Postoperative Blepharoptosis After Modern Phacoemulsification Procedure

Am J Ophthalmol. 2020 May:213:17-23. doi: 10.1016/j.ajo.2019.12.023. Epub 2020 Jan 9.


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 mm. Photo-based ptosis was assessed by a masked oculofacial plastic surgeon at the end of the study.

Results: A total of 234 patients (313 eyelids) were included. 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 = .03) lower preoperative levator function (13.9 vs 15.8 mm). No other factor was significantly different between the eyelids with and without postoperative ptosis.

Conclusion: Persistent clinically significant ptosis was observed in more than 3% of patients undergoing clear corneal sutureless phacoemulsification cataract surgery. It should be counseled 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blepharoptosis / diagnosis
  • Blepharoptosis / etiology*
  • Eyelids / pathology
  • Female
  • Humans
  • Internship and Residency
  • Lens Implantation, Intraocular
  • Male
  • Middle Aged
  • Operative Time
  • Ophthalmology / education
  • Phacoemulsification / adverse effects*
  • Phacoemulsification / education
  • Photography
  • Postoperative Complications*
  • ROC Curve
  • Retrospective Studies
  • Tertiary Care Centers