Effect of upper eyelid blepharoplasty on corneal biomechanical, topographic and tomographic parameters 4 weeks after surgery

Falk Sommer, Elisa Untch, Eberhard Spoerl, Robert Herber, Lutz E Pillunat, Naim Terai, Falk Sommer, Elisa Untch, Eberhard Spoerl, Robert Herber, Lutz E Pillunat, Naim Terai

Abstract

Purpose: To investigate the effect of "skin-only" upper eyelid blepharoplasty on corneal biomechanics and central as well as peripheral topographic/tomographic parameters before and 4 weeks after surgery.

Methods: In a prospective study, the corneal hysteresis (CH) and corneal resistance factor (CRF) were evaluated before and after blepharoplasty. Corneal topographic (maximum simulated keratometry value, inferior-superior value, index of surface variance, index of vertical asymmetry, index of height asymmetry, index of height decentration) and tomographic parameters (corneal thickness, corneal astigmatism and mean 5-mm- and 7-mm-zone keratometry value) were measured by the Pentacam HR. Statistical analysis was performed using a linear mixed model considering correlated data of both eyes.

Results: This study included 42 eyes of 35 patients (mean age: 64.5 years, range 52-82 years). Four weeks after surgery CH and CRF increased (9.4 ± 2.3 to 10.2 ± 2.2 mmHg and 9.7 ± 2.1 to 10.5 ± 2.2 mmHg) but did not reach statistical significance (P = 0.100 and P = 0.072). A significant increase in central maximum simulated keratometry value (Kmax) from 45.0 ± 2.3 to 45.4 ± 2.2 diopters (D) was observed (P = 0.004). Inferior-superior value (I-S) and index of surface variance (ISV) showed significant changes from 0.32 ± 0.98 to 0.10 ± 0.98 D (P = 0.02) and from 19.98 ± 9.84 to 22.93 ± 11.23 (P = 0.009), respectively. These alterations did not affect the subjective spherical equivalent (-0.09 ± 4.71 to -0.04 ± 4.51 D; P = 0.437) and the best-corrected distance visual acuity of patients (0.11 ± 0.14 to 0.15 ± 0.15 logMAR; P = 0.142). Age, gender and corneal thickness were not correlated with pre and postoperative differences of CH, CRF, corneal compensated IOP, Kmax, corneal astigmatism or I-S.

Conclusion: The trend of increasing CH and CRF values might indicate a rise of corneal damping capacity. Despite statistically significant differences of Kmax, I-S and ISV, all other tomographical and topographical parameters did not change 4 weeks after surgery. The corneal steepening with a mean change of 0.4 diopters and the decrease of I-S with a mean of 0.22 diopters do not seem to have a clinically relevant effect for blepharoplasty patients in daily practice.

Keywords: Central and peripheral cornea; Corneal hysteresis; Corneal resistance factor; Tomography; Topography; Upper eyelid blepharoplasty.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Corneal hysteresis (CH) and corneal resistance factor (CRF) before and 4 weeks after upper eyelid blepharoplasty
Fig. 2
Fig. 2
Goldmann-correlated IOP (IOPg) and corneal compensated IOP (IOPcc) before and 4 weeks after upper eyelid blepharoplasty
Fig. 3
Fig. 3
Maximum simulated keratometry value in the central 3-mm-zone (Kmax) before and 4 weeks after upper eyelid blepharoplasty
Fig. 4
Fig. 4
Mean 5-mm-zone keratometry (K5) and 7-mm-zone keratometry (K7) value before and 4 weeks after upper eyelid blepharoplasty
Fig. 5
Fig. 5
Corneal thickness before and 4 weeks after upper eyelid blepharoplasty
Fig. 6
Fig. 6
Corneal astigmatism before and 4 weeks after upper eyelid blepharoplasty
Fig. 7
Fig. 7
Inferior-superior value before and 4 weeks after upper eyelid blepharoplasty

References

    1. Drolet BC, Sullivan PK. Blepharoplasty. Plast Reconstr Surg. 2014;133:1195–1205. doi: 10.1097/PRS.0000000000000087.
    1. Holck DE, Dutton JJ, Wehrly SR. Changes in astigmatism after ptosis surgery measured by corneal topography. Ophthal Plast Reconstr Surg. 1998;14:151–158. doi: 10.1097/00002341-199803000-00001.
    1. Detorakis ET, Ioannakis K, Kozobolis VP. Corneal Topography in Involutional Ectropion of the Lower Eyelid: preoperative and postoperative evaluation. Cornea. 2005;24:431–434. doi: 10.1097/01.ico.0000151563.24989.f6.
    1. Lee DC. Analysis of corneal real astigmatism and high order aberration changes that cause visual disturbances after lower eyelid epiblepharon repair surgery. Sci Rep. 2020;10:7498. doi: 10.1038/s41598-020-64386-6.
    1. Lee DH, Jung JH, Ahn JH. Changes in corneal curvature after epiblepharon surgery in children. J Craniofac Surg. 2018;29:e191–e195. doi: 10.1097/SCS.0000000000004235.
    1. Brown MS, Siegel IM, Lisman RD. Prospective analysis of changes in corneal topography after upper eyelid surgery. Ophthal Plast Reconstr Surg. 1999;15:378–383. doi: 10.1097/00002341-199911000-00002.
    1. Simsek IB, Yilmaz B, Yildiz S, Artunay O. Effect of upper eyelid blepharoplasty on vision and corneal tomographic changes measured by Pentacam. Orbit. 2015;34:263–267. doi: 10.3109/01676830.2015.1057292.
    1. Rosa N, Lanza M, De Bernardo M, Signoriello G, Chiodini P. Relationship between corneal hysteresis and corneal resistance factor with other ocular parameters. Semin Ophthalmol. 2015;30:335–339. doi: 10.3109/08820538.2013.874479.
    1. Labiris G, Gatzioufas Z, Sideroudi H, Giarmoukakis A, Kozobolis V, Seitz B. Biomechanical diagnosis of keratoconus: evaluation of the keratoconus match index and the keratoconus match probability. Acta Ophthalmol. 2013;91:e258–e262. doi: 10.1111/aos.12056.
    1. Terai N, Raiskup F, Haustein M, Pillunat LE, Spoerl E. Identification of biomechanical properties of the cornea: the ocular response analyzer. Curr Eye Res. 2012;37:553–562. doi: 10.3109/02713683.2012.669007.
    1. Orucoglu F, Toker E. Comparative analysis of anterior segment parameters in normal and keratoconus eyes generated by scheimpflug tomography. J Ophthalmol. 2015;2015:925414. doi: 10.1155/2015/925414.
    1. Medeiros FA, Weinreb RN. Evaluation of the influence of corneal biomechanical properties on intraocular pressure measurements using the Ocular Response Analyzer. J Glaucoma. 2006;15:364–370. doi: 10.1097/01.ijg.0000212268.42606.97.
    1. Altin Ekin M, Karadeniz Uğurlu S. Prospective analysis of visual function changes in patients with dermatochalasis after upper eyelid blepharoplasty. Eur J Ophthalmol. 2020;30:978–984. doi: 10.1177/1120672119857501.
    1. Dogan E, Akbas Kocaoglu F, Yalniz-Akkaya Z, Elbeyli A, Burcu A, Ornek F. Scheimpflug Imaging in dermatochalasis patients before and after upper eyelid blepharoplasty. Semin Ophthalmol. 2015;30:193–196. doi: 10.3109/08820538.2013.839803.
    1. Kim JW, Lee H, Chang M, Park M, Lee TS, Baek S. What causes increased contrast sensitivity and improved functional visual acuity after upper eyelid blepharoplasty? J Craniofac Surg. 2013;24:1582–1585. doi: 10.1097/SCS.0b013e318292c5ac.
    1. Zinkernagel MS, Ebneter A, Ammann-Rauch D. Effect of upper eyelid surgery on corneal topography. Arch Ophthalmol. 2007;125:1610–1612. doi: 10.1001/archopht.125.12.1610.
    1. Enoch S, Grey JE, Harding KG. Recent advances and emerging treatments. BMJ. 2006;332:962–965. doi: 10.1136/bmj.332.7547.962.
    1. Ferguson M, Leigh I. Wound healing. In: Champion R, Burton J, Burns D, Breathnach S, editors. Textbook of dermatology. 6. Oxford: Blackwell Science; 1998. pp. 337–356.
    1. Shao W, Byrne P, Harrison A, Nelson E, Hilger P. Persistent blurred vision after blepharoplasty and ptosis repair. Arch Facial Plast Surg. 2004;6:155–157. doi: 10.1001/archfaci.6.3.155.
    1. Piñero DP, Nieto JC, Lopez-Miguel A. Characterization of corneal structure in keratoconus. J Cataract Refract Surg. 2012;38:2167–2183. doi: 10.1016/j.jcrs.2012.10.022.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi