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American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline: Eyelid Surgery for Upper Visual
Kenneth K Kim1, Mark S Granick1, Gregory A Baum1
1From the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at the University of California, Los Angeles; Kenneth K. Kim MD, Inc., Dream Medical Group; Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School; CNY Cosmetic & Reconstructive Surgery; Landon Plastic Surgery; Department of Ophthalmology, William H. Havener Eye Institute, The Ohio State University Wexner Medical Center; American Society of Plastic Surgeons; Ashton A. Kaidi MD, Inc.; Division of Plastic and Reconstructive Surgery, Department of Surgery, UPMC Hamot; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University; Department of Surgery, Division of Plastic and Reconstructive Surgery, the University of Chicago Medicine and Biological Sciences; private practice; Goretti Ho Taghva MD, Inc.; and GV Plastic Surgery.
Background:
A group of experts from different disciplines was convened to develop guidelines for the management of upper visual field impairments related to eyelid ptosis and dermatochalasis. The goal was to provide evidence-based recommendations to improve patient care.
Methods:
A multidisciplinary group of experts representing their specialty organizations was selected. A systematic literature review was performed including topics regarding documentation of the underlying cause for visual field impairment, selection of an appropriate surgical repair, assessment of the type of anesthesia, the use of adjunctive brow procedures, and follow-up assessments. The Grading of Recommendations, Assessment, Development, and Evaluation methodology process was used to evaluate the relevant studies. Clinical practice recommendations were developed using BRIDGE-Wiz (Building Recommendations In a Developers' Guideline Editor) software.
Results:
Each topic area was assessed. A clinical recommendation was made, and the relevant literature was discussed.
Conclusions:
The review of the literature revealed varied complication rates and diverse treatment modalities for the correction of upper visual field deficit. Strong recommendations could not be made in most topic areas because of a paucity of methodologically sound studies in the literature. More rigorously designed studies are needed to measure outcomes of interest, with fewer sources of potential error or bias.
Clinical Question/Level Of Evidence:
Therapeutic, V.
