Purpose

To compare outcomes of ptosis repair in eyes that have undergone prior incisional glaucoma surgery with eyes that have only had ptosis repair.

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Methods

Adult patients at a single center who underwent incisional glaucoma surgery and later had ptosis repair surgery on the same eye were age, sex, and race matched to control patients who had ptosis repair without prior incisional eye or upper eyelid surgery. An institutional clinical data registry was queried for patients that had glaucoma surgery (bleb forming and tube shunts) and ptosis surgery (external levator advancement (ELA) and Muller muscle resection (MMR)) from 2/3/00-3/11/25. The primary outcome was margin reflex distance (MRD1) 2.5-5 mm in the most recent post-op visit. Secondary outcomes were post-op MRD1 symmetry within 0.5 mm between eyes and ptosis reoperation rate. Fisher’s exact or Chi-square test was used for categorical variables. Wilcoxon ranked-sum test was used for continuous variables.

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Results

81 eyes of 70 patients were in the glaucoma group consisting of 52 blebs, 29 tubes, 65 ELA, and 5 MMR. 128 eyes of 70 patients were in the control group with 62 ELA and 8 MMR. There was no significant difference in the median age at ptosis repair, sex, and race. Median pre-op MRD1 was significant lower in the glaucoma group (-0.5 mm, IQR -0.5-1) than the control group (1 mm, IQR 0-1.5) (p=0.0016). There was no difference in ptosis surgery success (63.4% of control eyes vs. 55.9% in glaucoma eyes), but there was a significantly higher proportion of ptosis symmetry achieved in glaucoma eyes 80 (84.0% of eyes) compared to control eyes (62.5%) (p=0.0009). In eyes with blebs that underwent ELA, there was a higher reoperation rate (11 (23.4%)) compared to eyes that only underwent ELA (13 (11.3%)) (p=0.049).

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Conclusion

In this cohort, eyes that had a bleb and underwent ELA had almost double the reoperation rate of those without prior surgery. Eyes that had glaucoma surgery achieved more post-operative lid height symmetry, possibly due to fewer bilateral ptosis repairs. Eyes with prior incisional glaucoma surgery undergoing ptosis surgery may have higher variability in outcomes.

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Additional Authors

First name	Last name	Base Hospital / Institution
Amee	Azad	Massachusetts Eye and Ear, Harvard Medical School
Lisa	Lin	Johns Hopkins Wilmer Eye Institute
Michael	Yoon	Massachusetts Eye and Ear, Harvard Medical School

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