ASOPRSFall Scientific SymposiumSyllabus
185
T30
Lower LidPositionFollowingTransconjunctival Incision
KiraSegal
1
, Payal Patel
1
, BenLevine
1
, RichardLisman
2
, Gary Lelli, Jr.
1
.
1
Ophthalmology,Weill CornellMedical Center, NewYork, NY,
UnitedStates,
2
Ophthalmology, NYULangoneMedical Center, NewYork, NY, UnitedStates
Introduction:
Transconjunctival approach offers access to the inferior orbital contentswhile limiting cutaneous scaring.Many
suggest that transconjunctival surgery does not alter lower eyelid position, but this has not yet been examined in the literature.
Our purpose is to study lower eyelid position following transconjunctival incision.
Methods:
Retrospective review of patientswho underwent lower eyelid blepharoplasty via transconjunctival approach.
Patientswith front facing pre- and post-operative photoswere included. Patientswere excluded if they underwent any upper lid
procedure. Pre- and post-operative photosweremeasured forMRD1,MRD2, and a standardizationmeasurement (P-L1) by two
oculoplastic surgeons.The change in the ratios of MRD1/P-L1&MRD2/P-L1 pre- and post- operativelywere compared to
determine final eyelid position.
Results:
A total of 8 patients underwent 14 lower eyelid blepharoplasties via the transconjunctival approach.MRD2 decreased
post-operatively— asmeasured by deltaMRD2/P-L1 (average deltaMRD2/P-L1=0.005).When compared to the upper lid
(average deltaMRD1/P-L1= 0.006), the decrease inMRD2/P-L1 approached but did not reach significance (P=0.06).
Subjectively, lower lid appeared elevated post-operatively in 64% and 50% of patients as per rater 1 and rater 2, respectively.
Conclusions:
Transconjunctival incision is a safe and effective approach for accessing inferior structures in orbital surgery.
Though cicatricial ectropion and eyelid retraction are feared complications of transconjunctival approach, in a number of patients,
the lower lid is position is elevated from baseline post-operatively. In patientswith baseline lower lid retraction or inferior scleral
show, transconjunctival incisionmay provide further cosmetic advantage.
References:
ApplingWD, Patrinely JR, Salzer TA.Transconjunctival approach vs subciliary skin-muscle falp approach for orbital
fracture repair.Archives of Otolaryngology-Head&Neck surgery. 1993;119:1000-7.
BaumannA, Ewers R. Use of the preseptal transconjunctival approach in orbit reconstruction surgery. Journal of Oral andMaxillofacial
Surgery. 2001;59:287-91.
Goldberg RA, Lessner AM, Shorr N, Baylis HI.TheTransconjunctival Approach to theOrbital floor andOrbital Fat:A prospective Study.
Ophthal Plast Reconst Surg 1990;6:214-6.
Kashkouli MB, Pakdel F, KiavashV, et al.Transconjunctival Lower Blepharoplasty:A 2-SidedAssessment of Results and Subjects’
satisfaction. Ophthalmic Plastic and Reconstructive Surgery. 2013;29:249-55.
RaschkeGR, Rieger UM, rolf-Dieter Bader.Transconjunctival versus subciliary approach for orbital fracture repair-an anthropometric
evaluation of 221 cases. Clinical oral Investigations. 2013;17:933-42
Westfall CT, Shore JW, NuneryWR, et al. Operative complications of the transconjunctival inferior fornix approach. Ophthalmology.
1991;10:1525-8.
DetailedProgram
—Thursday,October 16, 2014
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