Open Access
CC BY 4.0 · Arch Plast Surg 2023; 50(05): 446-451
DOI: 10.1055/s-0043-1770082
Cosmetic
Original Article

Safety and Pitfalls of Blepharoptosis Surgery in Elderly People

Yuji Shirakawa 
1   Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
,
Kazuhisa Uemura 
1   Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
,
Shinji Kumegawa 
1   Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
,
Kazuki Ueno 
1   Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
,
Hiroki Iwanishi 
2   Department of Ophthalmology, Wakayama Medical University, Wakayama City, Wakayama, Japan
,
Shizuya Saika 
2   Department of Ophthalmology, Wakayama Medical University, Wakayama City, Wakayama, Japan
,
Shinichi Asamura 
1   Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
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Abstract

Background Elderly patients often have complications of blepharoptosis surgery that can result in the appearance or exacerbation of superficial punctate keratopathy (SPK). However, postoperative changes to SPK status have not been previously reported. We used subjective assessment of symptoms and measurement of SPK scale classification to investigate the safety and efficacy of blepharoptosis surgery in elderly patients.

Methods Included in this prospective study were 22 patients (44 eyes) with bilateral blepharoptosis that underwent surgery. Patients comprised 8 males and 14 females with a mean (±standard deviation) age of 75.7 ± 8.2 years (range: 61–89). Blepharoptosis surgery consisted of transcutaneous levator advancement and blepharoplasty including resection of soft tissue (skin, subcutaneous tissue, and the orbicularis oculi muscle). Margin reflex distance-1 (MRD-1) measurement, a questionnaire survey of symptoms and SPK scale classification, was administered preoperatively and 3 months postoperatively for evaluation.

Results The median MRD-1 was 1 mm preoperatively and 2.5 mm postoperatively, representing a significant postoperative improvement. SPK area and density scores were found to increase when the MRD-1 increase was more than 2.5 mm with surgery. All 10 items on the questionnaire tended have increased scores after surgery, and significant differences were observed in 7 items (poor visibility, ocular fatigue, heavy eyelid, foreign body sensation, difficulty in focusing, headaches, and stiff shoulders).

Conclusion Blepharoptosis surgery was found to be a safe and effective way to maintain the increase in MRD-1 within 2.0 mm. Despite the benefits, surgeons must nonetheless be aware that blepharoptosis surgery is a delicate procedure in elderly people.

Keywords

blepharoptosis - elderly patients - superficial punctate keratopathy - margin reflex distance-1 - subjective symptoms

Authors' Contributions

Design and conceptulization of the study: Y.S., S.S., and S.A.

Study conduction: Y.S., K.U., K.U., and H.I.

Clinical databeses: Y.S., K.U., S.K., and K.U.

Formal analysis: Y.S., K.U., S.K., and H.I.

Writing original draft: Y.S., K.U., and S.K.

Writing-review & editing: S.K., S.S., and S.A.


Ethical Approval

The study was approved by an appropriate institutional review board of Wakayama Medical University (approval number: 2549), and performed in accordance with the tenets of the Declaration of Helsinki.


Patient Consent

The patients’ legal guardian provided written informed consent for the publication and the use of the patients’ images.




Publication History

Received: 07 February 2023

Accepted: 10 May 2023

Article published online:
28 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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