ETIOLOGY OF PTOSIS AFTER CATARACT-SURGERY

Purpose: To determine whether using a lid speculum with a superior rec tus bridle suture in cataract surgery results in levator rectus aponeu rosis dehiscence caused by strong fascial attachments between the leva tor and superior rectus muscles. Setting: L.V. Prasad Eye Institute, H yderabad, India. Methods: This study comprised 220 patients having cat aract extraction with posterior chamber intraocular lens implantation. The patients were randomly assigned to one of two groups. In the firs t group (n = 108), a lid speculum was used during surgery. In the seco nd group (n = 112), no speculum was used. All patients had a superior rectus bridle suture. The occurrence of ptosis was analyzed by a maske d observer who was not involved in the surgery. Results: The incidence of ptosis was significantly higher in the speculum (44.4%) than in th e no-speculum (23.3%) group (P = .0009). Conclusion: The results indic ate that the opposing forces created by the lid speculum and bridle su ture can cause levator aponeurosis dehiscence because of the strong fa scial attachments between the superior rectus and levator muscles. The occurrence of ptosis in the no-speculum group implies a multifactoria l etiology, however.