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

1SuRak Eo, MD, PhD, 2Yeop Choi, MD, PhD

1Professor, Dept. of Plastic and Reconstructive Surgery

DongGuk University Graduate School of Medicine

2Choi Yeop Aesthetic Clinic

• Noth

thing ing to to di discl close se -

As Assessment sessment of

• f 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

 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 ??? ???

Li Limits mits

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.

• 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,

• veraction of frontalis muscle

PATIENTS & METHODS

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% 85% 85% 80% 80% 75% 75%

Subclinical Blepharoptosis 70 70 < < VIP VIP < 77 < 77 74%

• Frequently neglected
• Frustrated with the unpredicted result

Blepharoplasty, Epicanthoplasty

Case 19, F

VIP 58%

Prominent ptosis

VIP 88%

Case 2 (43/F)

Previous blephar haropl

• plasty

asty (3 times) Fat t graftin fting g to hollowed upper lid

VIP 67% VIP 82% / 86%

Epicanthoplasty, Lateral canthoplasty Levator-Müller muscle flap advancement Case 43, F

Scleral eye type

• co

conve nventi ntional

• nal 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

• n of

f th the e ey eye e app ppearance earance from grades III to II / I.

VIP

(Visual Iris-pupil complex Percentage)

Co Conc nclusion lusion

• 3D  2D

2D

• Simp

mpler, ler, rel

eliable, le, objec

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