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Plastic and Reconstructive Surgery Nov 2023The conventional frontalis muscle advancement technique still has some disadvantages, such as residual lagophthalmos, eyebrow ptosis, eyelid contour abnormality, and...
BACKGROUND
The conventional frontalis muscle advancement technique still has some disadvantages, such as residual lagophthalmos, eyebrow ptosis, eyelid contour abnormality, and undercorrection. This article describes the authors' extended frontalis muscle advancement technique, which takes extensive subcutaneous separation through the eyelid crease incision for the treatment of severe congenital blepharoptosis.
METHODS
A retrospective review was performed that included patients with severe congenital ptosis who underwent extended frontalis muscle advancement technique from April of 2019 to April of 2021. Preoperative evaluation included age, sex, and margin reflex distance 1, levator function, and lagophthalmos. Postoperative evaluation including correction result, closure function of eyelid, and cosmetic result was performed at the last follow-up.
RESULTS
From April of 2019 to April of 2021, a total of 102 patients (137 eyes) who underwent extended frontalis muscle advancement technique were included in the study. The mean postoperative margin reflex distance 1 in unilateral and bilateral ptosis patients was 3.84 ± 0.60 mm and 3.86 ± 0.56, respectively, and 126 eyes (92.0%) showed successful correction. Postoperatively, the mean residual lagophthalmos was 0.88 ± 1.40 mm, and 127 eyes (92.7%) showed excellent or good eyelid closure function. The average score of cosmetic results was 8.29 ± 1.34, and 94 patients (92.2%) had an excellent or good cosmetic result.
CONCLUSIONS
Extensive subcutaneous separation relieves the mutual restriction between the forehead skin and frontalis muscle. The extended frontalis muscle advancement technique is effective in correcting severe congenital ptosis, and minimizes undercorrection, residual lagophthalmos, eyelid contour abnormality, and eyebrow ptosis.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Humans; Infant; Blepharoptosis; Surgical Flaps; Blepharoplasty; Eyelids; Eyelid Diseases; Lagophthalmos; Retrospective Studies; Muscles; Oculomotor Muscles; Treatment Outcome
PubMed: 36877618
DOI: 10.1097/PRS.0000000000010368 -
Acta Neurologica Taiwanica Jun 2024Myasthenia gravis (MG) is the most common autoimmune disease that affects the neuromuscular junction and can cause weakness in various muscle groups. The most commonly...
PURPOSE
Myasthenia gravis (MG) is the most common autoimmune disease that affects the neuromuscular junction and can cause weakness in various muscle groups. The most commonly affected muscles are the eye, facial, and neck flexors. Focal or dominant weakness of the triceps muscle is rare. In this case, we aimed to describe a rare form of MG consisting of selective or dominant triceps muscle weakness.
CASE REPORT
We present a 45-year-old male patient whose initial complaints were diplopia and ptosis. Acetylcholine receptor antibody was positive. After 10 years of well-being following thymectomy, bilateral triceps weakness was added to his ocular symptoms despite regular medication (pyridostigmine and prednisone). Repetitive nerve stimulation (RNS) showed decremental responses in the right triceps muscles.
CONCLUSION
It is important to recognize this type of myasthenia gravis to facilitate diagnosis and appropriate treatment and to avoid unnecessary investigations and treatments.
Topics: Male; Humans; Middle Aged; Myasthenia Gravis; Muscle Weakness; Muscle, Skeletal; Pyridostigmine Bromide; Blepharoptosis
PubMed: 37848221
DOI: No ID Found -
[Zhonghua Yan Ke Za Zhi] Chinese... Nov 2021To evaluate the demographics, etiology composition, clinical characteristics and surgical outcomes of acquired ptosis patients. Retrospective case-series study. The...
To evaluate the demographics, etiology composition, clinical characteristics and surgical outcomes of acquired ptosis patients. Retrospective case-series study. The clinical records of 176 consecutive patients (312 eyes) with acquired ptosis were reviewed from January 2009 to December 2018 in the Ophthalmology Department of Tianjin Medical University General Hospital. The demographics, etiology composition, clinical characteristics, surgical strategies and outcomes were analyzed. There were 59 male (33.5%) and 117 female (66.5%) patients suffering acquired ptosis, with an average age of (64±7) years. The disease was bilateral in 136 cases and unilateral in 40 cases. There were four etiological components of acquired ptosis: 145 cases (82.4%) of aponeurotic ptosis, 17 cases (9.6%) of neurogenic ptosis, 10 cases (5.7%) of myogenic ptosis and 4 cases (2.3%) of traumatic ptosis. The clinical characteristics of acquired ptosis varied significantly depending on etiology. Ptosis surgeries were performed on 152 cases (279 eyes), and the success rate was 92.1% (140/152). Surgical procedures included levator aponeurosis surgeries on 148 cases (275 eyes), frontal muscle suspensions on 2 cases (2 eyes) and conjunctival-Müller's ectomies on 2 cases (2 eyes). Acquired ptosis is more likely to occur in senile and female populations with bilateral eyelids involved mostly. Aponeurotic ptosis is the predominant type of acquired ptosis. The treatment is performed according to the clear etiological diagnosis based on clinical features, and operations are efficient for most patients with acquired ptosis. .
Topics: Aged; Blepharoplasty; Blepharoptosis; Eyelids; Female; Humans; Male; Middle Aged; Oculomotor Muscles; Retrospective Studies
PubMed: 34743470
DOI: 10.3760/cma.j.cn112142-20210213-00089 -
Medicina (Kaunas, Lithuania) Mar 2023: Previous studies on ptosis recurrence after correction surgery have tended to focus on postoperative complications, surgical methods and suspension materials, few have...
: Previous studies on ptosis recurrence after correction surgery have tended to focus on postoperative complications, surgical methods and suspension materials, few have mentioned refractive error. This research is to investigate the potential relation between refractive error and recurrence after correction surgery in pediatric patients with simple congenital ptosis. : We conducted a retrospective analysis of data from patients with simple congenital ptosis who were treated at Zhongshan Ophthalmic Center (ZOC) between 2017 and 2020. In total, 111 eyelids of 85 patients without surgery-related complications who underwent frontalis muscle flap suspension (FMFS) for simple congenital ptosis were included. Postoperative changes in eyelid height were assessed. Cycloplegic refraction was assessed before surgery and during the follow-up period (every 3 months after surgery). Recurrence in the postoperative period was defined as a marginal reflex distance 1 (MRD1) of <1 mm. : There were 16 recurrence and 69 non-recurrence cases, with no statistically significant differences, in terms of patient age at the time of surgery, patient sex, or preoperative MRD1, between the recurrence and non-recurrence groups. The postoperative cylindrical diopter (adjusted odds ratio [OR] = 0.432, = 0.005), laterality (adjusted OR = 0.202, = 0.006), and preoperative MRD1 (adjusted OR = 0.617, = 0.019) were associated with ptosis recurrence after surgery. Differences between the recurrence and non-recurrence groups in spherical diopter and spherical equivalent (SE) before and after surgery were not statistically significant. In addition, preoperative refractive error and postoperative spherical diopter were not significantly associated with ptosis recurrence after correction surgery. : Ptosis recurrence after FMFS in pediatric cases of congenital ptosis is associated with refractive error. Timely refractive correction and amblyopia treatment may help to reduce ptosis recurrence.
Topics: Child; Humans; Retrospective Studies; Oculomotor Muscles; Blepharoptosis; Eyelids; Refractive Errors; Treatment Outcome
PubMed: 36984631
DOI: 10.3390/medicina59030630 -
European Journal of Ophthalmology Jul 2021To determine possible complications and efficacy of ptosis surgery in a series of chronic progressive external ophthalmoplegia (CPEO) patients with healthy tear film.
PURPOSE
To determine possible complications and efficacy of ptosis surgery in a series of chronic progressive external ophthalmoplegia (CPEO) patients with healthy tear film.
METHOD
It is a prospective interventional study on 24 eyes from 12 patients with the diagnosis of CPEO and ptosis. Pre-operatively, tear breakup test (TBUT) and Schirmer test were performed to assess lacrimal function unit. Levator resection was performed for 16 eyes with levator function (LF) more than 4 mm, while eight eyes from four patients with poorer LF underwent frontalis silicone sling surgery. Main outcome measures included change in marginal-to-reflex distance (MRD1) and incidence of post-operative exposure keratopathy.
RESULTS
The mean age of the patients was 45 ± 15 years. The mean of TBUT and Schirmer test were 12 ± 1.98 s and 15 ± 2.76 mm, respectively. The mean follow-up period was 34 months. Four eyes encountered mild to moderate exposure keratopathy. All cases were managed medically, with no need for surgical revision. The mean pre-operative MRD1, LF, and chin-up angle were -0.54 ± 1.03 mm, 4.21 ± 1.41 mm, and 21.6 ± 6.01 degrees, respectively. The mean post-operative MRD1, LF, and chin-up angle were 2.42 ± 0.60, 4.46 ± 1.53 mm, and 3.3 ± 1.01 degrees, respectively. At 1-year follow-up visit, improvement in MRD1 and chin-up posture was statistically significant (-value < 0.05).
CONCLUSION
Normal TBUT and Schirmer test results, prophylactic lubricating therapy, and close follow-up can be as important as Bell's phenomenon and palpebral fissure height in predicting post-operative complications.
Topics: Blepharoptosis; Eyelids; Humans; Oculomotor Muscles; Ophthalmoplegia, Chronic Progressive External; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 32847396
DOI: 10.1177/1120672120952344 -
The Journal of Craniofacial Surgery Sep 2022To investigate changes in the upper and lower eyelid positions using information from before and immediately after surgery in patients who underwent upper blepharoplasty...
PURPOSE
To investigate changes in the upper and lower eyelid positions using information from before and immediately after surgery in patients who underwent upper blepharoplasty and ptosis surgery.
MATERIALS AND METHODS
We retrospectively reviewed the clinical records of patients who underwent upper blepharoplasty with a diagnosis of dermatochalasis and patients who underwent levator advancement or levator resection with a diagnosis of congenital or aponeurotic ptosis. The marginal reflex distance 1 (MRD1), marginal reflex distance 2 (MRD2), palpebral fissure height (PFH), and operation time were also investigated.
RESULT
In the dermatochalasis group, the preoperative mean MRD1, MRD2, and PFH were 1.94±1.27, 4.71±0.95, and 6.65±1.65 mm, respectively. Mean MRD1, MRD2, and PFH values immediately after surgery were 1.80±0.79, 4.22±0.90, and 6.02±1.34 mm, respectively. In the ptosis group, the preoperative mean MRD1, MRD2, and PFH values were 0.27±1.34, 5.73±1.13, and 5.99±1.94 mm, respectively. Postoperative mean MRD1, MRD2, and PFH were 1.76±1.13, 4.22±1.01, and 5.98±1.60 mm, respectively.
CONCLUSIONS
It is important to remember that MRD2 could decrease during surgery. Therefore, to prevent overcorrection after upper eyelid surgery, MRD1 (not the overall PFH) should be considered to determine the appropriate extent of surgery during the procedure.
Topics: Blepharoplasty; Blepharoptosis; Eyelids; Humans; Oculomotor Muscles; Postoperative Period; Retrospective Studies; Treatment Outcome
PubMed: 35882245
DOI: 10.1097/SCS.0000000000008736 -
BMC Ophthalmology Jun 2023Upper eyelid surgeries, such as blepharoplasty and ptosis correction, are commonly performed procedures worldwide. This review examines the effects of these surgeries on... (Review)
Review
Upper eyelid surgeries, such as blepharoplasty and ptosis correction, are commonly performed procedures worldwide. This review examines the effects of these surgeries on ocular properties and visual function. A search of the PubMed and Google Scholar databases was conducted to identify relevant articles published after 2000. The results demonstrate that the ocular and adnexal organs function as a unified visual system, with changes in one component affecting the functions of others. Eyelid surgery can alter ocular properties and functions by modifying retinal lighting and ocular optics. These alterations can affect intraocular pressure estimation, corneal curvature, corneal epithelial thickness, refractive power of the cornea, and intraocular lens calculation. Additionally, eyelid surgery can exacerbate dry eye symptoms and impact contrast sensitivity, which is a significant factor in visual quality. Therefore, understanding these interactions is crucial before performing eyelid surgery and during follow-up. This review summarizes recent literature on the effects of upper eyelid surgery on corneal properties and visual function, emphasizing the importance of considering these factors when planning or undergoing such procedures.
Topics: Humans; Blepharoplasty; Astigmatism; Cornea; Blepharoptosis; Eyelids
PubMed: 37280563
DOI: 10.1186/s12886-023-03010-3 -
Ophthalmic Plastic and Reconstructive...Proper statistical analysis is an essential element in the evaluation of clinical trial outcomes. We had the informal observation that double-organ bias was a neglected... (Review)
Review
PURPOSE
Proper statistical analysis is an essential element in the evaluation of clinical trial outcomes. We had the informal observation that double-organ bias was a neglected issue during the statistical analyses of clinical trials on eyelid ptosis. The aim of this study was to formally document the prevalence of this bias in these studies.
METHODS
Clinical trials on eyelid ptosis, published in the last 20 years, were searched in PubMed with the terms; "((blepharoptosis) OR upper eyelid ptosis) OR eyelid ptosis" and with the filters "Randomized Controlled Trial (RCT), Clinical Trial, Humans." Two independent observers evaluated the articles for eligibility, field of the journal, field of the authors, presence of randomization, type of the study (surgical, medical), and statistical approach to double organ bias.
RESULTS
The PubMed search yielded 101 articles and 23 of them met the above-mentioned criteria. In 3 articles, primary outcome measure was not related with the eyes. Among the remaining 20 articles, 14 (70%) had double-organ bias in the statistics. The bias was slightly less common in randomized trials (60% vs. 80%), but the difference was not statistically significant. Its prevalence was similar between ophthalmology journals and the rest (p = 0.64). Interestingly, the bias tended to be more in Q1 journals (87.5%) compared to Q2 and Q3 journals (58.3%) and median impact factor was higher in biased articles (1.82 vs. 1.29), but the differences weren't statistically significant (p = 0.32, p = 0.24). There was no difference between the last 2 decades (66.6% vs. 75%, p = 0.64).
CONCLUSIONS
The prevalence of the double-organ bias was very high in published clinical trials on eyelid ptosis (70%) and even among RCTs (60%). The prevalence of the bias didn't prevent publication in higher impact factor journals and didn't change between journals from different disciplines or over time.
Topics: Blepharoptosis; Eye; Humans; Ophthalmology
PubMed: 33237672
DOI: 10.1097/IOP.0000000000001883 -
Arquivos Brasileiros de Oftalmologia 2023Blepharoptosis with coexisting strabismus can be observed in adults, and both these conditions affect cosmetic appearance and have psychosocial effects. Both also...
PURPOSE
Blepharoptosis with coexisting strabismus can be observed in adults, and both these conditions affect cosmetic appearance and have psychosocial effects. Both also commonly require surgery, which is typically performed using a sequential approach. This study aimed to evaluate the efficacy of simultaneous Müller's muscle-conjunctival resection with or without tarsectomy and strabismus surgery in adult patients with ptosis and coexisting strabismus.
METHODS
Patients with ptosis and coexisting strabismus who underwent simultaneous Müller's muscle-conjunctival resection with or without tarsectomy and horizontal strabismus surgery were retrospectively evaluated. Analysis included measurement of the angle of deviation in prism diopters, margin reflex distance, eyelid height asymmetry, and complications following surgery. Success of Müller's muscle-conjunctival resection with or without tarsectomy was defined as a margin reflex distance of ≥3.5 and ≤5 mm with a difference between the two upper eyelids of <1 mm. Strabismus success was defined as alignment with ±10 prism diopters of orthotropia.
RESULTS
The patients comprised three women and five men with a mean age of 37.12 years (range, 22-62 years). The strabismus stage of the surgery was performed first in all patients. Upper eyelid symmetry outcomes were assessed as perfect (<0.5 mm) in four patients and good (≥0.5 mm, <1 mm) in four patients. Success of Müller's muscle-conjunctival resection with or without tarsectomy was achieved in six of eight patients (75%), and strabismus success was achieved in all patients. No revision eyelid or strabismus surgery was required following simultaneous surgery in any of the patients.
CONCLUSION
Müller's muscle-conjunctival resection with or without tarsectomy combined with strabismus surgery may be an alternative approach for use in patients with ptosis and coexisting strabismus.
Topics: Adult; Male; Humans; Female; Blepharoptosis; Retrospective Studies; Blepharoplasty; Eyelids; Conjunctiva; Oculomotor Muscles; Strabismus
PubMed: 35417512
DOI: 10.5935/0004-2749.20230020 -
European Journal of Ophthalmology Jan 2022There is an increased risk for development of blepharoptosis after incisional glaucoma surgery. Data on safety and efficacy of ptosis repair in this group of patients in...
PURPOSE
There is an increased risk for development of blepharoptosis after incisional glaucoma surgery. Data on safety and efficacy of ptosis repair in this group of patients in limited. The goal of this study is to evaluate outcomes and identify potential risk factors for failure of ptosis repair in eyes with history of incisional glaucoma surgery.
METHODS
A retrospective chart review was performed of all patients who underwent incisional glaucoma surgery, specifically trabeculectomy or implantation of glaucoma drainage device (GDD), and subsequent ptosis repair at a single institution from 2009 to 2019. Ptosis surgery outcomes were compared to a control group who underwent ptosis repair after cataract surgery.
RESULTS
Seventy-eight eyes of 64 patients were included in the glaucoma surgery group. The rate of severe ptosis (margin reflex distance 1 ⩽ 0 mm) among glaucoma surgery patients was higher compared to control (35 of 78 (44.9%) vs 23 of 82 (28.6%). Ptosis repair was successful in 59 of 78 eyes (75.6%), which was similar to control. Risk for revision surgery was increased more than five-fold in the GDD group compared to control. There were no cases of early or late bleb-related complications.
CONCLUSIONS
Ptosis repair can be performed safely in patients after incisional glaucoma surgery. Müller muscle conjunctival resection and external levator advancement are equally effective. Patients with history of GDD should be advised about the potentially increased risk of need for revision surgery.
Topics: Blepharoptosis; Glaucoma; Humans; Oculomotor Muscles; Postoperative Complications; Retrospective Studies; Trabeculectomy
PubMed: 33779340
DOI: 10.1177/11206721211006643