Changes in Corneal Higher-order Aberrations and Astigmatism after Upper Eyelid Surgery

Purpose: We investigated the effects of upper eyelid surgery on corneal higher-order aberrations and astigmatism. Methods: We enrolled 38 patients (66 eyes) who underwent blepharoplasty and 48 (81 eyes) who underwent levator resection. The marginal reflex distance1 (MRD1), corneal astigmatism, and corneal higher-order aberrations were measured preoperatively, and at 6 months postoperatively, and the two groups were compared. Results: Corneal astigmatism decreased significantly in the ptosis repair group ( p < 0.001) but there was no significant change in the axis of astigmatism. Preoperative third-order and coma-like aberrations were significantly more common in the ptosis repair group than in the other group ( p = 0.027 and p = 0.044, respectively); both decreased significantly after the operation ( p = 0.030 and p = 0.006, respectively). The decrease in MRD1 and changes in the two aberrations showed a significantly stronger negative correlation in the ptosis repair group than in the other group (b = -0.186; p < 0.001 and b = -0.159; p < 0.001, respectively). Conclusions: For patients with both cataract and ptosis, it is best to perform levator resection surgery before cataract surgery, because corneal higher-order aberrations and astigmatism are improved by levator resection. In turn, this reduces postoperative refractive error and improve vision quality.