Corneal Fourier harmonic analysis in prostaglandin-associated periorbitopathy patients with blepharoptosis

Purpose: Prostaglandin-associated periorbitopathy (PAP), which causes skin hardening, ptosis, and deepening of the upper eyelid sulcus (DUES), has been suggested to affect corneal shape due to increased eyelid pressure. In this study, we performed a corneal shape analysis using anterior segment optical coherence tomography (AS-OCT) in patients with PAP accompanied by blepharoptosis. Study design: Retrospective study. Methods: Fourier harmonic corneal shape analysis using anterior segment OCT was performed in patients with a margin reflex distance-1 (MRD-1) of 2 mm or less (176 eyes of 101 cases). Cases with congenital ptosis, neurogenic ptosis, facial nerve palsy, thyroid eye disease, history of eyelid surgery, vitrectomy, glaucoma tube shunt surgery or filtration surgery were excluded. Patients were divided into two groups based on the presence or absence of prostaglandin analog (PGA) eye drops, and a comparative analysis was conducted. Results: In the comparison between the PGAs group (n=47) and the non-PGAs group (n=129), no significant differences were observed in age, gender, MRD-1, or levator function. However, the PGAs group exhibited significantly larger values for both regular and irregular astigmatism. Additionally, in the PGAs group, when the severity of PAP was classified (grades 0 to 3), there was a correlation between PAP grade and both regular and irregular astigmatism. Conclusion: Patients with PAP who developed ptosis exhibited significant increases in both regular and irregular astigmatism, with a correlation observed between PAP grade and astigmatism. It is suggested that the increased eyelid pressure due to PAP may influence corneal shape.