The effect of eyelid speculum on postoperative ptosis

Cilj istraživanja: Cilj ovog istraživanja bio je utvrditi utjecaj dviju različitih vrsta blefarostata na nastanak ptoze. Ispitanici i metode: U prospektivnom kohortnom istraživanju provedenom u Kliničkom bolničkom centru Split, u Klinici za očne bolesti, uključeni su ispitanici predviđeni za operaciju fakoemulzifikacije. Istraživanje se provodilo od veljače do svibnja 2022. godine. U istraživanju je sudjelovalo 27 ispitanika u dobi od 60 do 85 godina. Prvih 20 ispitanika operirano je pomoću punog blefarostata, a zadnjih sedam pomoću žičanog blefarostata. Visina vjeđnog rasporka mjerila se prije operacijskog zahvata te na redovnim kontrolama sedam dana nakon te još tri tjedna poslije pomoću Bulbitech uređaja ili manualno ravnalom. Rezultati: Mjerenjem Bulbitech uređajem na prvoj kontroli prije operacije srednja je vrijednost visine vjeđnog rasporka (VVR) iznosila 10,65 ± 1,69 mm, dok je srednja vrijednost udaljenosti refleksa svjetla u središtu rožnice od ruba gornje vjeđe (engl. MRD 1- Marginal reflex distance) iznosila 5,04 ± 1,22 mm. Na idućoj kontroli, sedam dana nakon operacije, mjerili smo VVR i MRD1 Bulbitech uređajem ili manualno ravnalom. Srednja vrijednost VVR iznosila je 9,94 ± 1,13 mm na Bulbitechu i 9,75 ± 2,63 mm ravnalom, dok je srednja vrijednost MRD1 iznosila 4,40 ± 0,88 mm na Bulbitechu. Na drugoj kontroli, 30 dana nakon operacije, srednja je vrijednost VVR iznosila 9,57 ± 1,57 mm na Bulbitechu i 9,77 ± 1,5 mm ravnalom, dok je srednja vrijednost MRD1 iznosila 3,95 ± 1,10 mm na Bulbitechu. Pri usporedbi vrsta blefarostata, žičanog i punog, dokazano je da su vrijednosti kod punog blefarostata bile niže od onih u žičanog, ali ta razlika nam nije bila statistički značajna (P = 0,398). Analizom pojedinih kontrola utvrđeno je kako su se statistički značajno razlikovali VVR na prvoj kontroli izmjeren na Bulbitechu (P = 0,033) i VVR izmjeren ravnalom nakon 7 dana (P = 0,012). Također postoji i statistički značajna korelacija između VVR i MRD te su te dvije mjere jednako valjane u praćenju poslijeoperacijske ptoze. Čimbenik korelacije r prije operacije iznosio je 0,94, nakon sedam dana 0,87 te nakon 30 dana 0,82. Zaključak: Statistički je utvrđeno značajno smanjenje VVR i MRD1 na kontrolnim pregledima, dok ne postoji statistički značajna razlika između punog i žičanog blefarostata.Objectives: The aim of this study was to determine whether there is a statistically significant difference between the use of two types of eyelid speculum on palpebral fissure height and Margin reflex distance 1 (MRD1) before and after cataract surgery. Subjects and Methods: This prospective cohort study, conducted at the Clinic of Ophthalmology at the University Hospital of Split, included the patients who underwent phacoemulsification cataract surgery. The study was conducted between February and May 2022. The study consisted of 27 patients aged 60 to 85 years. MRD1 and levator muscle function were measured manually or with Bulbitech device before the surgery, 7 days after, as well as 4 weeks after the surgery. With the first 20 patients, we used a solid type of speculum, while for the next 7, a wired speculum was used. Results: Using the Bulbitech device at the first preoperative control, the average value of VVR was 10.65 ± 1.69 mm while the average value of MRD1 was 5.04 ± 1.22 mm. At the next control, 7 days after surgery, we measured VVR and MRD1 either with the Bulbitech device or manually. The average value of VVR was 9.94 ± 1.13 mm on the Bulbitech and 9.75 ± 2,63 mm manually, while the average value of MRD1 was 4.40 ± 0.88 mm on the Bulbitech. At the second control, 4 weeks after surgery, the average value of VVR was 9.57 ± 1.57 mm on the Bulbitech and 9.77 ± 1.5 mm manually, while the average value of MRD1 was 3.95 ± 1.10 mm on the Bulbitech. When comparing the two types of eyelid speculum, wired and solid, it was shown that the values of solid eyelid speculum use were lower than those of the wired (P = 0.398). The analysis of individual controls determined that VVR was statistically significantly different at the first control measured on Bulbitechu (P = 0.033) and VVR measured manually after 7 days (P = 0.012). There is also a statistically significant correlation between VVR and MRD and they are equally valid in tracking postoperative ptosis. Correlation factor r was 0.94 preoperative, 0.87 after 7 days and 0.82 after 30 days. Conclusions: A statistically significant reduction in VVR and MRD1 values was found at control examinations, while there was no statistically significant difference between the use of solid and wired eyelid speculum