper eyelid ptosis repair and blepharoplasty with headache-related quality of life. JAMA Facial Plast Surg 2017; 19 (04) 293-297
- 7 Cahill KV, Bradley EA, Meyer DR. et al. Functional indications for upper eyelid ptosis and blepharoplasty surgery: a report by the American Academy of Ophthalmology. Ophthalmology 2011; 118 (12) 2510-2517
- 8 Pacella SJ, Codner MA. Minor complications after blepharoplasty: dry eyes, chemosis, granulomas, ptosis, and scleral show. Plast Reconstr Surg 2010; 125 (02) 709-718
- 9 Prischmann J, Sufyan A, Ting JY, Ruffin C, Perkins SW. Dry eye symptoms and chemosis following blepharoplasty: a 10-year retrospective review of 892 cases in a single-surgeon series. JAMA Facial Plast Surg 2013; 15 (01) 39-46
- 10 Federici TJ, Meyer DR, Lininger LL. Correlation of the vision-related functional impairment associated with blepharoptosis and the impact of blepharoptosis surgery. Ophthalmology 1999; 106 (09) 1705-1712
- 11 Watanabe A, Kakizaki H, Selva D. et al. Short-term changes in tear volume after blepharoptosis repair. Cornea 2014; 33 (01) 14-17
- 12 Watanabe A, Selva D, Kakizaki H. et al. Long-term tear volume changes after blepharoptosis surgery and blepharoplasty. Invest Ophthalmol Vis Sci 2014; 56 (01) 54-58
- 13 Sakane Y, Yamaguchi M, Yokoi N. et al. Development and validation of the Dry Eye-Related Quality-of-Life Score questionnaire. JAMA Ophthalmol 2013; 131 (10) 1331-1338
- 14 Shiraishi A, Sakane Y. Assessment of dry eye symptoms: current trends and issues of dry eye questionnaires in Japan. Invest Ophthalmol Vis Sci 2018; 59 (14) DES23-DES28
- 15 Pereira LS, Hwang TN, Kersten RC, Ray K, McCulley TJ. Levator superioris muscle function in involutional blepharoptosis. Am J Ophthalmol 2008; 145 (06) 1095-1098
- 16 Aakalu VK, Setabutr P. Current ptosis management: a national survey of ASOPRS members. Ophthal Plast Reconstr Surg 2011; 27 (04) 270-276
- 17 Floegel I, Horwath-Winter J, Muellner K, Haller-Schober EM. A conservative blepharoplasty may be a means of alleviating dry eye symptoms. Acta Ophthalmol Scand 2003; 81 (03) 230-232
- 18 Mertzanis P, Abetz L, Rajagopalan K. et al. The relative burden of dry eye in patients' lives: comparisons to a U.S. normative sample. Invest Ophthalmol Vis Sci 2005; 46 (01) 46-50
- 19 Rajagopalan K, Abetz L, Mertzanis P. et al. Comparing the discriminative validity of two generic and one disease-specific health-related quality of life measures in a sample of patients with dry eye. Value Health 2005; 8 (02) 168-174
- 20 Abetz L, Rajagopalan K, Mertzanis P, Begley C, Barnes R, Chalmers R. Impact of Dry Eye on Everyday Life (IDEEL) Study Group. Development and validation of the impact of dry eye on everyday life (IDEEL) questionnaire, a patient-reported outcomes (PRO) measure for the assessment of the burden of dry eye on patients. Health Qual Life Outcomes 2011; 9: 111
- 21 Murchison AP, Sires BA, Jian-Amadi A. Margin reflex distance in different ethnic groups. Arch Facial Plast Surg 2009; 11 (05) 303-305
- 22 Chen WPD. Asian upper blepharoplasty. JAMA Facial Plast Surg 2018; 20 (03) 249-250
- 23 Moesen I, van den Bosch W, Wubbels R, Paridaens D. Is dry eye associated with acquired aponeurogenic blepharoptosis?. Orbit 2014; 33 (03) 173-177
- 24 Brooks AM, Grant G, Gillies WE. The influence of superficial epithelial keratopathy on the corneal endothelium. Ophthalmology 1989; 96 (05) 704-708
- 25 Roussel T, Grutzmacher R, Coster D. Patterns of superficial keratopathy. Aust J Ophthalmol 1984; 12 (04) 301-316
- 26 Thygeson P. Clinical and laboratory observations on superficial punctate keratitis. Am J Ophthalmol 1966; 61 (5 Pt 2): 1344-1349
- 27 Kato H, Yokoi N, Watanabe A. et al. Relationship between ocular surface epithelial damage, tear abnormalities, and blink in patients with dry eye. Cornea 2019; 38 (03) 318-324
- 28 Wang MTM, Tien L, Han A. et al. Impact of blinking on ocular surface and tear film parameters. Ocul Surf 2018; 16 (04) 424-429
- 29 McMonnies CW. Incomplete blinking: exposure keratopathy, lid wiper epitheliopathy, dry eye, refractive surgery, and dry contact lenses. Cont Lens Anterior Eye 2007; 30 (01) 37-51
- 30 Uchino M, Dogru M, Yagi Y. et al. The features of dry eye disease in a Japanese elderly population. Optom Vis Sci 2006; 83 (11) 797-802
- 31 Dailey RA, Saulny SM, Sullivan SA. Müller muscle-conjunctival resection: effect on tear production. Ophthal Plast Reconstr Surg 2002; 18 (06) 421-425
- 32 Lee WB, McCord Jr CD, Somia N, Hirmand H. Optimizing blepharoplasty outcomes in patients with previous laser vision correction. Plast Reconstr Surg 2008; 122 (02) 587-594
- 33 Shields M, Putterman A. Re: “Müller muscle-conjunctival resection: effect on tear production”. Ophthal Plast Reconstr Surg 2003; 19 (03) 254-255