Eyeworld

NOV 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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November 2012 EW CATARACT 49 weakness of the levator muscle and ptosis. Recovery occurs over an 8-12 week period and results from hyper- trophy of remaining muscle fibers and regeneration of muscle fibers." With anesthetic, "use only the amount of anesthetic you need and perform surgery with topical anes- thesia alone when possible," Dr. Shriver suggested. "Ocular massage and compression decreases the risk of hematoma and edema but in- creases the risk of anesthetic effects as it increases its availability." Surgeons also can decrease the risk of ptosis following cataract sur- gery by avoiding bridle sutures, using small, sutureless temporal inci- sions, and reducing irritation on the ocular surface, Dr. Shriver said. Duration and treatment Luckily for surgeons and patients, lid drooping after cataract surgery is often short-lived. "Most transient ptosis resolves by 6 months, but there has been one reported case of spontaneous resolution 11 months post-operatively," she said. That case was believed to have been caused by a neuropraxia of the oculomotor nerve, Dr. Shriver said. Ptosis is either classified as tran- sient or persistent, depending on the duration. Transient ptosis, which lasts less than 6 months, often re- solves on its own without medical intervention. Dr. Lee said practitioners, how- ever, may "consider prescribing apr- aclonidine to achieve up to 2 mm of lift by stimulating Muller's muscle temporarily as the levator recovers." Persistent ptosis lasts more than 6 months and can be treated with surgical interventions such as a leva- tor advancement or conjunctival Mullerectomy. "Ptosis can be repaired by either an internal or external approach de- pending on the degree of ptosis re- sponse to phenylephrine testing, ocular surface health and integrity, and surgeon preference," Dr. Shriver said. Cataract patients should be warned of the risk of ptosis, and pto- sis patients with cataracts should be warned that the surgery could exac- erbate the condition. Repair of the ptosis also should be postponed until after the cataract surgery, Dr. Shriver said. When patients develop ptosis after cataract surgery "it is recom- mended that the patient be observed for at least a 6-month period and that the patient's eyelid measure- ments are stable prior to surgery," Dr. Shriver continued. "If surgery is performed within the first year after intraocular surgery, it has been rec- ommended that the levator be pli- cated rather than resected in the event that there will be a return of function necessitating a reversal of the ptosis repair." Dr. Shriver added that because of the potential effects of cataract surgery on the eyelids, if a patient desires elective eyelid surgery and is going to need cataract extraction within a year, she would recom- mend postponing the eyelid surgery until after cataract surgery. EW Editors' note: Drs. Lee and Shriver have no financial interests related to this ar- ticle. Contact information Lee: 305-326-6434, wlee@med.miami.edu Shriver: 561-355-8608, eshriver@med.miami.edu Finally... An Easy AND Comprehensive EMR for Ophthalmology Key Features Average Implementation Time: 90 days No Cost diagnostic machine & practice management integrations. Server Sync increases remote office productivity & eliminates outages caused by unreliable Internet connections. TM Subspecialty content included for Retina, Cornea, Pediatrics, & Glaucoma. Scalable to any practice size. www.EyeMDEMR.com (877) 2 EYE EMR

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