View 2019 Abstracts

Several studies have postulated that trauma to the levator complex through speculum use may contribute to an increased risk of ptosis after cataract surgery. Similarly, it is plausible that speculum use in cataract surgery may damage the inferior eyelid retractor, resulting in an increased risk of involutional entropion. This hypothesis is previously untested.

Data was extracted on all patients who had undergone cataract surgery at a single centre during a 10-year period. From this dataset, patients in whom both eyes were now pseudophakic were excluded. This created a study cohort with one eye ‘exposed’ to cataract surgery and their fellow eye serving as a ‘control’. Patients with any prior lower eyelid surgery or with a non-involutional cause of entropion were excluded. The relative risk of entropion surgery following cataract surgery was calculated between the ‘exposed’ and the ‘control’ eye.

We identified 27 patients who underwent cataract surgery in only one eye and subsequently had surgery for involutional entropion in either eye. Of these, 21 (78%) were in the ‘exposed’ group and 6 (22%) were in the ‘control’ group. The risk of onset of involutional entropion and subsequent surgical correction was 0.19% in the ‘exposed’ and 0.05% in the ‘control’ groups respectively. The relative risk was 3.5x higher in the ‘exposed’ group (p=0.007; 95% CI 1.4 – 8.7). Median time between procedures was 26 months (range 3-122). Owing to the nature of the study design, the incidence is likely underestimated, but the relative risk remains resistant to this limitation.

This study shows a trend towards an increased risk of surgery for involutional entropion following cataract surgery. These findings warrant further study.