Purpose: We reported a novel method for evaluating the cross-sectional image of the upper eyelid using anterior segment optical coherence tomography (AS-OCT). In this study, we examined the features of the eyelids, including the early characteristics of blepharoptosis, after the patients underwent three types of intraocular surgeries.
Methods: This prospective study included age- and sex-matched patients (48 eyes of 48 patients) who underwent phacoemulsification cataract surgery (PEA group, 70.2±6.3 years), Ex-PRESS^Ⓡ glaucoma filtration surgery (EX group, 72.1±4.7 years), and pars plana vitrectomy (PPV group, 69.1±4.4 years) at Ehime University Hospital and Hanamizuki Eye Clinic between March 2020 and December 2021. The upper eyelids were examined by AS-OCT (CASIA2, TOMEY Corporation) using the raster scan method before surgery, at 1 week, and after 1 month of the surgery. The analyzed main outcome parameters were the margin reflex distance 1 (MRD1, defined as the distance between the upper eyelid margin and pupil) calculated using the front monitor of AS-OCT, upper eyelid thickness (UET, defined as the length of the vertical line that passes through the eyelid peak to central cornea), and cross-sectional area (CSA, defined as the area of the eyelid sections 6-mm cranially from the corneal peak) of the upper eyelid measured in the sagittal images. The correlation between the postoperative decreasing MRD1 and possible risk factors, such as age, preoperative levator function, intraoperative width of the speculum, and operation time, was analyzed by performing simple linear regression analysis.
Results: Preoperative MRD1 was not significantly different among the three groups (p=0.253; analysis of variance). MRD1 was significantly lower at 1 week and 1 month after the surgery than MRD1 before the surgery in the EX group (p=0.033 and p=0.028, respectively). No significant difference was found in MRD1 in the PEA and PPV groups before and after the surgery. The postoperative CSA was significantly increased at 1 week in the EX (p=0.022) and PPV (p=0.031) groups. The postoperative decrease in MRD1 was significantly and negatively correlated with the levator function (r=-0.367, p=0.037) and significantly and positively correlated with the intraoperative width of the speculum (r =0.387, p=0.021).
Conclusions: The eyelid features change after undergoing intraocular surgery. Glaucoma filtration surgery, preoperative impaired levator function, and excessive intraoperative eye opening are possible risk factors of blepharoptosis.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 599-605,2023.