Effect of Apraclonidine on Eyelid Position and Use in Surgical Planning
Authors: Helya Aghazadeh, Audrey Chan. Author Disclosure Block: H. Aghazadeh: None. A. Chan: None.
Purpose: To investigate the role and reliability of apraclonidine (brand name Iopidine) eye drops in assessment of ptosis and surgical planning for ptosis repair.
Study Design: This study is designed as a retrospective chart review.
Methods: A retrospective chart review of patients referred for mild to moderate upper eyelid ptosis management to a major oculoplastic ophthalmology practice in Edmonton, Alberta was undertaken. Information collected includes date of initial presentation, sex, visual acuity, MRD1 and palpebral fissure height prior to and after instillation of 1 drop apraclonidine 0.5% eye drops into the affected eye, as well MRD1 and palpebral fissure height post ptosis repair with mullerectomy. Non-identifying photos of the eyes taken during the pre- and post-operative assessments were used to measure MRD1 and palpebral fissure height measurements pre- and post-instillation of apraclonidine, as well as post-operatively following mullerectomy for ptosis repair. The means and standard deviations for these measurements were calculated.
Results: A total of 17 eyes that had been referred for assessment and management of mild to moderate upper eyelid ptosis who had undergone mullerectomy for ptosis repair in the past 12 months were identified. During the pre-operative assessment, the mean change in MRD1 pre-apraclodine 0.5% drop instillation versus post-apraclodine instillation was found to be 1.38 mm, with a standard deviation of 0.90 mm. The mean difference between MRD1 measurements post-operatively following mullerectomy versus at the pre-operative assessment prior to apraclonidine instillation was found to be 1.47 mm, with a standard deviation of 0.81 mm. The mean difference between MRD1 measurements post-operatively following mullerectomy versus at the pre-operative assessment following apraclonidine instillation was
0.09 mm, with a standard deviation of 0.91 mm.
Conclusions: This study investigates a novel use of apraclonidine eye drops in pre-operative assessment of ptosis repair. The results of this study show great accuracy in prediction of post-operative MRD1 values with use of apraclonidine 0.5% during the pre-operative assessment. These results suggest that apraclonidine may be useful for routine pre-operative assessment, allowing for accurate prediction of post-operative eyelid position following posterior approach ptosis repair and aiding in patient selection for this type of surgical repair. The use of apraclonidine 0.5% eye drops would have the added benefit of avoiding pupil dilation. This is in contrast to phenylephrine 2.5% eye drops, which are commonly used in pre-operative ptosis repair assessments and can possibly result in pupillary dilation and decreased visual acuity of the patient for several hours.