A Prospective Study of Blepharoptosis after Panretinal Photocoagulation Using Ophthalmoscopic Contact Lens

Jeong Kim Yu; Woong Lim Han; Ho Kang Min; Cheol Seong Min; Yoon Cho Hee

doi:10.3341/jkos.2013.54.7.1006

Journal List > J Korean Ophthalmol Soc > v.54(7) > 1009412

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Yu, Han, Min, Min, and Hee: A Prospective Study of Blepharoptosis after Panretinal Photocoagulation Using Ophthalmoscopic Contact Lens

Original Article

J Korean Ophthalmol Soc 2013;54(7):1006-1012.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.7.1006

A Prospective Study of Blepharoptosis after Panretinal Photocoagulation Using Ophthalmoscopic Contact Lens

Jeong Kim Yu, MD, Woong Lim Han, MD, Ho Kang Min, MD, Cheol Seong Min, MD, Yoon Cho Hee, MD

¹Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea

Address reprint requests to Hee Yoon Cho, MD Department of Ophthalmology, Hanyang University Guri Hospital, #153 Gyeongchun-ro, Guri 471-701, Korea Tel: 82-31-560-2350, Fax: 82-31-564-9479 E-mail: hycho@hanyang.ac.kr

Received 13 July 201215 January 2013 Accepted 22 April 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the possibility of blepharoptosis as a complication after panretinal photocoagulation using oph-thalmoscopic contact lens.

Methods

We prospectively evaluated patients who were diagnosed with diabetic retinopathy and scheduled to be treated with panretinal photocoagulation. Margin reflex distance 1 (MRD1), levator function, palpebral fissure height and width, and tarsal plate height were measured at the day of photocoagulation and 3 months after treatment.

Results

MRD1 was decreased in 8 eyes (25.8%), levator function was decreased in 5 eyes (16.1%), and palpebral fissure height was decreased in 6 eyes (19.4%). The decrement of MRD1 and palpebral fissure height after photocoagulation were significant ( p = 0.008, p = 0.031, respectively). There was a significant negative correlation between MRD1 decre-ment and tarsal plate height ( p = 0.045).

Conclusions

We identified blepharoptosis after panretinal photocoagulation using contact ophthalmoscopic lens, which was related with low tarsal plate height.

Keywords: Blepharoptosis, Diabetic retinopathy, Ophthalmoscopic contact lens, Panretinal photocoagulation, Ptosis

References

1. The Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. Ophthalmology. 1981; 88:583–600.

2. Neubauer AS, Ulbig MW. Laser treatment in diabetic retinopathy. Ophthalmologica. 2007; 221:95–102.

3. Prendiville PL, McDonnell PJ. Complications of laser surgery. Int Ophthalmol Clin. 1992; 32:179–204.

4. Yuki T, Kimura Y, Nanbu S, et al. Ciliary body and choroidal de-tachment after laser photocoagulation for diabetic retinopathy. A high-frequency ultrasound study. Ophthalomology. 1997; 104:1259–64.

5. Mehat MS, Sood V, Madge S. Blepharoptosis following anterior segment surgery: a new theory for an old problem. Orbit. 2012; 31:274–8.

6. Kaplan LJ, Jaffe NS, Clayman HM. Ptosis and cataract surgery: A multivarient computer analsis of a prospective study. Ophthalmology. 1985; 92:237–42.

7. Deady JP, Price NJ, Sutton GA. Ptosis following cataract and trabe-culectomy surgery. Br J Ophthalmol. 1989; 73:283–5.

8. Loeffler M, Solomon LD, Renaud M. Postcataract extraction pto-sis: Effect of the bridle suture. J Cataract Refract Surg. 1990; 16:501–4.

9. Singh SK, Sekhar GC, Gupta S. Etiology of ptosis after cataract surgery. J Cataract Refract Surg. 1997; 23:1409–13.

10. Feibel RM, Custer PL, Gordon MO. Postcataract ptosis: a random-ized double masked comparison of peribulbar and retrobulbar anesthesia. Ophthalmology. 1993; 100:660–5.

11. Ropo A, Ruusuvaara P, Paloheimo M, et al. Periocular anaesthesia: technique, effectiveness and complications with special reference to postoperative ptosis. Acta Ophthalmol (Copenh). 1990; 68:728–32.

12. Alpar JJ. Acquired ptosis following cataract and glaucoma surgery. Glaucoma. 1982; 4:66–8.

13. Altieri M, Truscott E, Kingston AE, et al. Ptosis secondary to ante-rior segment surgery and its repair in a two-year follow-up study. Ophthalmologica. 2005; 219:129–35.

14. Bernardino CR, Rubin PA. Ptosis after cataract surgery. Semin Ophthalmol. 2002; 17:144–8.

15. Ahuero AE, Hatton MP. Eyelid malposition after cataract and re-fractive surgery. Int Ophthalmol Clin. 2010; 50:25–36.

16. Linberg JV, Mcdonald MB, Safir A, Googe JM. Ptosis following radial keratotomy: performed using a rigid eyelid speculum. Ophthalmology. 1986; 93:1509–12.

17. Kim KR, Lee KT, Choi WC. Blepharoptosis after ocular surgery and aponeurosis repair. J Korean Ophthalmol Soc. 2002; 43:2253–7.

18. Lee KH, Lee JK, Ahn Y. A prospective study of ptosis following cataract surgery. J Korean Ophthalmol Soc. 1995; 36:1677–81.

19. Cho YK, Kim HS, Lee YC. Etiological factors of the ptosis after cataract surgery. J Korean Ophthalmol Soc. 2000; 41:1918–24.

20. Uhm SL, Kim JD, Kim JH. Clinical evaluation of ptosis after peri-bulbar anesthesia. J Korean Ophthalmol Soc. 1992; 33:23–8.

21. Paris GL, Quickert MH. Disinsertion of the aponeurosis of the le-vator palpebrae superioris muscle after cataract extraction. Am J Ophthalmol. 1976; 81:337–40.

22. Dal Canto AJ, Downs-Kelly E, Perry JD. Ptosis and orbital fat prolapse after posterior sub-tenon’s capsule triamcinolone injection. Ophthalmology. 2005; 112:1092–7.

23. Song A, Carter KD, Nerad JA, et al. Steroid-induced ptosis: case studies and histopathologic analysis. Eye (Lond). 2008; 22:491–5.

24. Song I, Cho H, Lee Y. Ptosis following laser treatment. Ophthal- mology. 2011; 118:1482.e4-6.

25. Puvanachandra N, Hustler A, Seah LL, Tyers AG. The incidence of ptosis following extracapsular and phacoemulsification surgery: comparison of two prospective studies and review of the literature. Orbit. 2010; 29:321–3.

26. The Early Treatment of Diabetic Retinopathy Study Research Group. Techniques for scatter and local photocoagulation treat-ment of diabetic retinopathy: Early Treatment Diabetic Retinopathy Study report No. 3. Int Ophthalmol Clin. 1987; 27:254–64.

27. Yoon DH, Lee SW, Choi O, et al. Ophthalmology, 7th ed. Seoul: Ilchokak;2005. p. 4.

28. Kim YD, Lee SY, Kim SJ, et al. Ophthalmic plastic and re-constructive surgery, 2nd ed. Seoul: Naewae;2009. p. 17.

29. Kakizaki H, Leibovitch I, Selva D, et al. Orbital septum attachment on the levator aponeurosis in Asians: In vivo and cadaver study. Ophthalmology. 2009; 116:2031–5.

30. Watanabe A, Araki B, Noso K, et al. Histopathology of blephar-optosis induced by prolonged hard contact lens wear. Am J Ophthalmol. 2006; 141:1092–6.

Figure 1.

Distribution of the MRD1 before panretinal photocoagulation.

Figure 2.

Distribution of the levator function before panretinal photocoagulation.

Figure 3.

Distribution of the patients classified into 4 groups by Δ MRD1.

Figure 4.

Significant negative correlationbetween Δ MRD1 and tarsal plate height using correlation analysis (R²=0.132).

Figure 5.

Superquad 160® contact ophthalmoscopiclens (Volk Optical, Inc., USA). The diameters of the eye contact part of each ophthalmoscopic lens are about 16.5 mm, respectively, and the shaft of each contact ophthalmoscopic lens comes in contact with the upper eyelid at an angle of 40 degrees.

Figure 6.

The illustration shows the relation between the eye-lid and contact ophthalmoscopic lens. When the contact oph-thalmoscopic lens is fitted to the eyes, the lower part of the up-per eyelid is bent against the patient’s eyes and the dehiscence or disinsertion at the insertion part of levatoraponeurosis could occur (arrow).

Table 1.

Baseline evaluation of eyelid before panretinal photo-coagulation using ophthalmoscopic contact lens

	Palpebral fissure height (mm)	MRD1(mm)	Levator function (mm)
Treated eye (mm)	6.8 ± 1.4	2.3 ± 1.2	12.3 ± 1.9
	(4.0-10.0)	(0.0-5.0)	(8.0-15.0)
Untreated eye (mm)	6.7 ± 1.4	2.3 ± 1.1	12.4 ± 1.9
	(4.0-10.0)	(0.5-5.0)	(8.0-15.0)

Values are presented as mean ± SD. MRD1 = margin reflex distance 1.

Table 2.

Changes of MRD1 and levator function, palpebral fissure height after panretinal photocoagulation using ophthalmoscopic contact lens

		PostPRP - PrePRP	p-value^*
Treated eyes	MRD1 (mm)	-0.2 ± 0.4 (-1.5-0.0)	0.008
	Levator function (mm)	-0.1 ± 0.3 (-2.0-0.0)	0.063
	Palpebral fissure height (mm)	-0.1 ± 0.3 (-1.0-0.0)	0.031
Untreated eyes	MRD1 (mm)	-0.1 ± 0.4 (-1.5-0.5)	0.203
	Levator function (mm)	-0.1 ± 0.2 (-1.5-0.0)	0.250
	Palpebral fissure height (mm)	-0.1 ± 0.2 (-1.0-0.0)	0.063

Values are presented as mean ± SD. PRP = panretinal photocoagulation; MRD1 = margin reflex distance 1.

^* Wilcoxon test.

Table 3.

Correlation between Δ MRD1 and associated factors

Δ MRD1 (mm)	p‐ value^*	Pearson correlation^*
Age	0.203	0.235
Palpebral fissure height	0.140	0.271
Palpebral fissure width	0.897	‐0.024
Tarsal plate height (mm)	0.045^†	‐0.363^†
Levator function	0.630	‐0.090

Δ MRD1 = margin reflex distance 1 at 3 months after panretinal photocoagulation - margin reflex distance 1 before panretinal photocoagulation.

^* Statistical significances were tested by correlation analysis

^† Significant correlation between ΔMRD1 and tarsal plate height (p = 0.045).

TOOLS

Similar articles