Going sutureless may sound like an attractive prospect for cataract patients, but it may not always be the best option. Sutureless clear corneal cataract incisions boast benefits such as reduced conjunctival trauma, less discomfort and bleeding, absence of suture-induced astigmatism and faster visual rehabilitation.1 However, research shows side effects, although still rare, can be more frequent than traditional sutured techniques.1,2 A new study recommends better preoperative screening and counseling to prevent these issues.

The recent study from Iranian investigators shows that clear corneal sutureless phacoemulsification can result in persistent and clinically significant ptosis.2 The study looked into the cases of 313 eyes of 234 patients. Eyelids with persistent postoperative ptosis showed a significantly lower preoperative levator function (13.9mm vs.15.8mm).

The researchers measured participants’ margin reflex distance 1, margin reflex distance 2 and levator function. Eyes with any drop in margin reflex distance 1 were considered to have clinical ptosis. Any margin reflex distance 1 drop of 2mm or more was considered clinically significant. Researchers also used facial photography before, one month after and six months after the surgery to determine photo-based ptosis.2

They found clinically significant ptosis in 3.2% of patients who underwent clear corneal sutureless phacoemulsification.2 They added that lower preoperative levator function was significantly associated with a higher frequency of postoperative ptosis.2 They noted persistent clinical ptosis in 25.4% and photo-based ptosis in 3.3%.2

No other factors were significantly different between the eyelids with and without postoperative ptosis.2 The team could not associate the ptosis with the duration of the surgery, surgeon experience or any other variable.2 

1. Mahmood A, Al-Swailem S, Behrens A. Clear Corneal Incision in Cataract Surgery. Middle East Afr J Ophthalmol. 2014;21(1):25-31.

2. Kashkouli M, Abdolalizadeh P, Es’haghi A, et al. Postoperative blepharoptosis after modern phacoemulsification procedure. January 9, 2019. [Epub ahead of print].