Ptosis secondary to anterior segment surgery and its repair in a two-year follow-up study.

OBJECTIVE: Aponeurotic blepharoptosis is a postoperative complication of anterior segment surgery with a reported incidence of 1-2% and a variable aetiology. In this 2-year follow-up study, we investigated the incidence of this postoperative complication in our experience of anterior segment surgery and propose a modified technique of aponeurosis advancement for its repair. METHODS: 200 consecutive patients undergoing anterior segment surgery in our eye clinic were enrolled in the study. Patients who developed any other operative or postoperative complication were excluded from the study. In all patients, the following upper lid parameters were calculated to determine whether postoperative blepharoptosis had occurred: margin-reflex distance, upper eyelid crease, use of frontalis muscle and levator function. A questionnaire was submitted to all blepharoptosis patients investigating mainly their subjective judgement of the impact of blepharoptosis on their quality of life and if they had been informed accurately about the incidence of this postoperative complication. RESULTS: 163 patients were included in our study. 11 had postoperative blepharoptosis (6.7%). 9 patients wanted ptosis repair and were operated on with our modified technique. None of the 11 ptosis patients had been informed about the possible occurrence of the blepharoptosis as postoperative complication. Our modified technique shows good, long-lasting results. CONCLUSIONS: Postoperative blepharoptosis is a well-known postoperative complication of anterior segment surgery. It can be successfully treated surgically by aponeurosis advancement. It is our opinion that all patients should be informed of the possibility of postoperative blepharoptosis when consenting for anterior segment surgery.

Modified retractor plication technique in lower lid entropion repair: a 4-year follow-up study.

BACKGROUND: Lower eyelid entropion is an eyelid malposition characterized by inward rotation of the eyelid margin associated with potentially significant discomfort and, occasionally, keratopathy. In this study we evaluated and compared the efficacy of two surgical techniques of retractor plication for involutional lower lid entropion repair. METHODS: Sixty-two consecutive patients (62 eyes) with involutional lower lid entropion were included. Of the 62, 34 underwent the Jones retractor plication technique, and 28 underwent a modification of this technique that simplifies the procedure. We evaluated horizontal lid laxity, medial canthal tendon laxity and lower lid excursion before and after surgery, and determined the rate of entropion recurrence in the two groups. All measures were obtained before and 1 month, 6 months, 1 year, 2 years, 3 years and 4 years after surgery. RESULTS: Preoperatively, there was no statistically significant difference between the two groups in any of the measures studied. Postoperatively, the mean amount of horizontal lid laxity was significantly less in the modified technique group than in the Jones technique group (6.86 mm [standard deviation (SD) 0.41 mm] vs. 7.30 mm [SD 0.64 mm]) (p < 0.05). Similarly, the mean amount of medial canthal tendon laxity in the resting position was significantly less in the modified technique group than in the Jones technique group (1.90 mm [SD 0.56 mm] vs. 1.25 mm [SD 0.43 mm]) (p < 0.05). The rate of entropion recurrence was significantly lower in the modified technique group (7.1%) than in the Jones technique group (14.7%) (p < 0.05). INTERPRETATION: The modified retractor plication technique showed encouraging results in terms of successful and long-lasting lower lid entropion repair.