Effect of superior blepharoplasty on tear film: objective evaluation with the Keratograph 5M - a pilot study

ABSTRACT Purpose: To evaluate the effect of superior blepharoplasty on the tear film using the corneal topographer Keratograph 5M. Methods: A prospective study was performed of 27 eyes of 14 patients with superior dermatochalasis who underwent superior blepharoplasty between May and June 2016. Conservative upper eyelid blepharoplasty was performed by an en bloc resection of anterior lamellar tissue that included skin, subcutaneous tissue, and the orbicularis oculi muscle. All the eyes were imaged using the noninvasive tear breakup time tools of the Keratograph 5M. The following parameters were recorded in each patient before and 6 weeks after surgery: first noninvasive Keratograph 5M tear breakup time (the time at which the first breakup of tears occurs) and average noninvasive Keratograph 5M tear breakup time (the average time of all breakup incidents). The exclusion criteria were ophthalmological pathology, previous eyelid surgery, use of eye drops, systemic pathology, and medication that interferes with lacrimal tears. Results: The mean age of the patients was 65.1 years (range, 51-84); 86% were female. Student’s t-test was used to compare the values of first and average noninvasive Keratograph 5M tear breakup times before and after surgery. The values for first noninvasive Keratograph 5M tear breakup time evaluated before and after surgery were not significantly different (9.04 and 8.71, respectively; p=0.926). The values for average noninvasive Keratograph 5M tear breakup time evaluated before and after surgery were also not significantly different (13.01 seconds and 13.14 seconds, respectively; p=0.835). Conclusions: The results of this pilot study suggest that upper blepharoplasty does not affect tear breakup time according to the objective evaluation of breakup time with the Keratograph 5M.

摘要 研究目的：采用角膜地形图仪（corneal topographer）Keratograph 5M，评估上睑成形术（superior blepharoplasty）对泪膜（tear film）的影响。研究方法：本研究为前瞻性研究，纳入2016年5月至6月期间接受上睑成形术的14例上睑皮肤松弛症（superior dermatochalasis）患者，共计27只眼。术式采用前层组织整块切除术（en bloc resection）行保守性上睑成形术，切除组织包含皮肤、皮下组织及眼轮匝肌（orbicularis oculi muscle）。所有患眼均通过Keratograph 5M的无创泪膜破裂时间工具进行成像检测。分别于术前及术后6周，记录每位患者的两项参数：首次无创Keratograph 5M泪膜破裂时间（即泪膜首次出现破裂的时间），以及平均无创Keratograph 5M泪膜破裂时间（即所有泪膜破裂事件的平均时长）。本研究排除标准包括：眼部病理改变、既往眼睑手术史、滴眼液使用史、全身疾病及影响泪液分泌的药物。研究结果：本研究纳入患者的平均年龄为65.1岁（年龄范围51~84岁），其中女性占比86%。采用Student t检验（Student’s t-test）比较术前与术后的首次及平均无创Keratograph 5M泪膜破裂时间。结果显示，术前与术后的首次无创Keratograph 5M泪膜破裂时间分别为9.04与8.71，差异无统计学意义（p=0.926）；术前与术后的平均无创Keratograph 5M泪膜破裂时间分别为13.01秒与13.14秒，差异亦无统计学意义（p=0.835）。研究结论：本初步研究（pilot study）结果表明，通过Keratograph 5M对泪膜破裂时间进行客观评估，上睑成形术并未对泪膜破裂时间产生显著影响。