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Influence of epinephrine contained in local anesthetics on upper eyelid height in transconjunctival blepharoptosis surgery

  • Oculoplastics and Orbit
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Abstract

Purpose

To examine the influence of epinephrine contained in local anesthetic on upper eyelid height in transconjunctival aponeurotic repair for aponeurotic blepharoptosis.

Methods

This retrospective study included 164 eyelids from 94 patients with aponeurotic blepharoptosis. Patients were divided according to the use of local anesthetic with (group A, n = 108) or without 1:100000 epinephrine (group B, n = 56). Margin reflex distance-1 (MRD-1) was measured before and after local anesthesia, and before, during, and 3 months after surgery. Change in MRD-1a (∆MRD-1a) was calculated by subtracting the postanesthetic MRD-1 value from the preanesthetic value, and we defined ∆MRD-1b by subtracting the postoperative 3-month MRD-1 value from the intraoperative value.

Results

∆MRD-1a was positive in group A (0.57 ± 0.63 mm) and negative in group B (− 0.50 ± 0.45 mm; p < 0.001). Postoperative MRD-1 decreased significantly from intraoperative MRD-1 in group A (P < 0.001), although there was no significant difference between intraoperative and postoperative MRD-1 in group B (p = 0.255). The magnitude of ∆MRD-1b in group A (− 0.86 ± 0.63) was larger than that in group B (− 0.23 ± 0.26; p < 0.001).

Conclusions

Epinephrine stimulates Müller’s muscle during surgery, which leads to postoperative upper eyelid droop after the disappearance of the epinephrine effect. Using local anesthetics without epinephrine may allow more accurate estimation of postoperative eyelid height in transconjunctival aponeurotic repair.

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Acknowledgments

We thank Jane Charbonneau, DVM, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Ophthalmology, Jikei University School of Medicine, Tokyo, 105-8471, Japan

    Hiromichi Matsuda, Yuri Hanzawa & Tadashi Nakano

  2. Department of Ophthalmology, Daisan Hospital, The Jikei University School of Medicine, Komae, Tokyo, Japan

    Yoshiaki Kabata

  3. Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan

    Yasuhiro Takahashi

Authors
  1. Hiromichi Matsuda
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  2. Yoshiaki Kabata
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  3. Yasuhiro Takahashi
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  4. Yuri Hanzawa
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  5. Tadashi Nakano
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Contributions

All authors qualify for authorship based on their contributions to the conception and design (HM), acquisition of data (HM and YH), literature search (HM and YK), and analyses and interpretation of data (HM, YT, YH, and TN). All authors contributed to drafting the article and revising it critically for important intellectual content and provided final approval of the version to be published.

Corresponding author

Correspondence to Hiromichi Matsuda.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

The Jikei Medical University institutional review board (IRB) approved this study (No. 30-365), and the study followed the tenets of the Declaration of Helsinki. The IRB granted a waiver of informed consent for this study on the basis of the ethics guidelines for medical and health research involving human subjects established by the Japanese Ministry of Education, Culture, Sports, Science and Technology, and by the Ministry of Health, Labor and Welfare. The waiver was granted as the study was a retrospective chart review, not an interventional study. The IRB requested that we present an outlined description of this study to the public via a notice board in our institution, to provide an additional opportunity for patients to refuse participation in the study before patient records were de-identified and made anonymous. None of the patients declined participation.

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Matsuda, H., Kabata, Y., Takahashi, Y. et al. Influence of epinephrine contained in local anesthetics on upper eyelid height in transconjunctival blepharoptosis surgery. Graefes Arch Clin Exp Ophthalmol 258, 1287–1292 (2020). https://doi.org/10.1007/s00417-020-04627-6

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  • DOI: https://doi.org/10.1007/s00417-020-04627-6

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