Correlation between the number of intravitreal injections and acquired blepharoptosis caused by eyelid speculum: a prospective study

Objectives To investigate the correlation between the number of intravitreal injection applications and possible involutional blepharoptosis secondary to the eyelid speculum used during this procedure with real-life data. Patients and methods This prospective study consisted of 34 eyes of 30 patients. Demographic characteristics such as age and sex recorded, and also previous eye operations. The margin-to-reflex distance 1 (MRD-1) and margin-to-reflex distance 2 (MRD-2) values and levator function (LF) in millimeters were noted at the first visit time of the indication for intravitreal injection. Before each repeated intravitreal injection, MRD-1, MRD-2, and LF values were measured and noted by the same researcher during the next three visits. This study was conducted between December 2023 and May 2024. Main results The mean age of our patients was 64.06±12.30 years. Among the patients, 52.9% were females and 47.1% were males. Only 23.5% of our patients had a history of previous eye surgery other than eyelid surgery. There was a decrease in MRD-1 mean values from the first visit to the fourth visit ( P =0.001). There was a decrease in MRD-2 mean values from the first visit to the fourth visit ( P =0.218). There was a decrease in LF mean values from the first visit to the fourth visit ( P =0.001). The mean MRD-1 of the second visit and mean MRD-1 of the fourth visit values were found to be higher in the group without previous eye surgery ( P =0.036 and 0.041, consecutively). LF values were found to be higher in men than women during four visits ( P =0.002, 0.005, 0.008, and 0.005, respectively). A statistically significant negative correlation was found between age and LF during four visits ( r =−496, P =0.003; r =−370, P =0.040; r =−365, P =0.048; r =−393, P =0.035, respectively). Conclusion In addition to the benefits of intravitreal injections used in the treatment of diseases that may cause vision loss, it should not be forgotten that involutional ptosis, which may be caused by the eyelid speculum used during intravitreal injection application, can cause a decrease in vision quality by causing narrowing of the visual field in addition to senile changes, especially in older age group patients.