Epithelial and Topographic Corneal Remodeling After Ptosis and Ectropion Surgery: An MS-39-Based Study

Background/Objectives: Eyelid malpositions can alter corneal shape through chronic mechanical forces, yet conventional topographic devices do not distinguish epithelial from stromal contributions to these changes. This study aimed to characterize layer-specific corneal remodeling after surgical correction of ptosis and ectropion using hybrid spectral-domain OCT/Placido tomography and to assess whether epithelial thickness mapping provides clinically relevant information beyond standard corneal topography. Methods: This study is a retrospective single-center study evaluating 33 eyes of 20 patients: 16 with ptosis and 17 with ectropion. MS-39 imaging was collected preoperatively, at 14 days, and at 6 months. Primary outcomes included sectoral epithelial thickness and inferior-superior (I-S) epithelial asymmetry. Secondary outcomes included central corneal and estimated minimum stromal thickness; keratometric values were analyzed as tertiary outcomes. Results: In the ptosis group, superior epithelial thickness increased from 40.7 to 44.3 µm at 6 months (p = 0.001), while I-S asymmetry decreased from 10.1 to 4.5 µm (p = 0.001). In the ectropion group, inferior epithelial thickness decreased from 54.8 to 51.0 µm, with changes detectable at 14 days, and I-S asymmetry decreased from 8.1 to 3.8 µm. Central corneal and estimated minimum stromal thickness remained stable in both groups. K2 and anterior corneal astigmatism decreased significantly by 6 months in both groups. Conclusions: Surgical correction of eyelid malpositions was associated with predominantly epithelial remodeling, while stromal thickness remained stable. These epithelial changes may modify keratometric and astigmatic measurements, supporting reassessment after corneal stabilization, the timing of which requires further characterization, in patients considered for refractive or premium cataract surgery.