CO2 Laser Blepharoplasty for Vulnerable Elderly Patients with Severe Ptosis

Abstract

OBJECTIVE: To report the success of CO2 Laser Blepharoplasty (CLB) for severe ptosis (SP) in vulnerable elder patients (VEP).MATERIALS AND METHODS: A retrospective review of 32 consecutive cases of SP was carried out between 2013-2014 at Bangkok Hospital, Ramkamhaeng Hospital, Patana Medical Center Clinic in Bangkok. All SP case (margin refl ex distance (MRD1) 0-1 mm) were aged 60 years or above, ranging between 60-84 years of age, old aged patients were 80 years or above (5 patients (15.62%)). The average age was 68.5 years, 20 of the patients were women (72.5%), and 12 were men (37.5%). Each patient had at least one or more underlying diseases: diabetes mellitus (DM) in 12 cases (37.5%), hypertension (HT) in 10 (31.25%), heart diseases (HD) (i.e. post balloon cath, cardiac intervention, coronary bypass) in 8 (25%), bleeding diathesis (i.e. ITP, cannot stop anticoagulation or antiplatelet) in 4 (12.5%), and Parkinson’s disease in 2 cases (6.25%). The levator aponeurosis advancement (LA) was performed with a CO2 laser device in Ultrapulse mode, (power 5-7 W) under local anesthesia. Light intravenous sedation for the 5 very old aged patients was added to calm and comfort them during the operation. The LA adjustment for eyelid height and contour in an upright position was selected to obtain the most consistently favorable postoperative results. MRD1 (pre-and post-op) Intra-op bleeding, post-op bleeding, pain and patient satisfaction were assessed.RESULTS: Margin refl ex distance (MRD1) pre-op = 0-1 mm, post-op average = 2.8 mm (p < 0.01), low bleeding or nearly bloodless during intra-op & post-op. The advantage of CO2 laser over conventional surgery is easy dissection of skin and fat tissue and especially being able to clearly identify the LA with ease. Twenty eight cases (87.5%) had mild pain or less, 4 cases (12.5%) had moderate pain, no severe pain observed. There was no serious complication or any harmful effect to the patients or their underlying diseases. All patients reported a high degree of satisfaction after the operation and were happy with their better vision and facial presentation.CONCLUSION: CLB can be a good choice for diffi cult cases, especially SP and complicated VEP.