PMC9082211_01
Recurrent blepharoptosis of the right eye of an 81-year-old man who had repeated external levator advancement surgery (left). An inter-eye symmetry was achieved following a repeated blepharoptosis surgery in our hospital (right).
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F1
The MRD1 was 1.0 mm for the right eye and 3.0 mm for the left eye (Fig. 1). The postoperative results were satisfying with a well-balance bilateral MRD1 (Fig. 1).
Slit-lamp photograph of the patient's right eye at the first visit. Upper corneal stromal opacity (upper), longitudinal scratch pattern corneal lesions (lower left), and the thinning of cornea (lower right) can be seen.
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F2
The corneal stroma was cloudy due to the epithelial lesions and intrastromal opacities (Fig. 2).
Inverted upper eyelid showing a large palpebral fold. No apparent suture exposure were found (left) even when an effort was made to further invert the lid using a swab (right).
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F3
The upper eyelid was inverted to search for any exposed sutures, and a large conjunctival fold was found without any sutures (Fig. 3).
Following topical anesthesia, the large palpebral fold was further rotated using a pair of forceps to search for suture exposure at the upmost conjunctiva fornix (left). Three suture bites were found with two protruding the palpebral conjunctiva (right, solid circle).
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F4
This then revealed three suture bites behind the conjunctival fold and two were protruding above the conjunctiva (Fig. 4).
Anterior segment optical coherence tomography showing severe astigmatism before suture removal (upper left) and even at 1 year after suture removal (upper right). OPD-III scan showing high values of higher order aberration at first visit (lower left) and 1 year after treatment as well (lower right).
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F5
The HOA was 3.346 mum for the right eye in contrast to 0.411 mum for his left eye (Fig. 5). The keratometric astigmatism was 6.8 D, the eccentricity of the cornea was 0.72, and the HOA of right cornea was 2.993 mum, a very high degree of abnormality (Fig. 5).