Quantitative assessment of subfoveal choroidal thickness, retinal thickness, and choroidal vascularity index after upper eyelid blepharoplasty.

[PURPOSE] To evaluate the quantitative changes in subfoveal choroidal thickness (CT), retinal thickness, and choroidal vascularity index (CVI) following upper eyelid blepharoplasty in patients with dermatochalasis, using spectral-domain optical coherence tomography (SD-OCT).

[METHODS] This retrospective study included 78 eyes of 78 patients (mean age: 57.9 ± 8.7 years) who underwent upper eyelid blepharoplasty between May 2024 and May 2025. Only right eyes with high-quality SD-OCT images obtained both preoperatively and at 3 months postoperatively were included. Retinal thickness was assessed in 9 ETDRS subfields. Subfoveal CT and CVI were measured using horizontal B-scan images. CVI was calculated based on the binarization method described by Agrawal et al., using ImageJ software. Pre- and postoperative values were compared using paired t-tests or Wilcoxon signed-rank tests depending on normality.

[RESULTS] Subfoveal CT significantly increased after surgery (287.22 ± 39.67 µm to 294.23 ± 39.74 µm; p = 0.030). A marked increase in CVI was also observed (61.48 ± 9.13% to 63.63 ± 9.13%; p < 0.001). No significant differences were detected in most retinal segments, except for the inferior inner (p = 0.016) and inferior outer (p = 0.002) regions, which showed statistically significant thickening postoperatively.

[CONCLUSIONS] Upper eyelid blepharoplasty is associated with measurable structural changes in the posterior segment, including increased subfoveal CT and CVI, as well as regional thickening of the inferior retina. These findings suggest that blepharoplasty may influence choroidal hemodynamics and retinal adaptation beyond its functional and cosmetic benefits.