Surgical Treatment of Epiblepharon Effectively Alleviates Keratopathy but Not Astigmatism: A Case-Control Study Utilizing Vector Analysis in East Asian Children.

Shang-Te Ma,Yo-Shen Chen,Tzu-Hsun Tsai,Yao-Lin Liu,Ching-Ju Hsieh,N Ra Szentm Ry

doi:10.1155/2020/5073895

Abstract

Purpose To identify an appropriate surgical indication of epiblepharon by comparing keratopathy and astigmatism outcomes after surgical and medical treatments for epiblepharon in Asian children. Methods Children diagnosed with epiblepharon (n = 82, age 5.93 ± 2.76 years) with >6 months of follow-up were enrolled. The clinical presentations and cycloplegic refractive status at the baseline and 3 and 6 months after treatment were compared between surgical (91 eyes from 47 children) and nonsurgical (67 eyes from 35 children) groups. The refractive and keratometric astigmatism at each time point were evaluated with vector analysis methods. For Thibos and Horner's method, the astigmatic power vector was decomposed into horizontal and oblique meridians (J0 and J45). However, the treatment-induced astigmatism (TIA) vectors were calculated by Alpins' method and depicted by the AstigMATIC software. Results In the surgical and nonsurgical groups, the baseline astigmatism magnitude was similar (2.22 ± 1.39 and 2.26 ± 1.46 D, p = 0.87). The rate of complete resolution of keratopathy at 6 months was 71.4% and 11.5%. The astigmatism magnitude in the surgical group differed among baseline and 3 months (2.25 ± 1.23 D) and 6 months postoperatively (1.97 ± 1.28 D) (p = 0.001). Power vector analyses confirmed a nuanced against-the-rule shift in the surgical group. This trend was especially observed in the subgroup of baseline astigmatism >2.0 D. However, the difference in the astigmatism magnitude between surgical and nonsurgical groups, even in highly astigmatic children, was not significant at 6 months. Conclusions The improvement of keratopathy in the surgical group was greater than that in the nonsurgical group in consideration of the more advanced severity in the surgery group at baseline. Decreased with-the-rule astigmatism can be observed at 6 months postoperatively, particularly among those with greater baseline astigmatism. However, the amount of change is small, and the outcome does not differ significantly from the nonsurgical treatment. Therefore, surgical indications should majorly base on the severity of symptoms and keratopathy.

Highlights

Epiblepharon is a congenital eyelid anomaly that is more prevalent in Asian children. is structural lid abnormality usually presents in the lower eyelids and preferentially affects both eyes in about half of the Asian infants [1, 2]
Children with epiblepharon who were younger than 18 years and were treated and followed up by a single surgeon (THT) for more than 6 months at the National Taiwan University Hospital from 2007 to 2016 were enrolled. e study protocol was approved by the Research Ethics Committee of the National Taiwan University Hospital. e severity of keratopathy related to epiblepharon with cilia touch was assessed based on the grading system proposed by Kim et al [20]. e grading of keratopathy severity was divided into grade 0 to grade 3 according to the fluorescent staining pattern under biomicroscopy with cobalt blue light
Most patients had bilateral involvement (76/82, 92.7%). e baseline demographic data are shown in Table 1. e subjective ocular irritation symptoms and the severity of keratopathy were more prominent in children in the surgical group. ey reported symptoms, including frequent eye rubbing (51.1%), irritation (38.3%), photophobia (23.4%), epiphora or red eye (21.2%), and frequent eye squeezing (12.8%). ere was no significant difference between the two groups in terms of age at treatment, sex, spherical equivalent, magnitude of astigmatism, J0 and J45 in ibos and Horner’s astigmatic vector analysis, and the type of astigmatism. e major astigmatism type in both groups was WTR astigmatism

Summary

Introduction

Epiblepharon is a congenital eyelid anomaly that is more prevalent in Asian children. is structural lid abnormality usually presents in the lower eyelids and preferentially affects both eyes in about half of the Asian infants [1, 2]. Is structural lid abnormality usually presents in the lower eyelids and preferentially affects both eyes in about half of the Asian infants [1, 2]. It is characterized by a horizontal and redundant skinfold with underlying pretarsal orbicularis muscle extending over the eyelid margin and misdirecting the eyelashes toward the ocular surface [3]. E most common type of astigmatism in epiblepharon patients is the with-the-rule (WTR) type, in those who had long-term persistent corneal erosion [9,10,11,12, 14]. Amblyopia is more common among children with epiblepharon [10, 11, 16], which may be related to high astigmatism or prolonged keratopathy [14]

Methods

Results

Conclusion