Postoperative Ptosis after Cataract and Glaucoma Surgery

A retrospective study was done on 189 eyes of 156 patients who underwent cataract and/or glaucoma surgery to evaluate the effect of surgical technique, operation time, age of patients, mitomycin C use and superior rectus muscle injury on the incidence of postoperative ptosis. Interpalpebral fissure and levator funtion were measured preand postoperatively. All patients had topical and pin-point anesthesia. For the cataract patients, wire speculum was used and traction suture on superior rectus muscle was performed with 4-0 black silk. For the glaucoma patients, plate speculum was used and traction suture on superior rectus muscle was performed with 6-0 black silk. Decrease of the interpalpebral fissure over 2mm were observed in 7 of 115 eyes (6.0%) in cataract surgery, 5 of 51 eyes (9.8%) in glaucoma surgery and 3 of 23 eyes (13.0%) in triple surgery for cataract and glaucoma at postoperative 6 months. The variables significantly infuencing the incidence of ptosis were as follows; age of the patients (more than 50 years old. relative risk=1.7), operation time (more than 40 minutes, R.R=2.3) and mitomycin C use (R.R.=1.9). Development of superior rectus hematoma during the traction suture did not affect the incidence of postoperative ptosis.

Clinical Evaluation of Ptosis after Scleral Buckling

We evaluated the degree of ptosis, the function of levator muscle, and postoperative interval to recovery of ptosis in 20 patients who underwent scleral buckling for retinal detachment. The MRD 1(Margin reflex distance 1), function of levator muscle by Berke method and interpalpebral fissure height were evaluated at preoperative day and 1, 3 days, 1, 2, 4, 6, 8, weeks, and 6 months after surgery. The results were compared according to age, gender, extent of buckling, location of buckle. All patients were reported to develop ptosis at postoperative day one, and 20% of them showed mild ptosis persistent until 8 weeks after surgery. The decrement of MRD 1 was statistically significant until postoperative 2 weeks, but impaired function of levator muscle was statistically significant until postoperative 6 weeks(P<0.05). The postoperative interval to recovery of MRD 1 was delayed in group of old age(order than 40 years), in male and when the buckle was located under the superior rectus muscle(P<0.05). The postoperative interval to recovery of function of levator muscle was delayed in group of female, when the buckle extent was more than 180 degrees and when the buckle was located under the superior rectus muscle(P<0.05).