Effect of upper eyelid blepharoplasty with or without orbicularis oculi muscle removal on anterior segment parameters, keratometry, and ocular biometry

To evaluate the effect of upper eyelid blepharoplasty with or without the removal of a strip of orbicularis oculi muscle on corneal topographic parameters, anterior segment parameters, intraocular pressure, and ocular biometry.

This prospective study examined 428 eyes of 214 patients with dermatochalasis. Patients were divided into two groups randomly: those who underwent orbicularis oculi muscle excision (Group 1) during blepharoplasty and those who did not (Group 2). Following a detailed ophthalmological examination, corneal topography was used to evaluate the eyes anterior chamber depth (ACD), iridocorneal angle (ICA), keratometry measurements, and corneal astigmatism (CA) in the preoperative and postoperative first and third months. Ocular biometry was used to assess axial length (AXL) and intraocular lens (IOL) power. Goldmann applanation tonometry was used to measure intraocular pressure (IOP).

The age and gender distribution between the groups were similar (p = 0.595 and p = 0.493, respectively). In Group 1, the mean steep keratometry (K2) value increased by 1.1 D and the mean CA increased by 0.81 D in the first month (p < 0.001 for both comparisons). The increases in K2 and CA were 0.7 D and 0.63 D, respectively, in Group 2 (p < 0.001 and p = 0.004, respectively). At the postoperative third month, both groups demonstrated statistically significant persistent elevations in K2 and CA values (p < 0.05 for all comparisons) compared to preoperative measurements. Group 1 exhibited statistically significant decreases in both IOL power calculations (0.43 D according to the Barrett formula and 0.40 D according to the SRK/T formula, p < 0.001, for both) and ICA (38.1 ± 4.7° vs. 35.8 ± 4.1°, p = 0.009) measurements at the only one-month postoperative follow-up. IOP, AXL, and ACD measurements did not exhibit any significant changes in both groups at the first and third postoperative months.

In addition to changes in keratometry and CA, blepharoplasty with muscle excision significantly decreased IOL power and ICA. It may be beneficial to inquire about recent blepharoplasty history and the surgical technique employed in patients scheduled for cataract or refractive surgery.