Etiology of ptosis after cataract surgery

Purpose: To determine whether using a lid speculum with a superior rectus bridle suture in cataract surgery results in levator rectus aponeurosis dehiscence caused by strong fascial attachments between the levator and superior rectus muscles. Setting: L.V. Prasad Eye Institute, Hyderabad, India. Methods: This study comprised 220 patients having cataract extraction with posterior chamber intraocular lens implantation. The patients were randomly assigned to one of two groups. In the first group (n = 108), a lid speculum was used during surgery. In the second group (n = 112), no speculum was used. All patients had a superior rectus bridle suture. The occurrence of ptosis was analyzed by a masked observer who was not involved in the surgery. Results: The incidence of ptosis was significantly higher in the speculum (44.4%) than in the no-speculum (23.3%) group (P = .0009). Conclusion: The results indicate that the opposing forces created by the lid speculum and bridle suture can cause levator aponeurosis dehiscence because of the strong fascial attachments between the superior rectus and levator muscles. The occurrence of ptosis in the no-speculum group implies a multifactorial etiology, however.