title: Etiology of ptosis after cataract surgery.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: L.V. Prasad Eye Institute, Hyderabad, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Singh
authors.forename: G C
authors.initials: GC
authors.lastname: Sekhar
authors.forename: S
authors.initials: S
authors.lastname: Gupta
mesh_terms: D001763:Blepharoptosis / Q000453:epidemiology / Q000209:etiology*; D002387:Cataract Extraction / Q000009:adverse effects* / Q000295:instrumentation; D005143:Eyelids / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009801:Oculomotor Muscles / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D013536:Suture Techniques / Q000009:adverse effects*