Effect of upper eyelid blepharoplasty on corneal biomechanical, topographic and tomographic parameters 4 weeks after surgery

Abstract

Purpose: To investigate the effect of "skin-only" upper eyelid blepharoplasty on corneal biomechanics and central as well as peripheral topographic/tomographic parameters before and 4 weeks after surgery.

Methods: In a prospective study, the corneal hysteresis (CH) and corneal resistance factor (CRF) were evaluated before and after blepharoplasty. Corneal topographic (maximum simulated keratometry value, inferior-superior value, index of surface variance, index of vertical asymmetry, index of height asymmetry, index of height decentration) and tomographic parameters (corneal thickness, corneal astigmatism and mean 5-mm- and 7-mm-zone keratometry value) were measured by the Pentacam HR. Statistical analysis was performed using a linear mixed model considering correlated data of both eyes.

Results: This study included 42 eyes of 35 patients (mean age: 64.5 years, range 52-82 years). Four weeks after surgery CH and CRF increased (9.4 ± 2.3 to 10.2 ± 2.2 mmHg and 9.7 ± 2.1 to 10.5 ± 2.2 mmHg) but did not reach statistical significance (P = 0.100 and P = 0.072). A significant increase in central maximum simulated keratometry value (Kmax) from 45.0 ± 2.3 to 45.4 ± 2.2 diopters (D) was observed (P = 0.004). Inferior-superior value (I-S) and index of surface variance (ISV) showed significant changes from 0.32 ± 0.98 to 0.10 ± 0.98 D (P = 0.02) and from 19.98 ± 9.84 to 22.93 ± 11.23 (P = 0.009), respectively. These alterations did not affect the subjective spherical equivalent (-0.09 ± 4.71 to -0.04 ± 4.51 D; P = 0.437) and the best-corrected distance visual acuity of patients (0.11 ± 0.14 to 0.15 ± 0.15 logMAR; P = 0.142). Age, gender and corneal thickness were not correlated with pre and postoperative differences of CH, CRF, corneal compensated IOP, Kmax, corneal astigmatism or I-S.

Conclusion: The trend of increasing CH and CRF values might indicate a rise of corneal damping capacity. Despite statistically significant differences of Kmax, I-S and ISV, all other tomographical and topographical parameters did not change 4 weeks after surgery. The corneal steepening with a mean change of 0.4 diopters and the decrease of I-S with a mean of 0.22 diopters do not seem to have a clinically relevant effect for blepharoplasty patients in daily practice.

Keywords: Central and peripheral cornea; Corneal hysteresis; Corneal resistance factor; Tomography; Topography; Upper eyelid blepharoplasty.

Fig. 1

Corneal hysteresis (CH) and corneal resistance factor (CRF) before and 4 weeks after upper eyelid blepharoplasty

Fig. 2

Goldmann-correlated IOP (IOPg) and corneal compensated IOP (IOPcc) before and 4 weeks after upper eyelid blepharoplasty

Fig. 3

Maximum simulated keratometry value in the central 3-mm-zone (Kmax) before and 4 weeks after upper eyelid blepharoplasty

Fig. 4

Mean 5-mm-zone keratometry (K5) and 7-mm-zone keratometry (K7) value before and 4 weeks after upper eyelid blepharoplasty

Fig. 5

Corneal thickness before and 4 weeks after upper eyelid blepharoplasty

Fig. 6

Corneal astigmatism before and 4 weeks after upper eyelid blepharoplasty

Fig. 7

Inferior-superior value before and 4 weeks after upper eyelid blepharoplasty