Postoperative Blepharoptosis after Modern Phacoemulsification Procedure

Abstract Purpose To investigate the frequency of transient (1 month) and persistent (at least 6 months) postoperative ptosis following clear corneal sutureless phacoemulsification and to analyze the factors affecting them. Design Cohort study Methods Patients who underwent phacoemulsification cataract surgery from October 2016 to June 2018 in a tertiary center were enrolled. Margin reflex distance 1 (MRD1), MRD2, and levator function were measured and facial photography was taken before, 1 month and at least 6 months after the surgery. Clinical ptosis was defined as any postoperative drop of MRD1 and Clinically significant ptosis as MRD1 drop of ≥2 millimeters. Photo-based ptosis was assessed by a masked oculo-facial plastic surgeon at the end of the study. Results Included were 234 patients (313 eyelids). The majority of surgeries were performed by senior residents (65.5%, 205/313) and under topical anesthesia (78.0%, 244/313). Persistent clinical, clinically significant and photo-based ptosis were 25.4% (71/279), 3.2% (9/279), and 3.3% (9/276). Eyelids with persistent postoperative ptosis showed a significantly (P=0.03) lower preoperative levator function (13.9 vs.15.8 millimeters). No other factor was significantly different between the eyelids with and without postoperative ptosis. Conclusion Persistent clinically significant ptosis was observed in over 3% of patients undergoing clear corneal sutureless phacoemulsification cataract surgery. It should be counselled preoperatively. Lower preoperative levator function was significantly associated with a higher frequency of postoperative ptosis. Duration of surgery, level of surgeons, and other variables did not have any significant effect on the frequency of postoperative ptosis.