Abstract
Objective
We conducted a systematic review and meta-analysis to evaluate the incidence and risk factors of ptosis following ocular surgery.
Methods
PubMed, Embase, and Cochrane Library were searched for articles that assessed the incidence or risk factors of ptosis following ocular surgery up to October 2017. We used a fixed effects model to calculate a pooled estimate of incidence, with subgroup analyses to evaluate the effect of different variables. The relative risks (RRs) or odds ratios (ORs) and 95% confidence intervals (CIs) for all available factors were calculated using the fixed effects models.
Results
A total of 16 studies on 2856 eyes were analyzed, including 3 randomized controlled trials (RCTs) and 13 cohort studies. The overall incidence of ptosis following ocular surgery was 11.4% (95% CI 10.1–12.8%). Subgroup analyses showed that the region and the surgery type were significantly associated with the incidence of postoperative ptosis. Men were less likely to get postoperative ptosis than women (OR 0.62; 95% CI 0.43–0.89). However, age (OR 0.77; 95% CI 0.48–1.23), side (OR 1.37; 95% CI 0.84–2.25), type of anesthesia (OR 0.57; 95% CI 0.16–2.05), prior surgery (OR 1.09; 95% CI 0.64–1.83), bridle suture (OR 2.04; 95% CI 0.94–4.42), or combined surgery (OR 0.95; 95% CI 0.58–1.57) did not significantly change the risk of ptosis following ocular surgery.
Conclusion
More than one in ten patients who undergo ocular surgery will develop ptosis. Different regions and surgery types may influence the occurrence of this abnormality. Female gender is a risk factor for development of postoperative ptosis.
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References
Finsterer J (2003) Ptosis: causes, presentation, and management. Aesthet Plast Surg 27:193–204
Baroody M, Holds JB, Vick VL (2005) Advances in the diagnosis and treatment of ptosis. Curr Opin Ophthalmol 16:351
Ahuero AE, Hatton MP (2010) Eyelid malposition after cataract and refractive surgery. Int Ophthalmol Clin 50:25–36
Paris GL, Quickert MH (1976) Disinsertion of the aponeurosis of the levator palpebrae superioris muscle after cataract extraction. Am J Ophthalmol 81:337–340
Godfrey KJ, Korn BS, Kikkawa DO (2016) Blepharoptosis following ocular surgery. Curr Opin Ophthalmol 27:31–37
Bernardino CR, Rubin PAD (2002) Ptosis after cataract surgery. Semin Ophthalmol 17:144–148
Mehat MS, Sood V, Madge S (2012) Blepharoptosis following anterior segment surgery: a new theory for an old problem. Orbit 31:274–278
Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341
Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12
Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64:401–406
Higgins JPT, Thompson SG, Deeks JJ, Altma DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560
Park A, Eliassi-Rad B, Desai M (2017) Ptosis after glaucoma surgery. Clin Ophthalmol 11:1483–1489
Naruo-Tsuchisaka A, Maruyama K, Arimoto G, Goto H (2015) Incidence of postoperative ptosis following trabeculectomy with mitomycin C. J Glaucoma 24:417–420
Koh V, Tatsios J, Chew P, Amrith S (2015) Comparison of incidence of ptosis after combined phacotrabeculectomy with mitomycin C and phacoemulsification. Indian J Ophthalmol 63:895–898
Puvanachandra N, Hustler A, Seah LL, Tyers AG (2010) The incidence of ptosis following extracapsular and phacoemulsification surgery: comparison of two prospective studies and review of the literature. Orbit 29:321–323
Besharati MR, Lotfi MH, Nourani F (2008) Outcomes and complications of strabismus surgery in Yazd, Iran. Int J Ophthalmol-Chi 8:1104–1107
Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE (2005) Perioperative complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Am J Ophthalmol 140:16–22
Altieri M, EKingston AT, Bertagno R, Altieri G (2005) Ptosis secondary to anterior segment surgery and its repair in a two-year follow-up study. Ophthalmologica 219:129–135
Patel JI, Blount M, Jones C (2002) Surgical blepharoptosis—the bridle suture factor? Eye 16:535–537
Sundar KS, Deshpande M, Gurunadh VS, Palit MG, Baijal V (1999) Evaluation of ocular deviations and ptosis after cataract surgery. Med J Armed Forces India 55:3–5
Singh SK, Sekhar GC, Gupta S (1997) Etiology of ptosis after cataract surgery. J Cataract Refract Surg 22:1409–1413
Song MS, Shin DH, Spoor TC (1996) Incidence of ptosis following trabeculectomy: a comparative study. Korean J Ophthalmol 10:97–103
Feibel RM, Custer PL, Gordon MO (1993) Postcataract ptosis. A randomized, double-masked comparison of peribulbar and retrobulbar anesthesia. Ophthalmology 100:660–665
Loeffler M, Solomon LD, Renaud M (1990) Postcataract extraction ptosis: effect of the bridle suture. J Cataract Refract Surg 16:501–504
Deady JP, Price NJ, Sutton GA (1989) Ptosis following cataract and trabeculectomy surgery. Brit J Ophthalmol 73:283–285
Linberg JV, McDonald MB, Safir A, Goole JM (1986) Ptosis following radial keratotomy: performed using a rigid eyelid speculum. Ophthalmology 93:1509–1512
Kaplan LJ, Jaffe NS, Clayman HM (1985) Ptosis and cataract surgery. A multivariant computer analysis of a prospective study. Ophthalmology 92:237–242
Cheng ACK, Young AL, Law RWK, Lam DSC (2004) Ptosis after laser in situ keratomileusis. J Cataract Refract Surg 30:1572–1574
Rainin EA, Carlson BM (1985) Postoperative diplopia and ptosis: a clinical hypothesis based on the myotoxicity of local anesthetics. Arch Ophthalmol 103:1337–1339
Crosby NJ, Shepherd D, Murray A (2013) Mechanical testing of lid speculae and relationship to postoperative ptosis. Eye 27:1098–1101
Funding
This work was financially supported by Zhejiang Provincial Program for Medical and Health Science Co-sponsored by Province and Ministry (grant number 2016137996) and the National Key Research and Development Program of China (grant number 2016YFC1100403).
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Wang, Y., Lou, L., Liu, Z. et al. Incidence and risk of ptosis following ocular surgery: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 257, 397–404 (2019). https://doi.org/10.1007/s00417-018-4130-6
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DOI: https://doi.org/10.1007/s00417-018-4130-6