Two-Dimensional Analysis of Palpebral Opening in Blepharoptosis - PowerPoint PPT Presentation

Two-Dimensional Analysis of Palpebral Opening in Blepharoptosis Visual Iris-Pupil Complex Percentage by Digital Photography 1 SuRak Eo, MD, PhD, 2 Yeop Choi, MD, PhD 1 Professor, Dept. of Plastic and Reconstructive Surgery DongGuk University Graduate School of Medicine 2 Choi Yeop Aesthetic Clinic - Noth thing ing to to di discl close se -

As Assessment sessment of of B Ble lepharop pharoptosis tosis • Margin reflex distance (MRD) : MRD1 (4 ~ 4.5 mm) : MRD2 • Vertical dimension of palpebral fissure width : 9~11 mm • Margin limbal distance • Margin crease distance • Palpebral fissure width on down gaze

Limits Li mits  linear mathematical models using a ruler.  patient overstraining and variable inspector skills  concordant results are not easily obtained  most effective in cases of significant blepharoptosis  Sub ubcli clinical nical ??? ???  Childr ldren en ??? ???

Ne New 2 w 2-di dimensional mensional sc sche heme me • Digital photography • Visual lris-pupil complex Percentage (VI VIP) P) : a measure of the exposed corneal surface area : calculated by subtracting the hidden corneal surface area from the totally estimated corneal surface area in primary gaze.

PATIENTS & METHODS • 2008 ~ 2011 for upper blepharoplasty at ChoiYeop aesthetic clinic • Reviewed the photos : 1384 eyes of 692 patients (aged 14 ~ 67 years) : 2 plastic surgeons, 2 nurses, and 1 graphic designer : get VIP scores using Adobe Photoshop • Total 1305 1305 eyes – Exclude 79 eyes - 50 eyes : non concordant borderline eyes - 29 eyes : retracted upper lids, excessive skin hooding, overaction of frontalis muscle

VIP VIP (E (Exposed ed corneal al sur urface/Total e/Total ir iris is-pup upil il comple lex x sur urface) ce) x 100 = (2 (29,564/33 33,68 ,689) ) X 10 100 VIP = 87.8%

RESULTS

VIP VIP Sco Score res 60 60% 75% 75% 85% 85% 80% 80%

Subclinical Blepharoptosis 70 70 < < VIP VIP < 77 < 77 74% • Frequently neglected • Frustrated with the unpredicted result

Case 19, F Blepharoplasty, Epicanthoplasty VIP 58% VIP 88% Prominent ptosis

Case 43, F Scleral eye type Previous blephar haropl oplasty asty (3 times) Fat t graftin fting g to hollowed upper lid Epicanthoplasty, Lateral canthoplasty Levator-Müller muscle flap advancement Case 2 (43/F) VIP 67% VIP 82% / 86%

• co conve nventi ntional onal pt ptosis is sur urge gery ry – improvement form the grades IV, to grades II / I • We sometimes need the sligh ght t co correc ecti tion on of f th the e ey eye e app ppearance earance from grades III to II / I.

Co Conc nclusion lusion VIP (Visual Iris-pupil complex Percentage) • 3D  2D 2D ler, rel eliable, le, o bjec • Simp mpler, ective tive asses essmen sment t more re fea easible ble, more re re repro roduci cible ble • Subclin linic ical l ptosis is is is easy to quantify ify • Suggest aesthet hetic ic guid idelin line • help lp patie ients s understan tand d ptosis is status s correctl ctly • Assessment is easy for surgeon and patient. • Observational and technical errors can be minimized. • Provide an option for quantifying ptosis in subclinical cases