A STUDY TO ANALYSE THE CAUSES OF PERSISTENT POSTOPERATIVE PTOSIS AFTER CATARACT SURGERY

BACKGROUND One of the most common ocular surgery, i.e. cataract surgery is today highly efficient and has a predictable outcome. Still, eyelid malpositions can occur after cataract surgery. Of these, blepharoptosis of upper eyelid occurs and sometimes persists even after few months of surgery. This occurrence depends on the surgical technique and method of ocular anaesthesia given. The aim of the study is to know the incidence and probability of developing postoperative persistent ptosis (>12 weeks) after different surgical techniques and anaesthetic methods. MATERIALS AND METHODS Retrospective analysis of 200 cataract surgery patients operated at Ophthalmology Department at Government Stanley Medical College and Hospital was done regarding the incidence and progression/persistence of postoperative ptosis. The causes analysed being method of cataract surgery performed whether ECCE by classical incision, SICS or by phacoemulsification. The anaesthesia being given was analysed whether peribulbar block or topical proparacaine block. The association between age factor and development of ptosis was analysed as well the worsening of pre-existing mild ptosis was also analysed in this study. RESULTS Of the 200 patients, 25 patients had pre-existing mild ptosis. Of these 25, fourteen patients worsened after surgery and had persistent ptosis. Of the 200 patients, new-onset ptosis was observed in 36 patients in first 14 days of postoperative period. Of these 36 patients, 11 patients had persistent ptosis at 12 weeks. Of those 100 patients operated by SICS and ECCE - 8 patients developed persistent ptosis compared to 4 patients who underwent phacoemulsification. Of those who had pre-existing ptosis and had repeat peribulbar blocks, 50% developed persistent ptosis. Of the 50 patients who had phacoemulsification under topical anaesthesia, only one developed ptosis. Development of ptosis by age criteria showed that 50-75% of persistent ptosis involved patients of age 70 or above. CONCLUSION Regarding development of persistent ptosis, the incidence is more with ECCE of classic incision/SICS than phacoemulsification, because of use of bridle suture and speculum usage. Ptosis is least in topical phacoemulsification. When peribulbar block is repeated, the probability of persistent ptosis development is higher. The patients who are above 70 years and who had preexisting ptosis worsened more after repeat peribulbar blocks. The phacoemulsification under topical anaesthesia group had the least postoperative ptosis