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Zloto O, Paiusco V, Murta F. How to assess blepharoptosis via telemedicine: method and its reliability. Int Ophthalmol 2024; 44:106. [PMID: 38386214 DOI: 10.1007/s10792-024-02926-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/17/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE To report the method to assess belpahroptosis and its reliability of adult ptosis using video consultation. METHODS This is a retrospective, comparative, case series. The surgical waiting list for ptosis surgery between 8/2020 and 1/2021 was checked and only cases listed for surgery via video consultation assessment, without any previous face-to-face consultation, were included. The following data were collected for patients who underwent video consultation before surgery: Demographic data, level of experience of clinician, levator function, Cogan's twitch sign, fatigability test, eye motility, presence of lagophthalmos, clinical history to rule out Myasthenia Gravis, other myopathies or Horner syndrome, whether the surgery was performed or canceled, reason for cancellation, date of surgery, type of procedure and surgeon experience. RESULTS A total of 176 patients underwent ptosis surgery. From those, 45 patients (25.6%) had only video assessment prior to surgery, 36 patients (80%) eventually underwent ptosis surgery. Surgery was canceled in 20% of the cases: in 2 cases (4.44%) due to misdiagnosis of ptosis during video consultation, confirmed on the day of surgery during pre-surgical face-to-face assessment; the other 7 cases (15.55%) belpharoptosis was confirmed on face-to-face examination but the surgery was canceled due to other reasons. The diagnosis of ptosis assessment via video consultation was corrected in 43 cases (95%) (p_value = 0.156, chi_ square). The accuracy of ptosis diagnosis was 13 out of 15 (86.7%) by fellow assessments and 30 out of 30 (100%) by consultant assessments (p_value = 0.041, chi_ square). In most of the cases ptosis assessment in video consultation included: rough judgment of levator function, eye motility and checking signs of lagophthalmos. CONCLUSIONS Video consultation is an efficient and reliable way to assess patients with ptosis, with 95% of reliability. Although a thorough ptosis assessment is advised, there was no difference between the accuracy of diagnosis on those who did not have the full suggested assessment.
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Affiliation(s)
- Ofira Zloto
- Adnexal Service, Moorfields Eye Hospital, London, EC1V 2PD, England, UK.
| | | | - Fabiola Murta
- Adnexal Service, Moorfields Eye Hospital, London, EC1V 2PD, England, UK
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2
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Diagnosis and Management of Pseudoblepharoptosis in Eastern Asians: A Commonly Observed But Easily Overlooked Type of Blepharoptosis. J Craniofac Surg 2023; 34:498-502. [PMID: 36731095 DOI: 10.1097/scs.0000000000008935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pseudoblepharoptosis, which is characterized by ptotic eyelid appearance with normal levator function, is a common abnormality observed in Eastern Asians. Misdiagnosis of pseudoblepharoptosis may lead to inappropriate treatments and unwanted complications. Using the data obtained from a modified levator function examination, this study sought to improve the diagnosis and explore the appropriate treatment of pseudoblepharoptosis based on the typical eyelid anatomy of Eastern Asians. METHODS This retrospective study included patients with drooping and bulky eyelids who had been preoperatively diagnosed between January 2018 and December 2018 using a modified approach. Debulking of the retro-orbicularis oculus fat and orbital septum fat and release of the ligament-like structure were performed to correct pseudoblepharoptosis without manipulating the levator muscle. The functional and aesthetic outcomes were evaluated postoperatively. RESULTS The proposed modified approach was significantly more accurate than the traditional technique. Of the patients, 78 (84.8%) and 9 (9.8%) showed good and moderate cosmetic outcomes, respectively. The margin reflex distance 1 value significantly improved from 1.74±0.87 mm preoperatively to 4.56±0.71 mm postoperatively ( P <0.05). Moreover, 179 (97.3%) of the 184 eyelids examined achieved adequate correction. CONCLUSIONS The modified levator function examination approach used in this study may help improve the diagnosis of pseudoblepharoptosis. Surgical intervention focused on correcting the bulky and drooping upper eyelids and orbital septum may lead to satisfactory outcomes in Eastern Asians with pseudoblepharoptosis without manipulating the levator muscle.
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Pongsachareonnont P, Hemarat K, Panjaphongse R, Liu W, Vagefi MR, Stewart JM. Factors associated with the development of blepharoptosis after pars plana vitrectomy surgery. Semin Ophthalmol 2021; 37:509-514. [PMID: 34957908 DOI: 10.1080/08820538.2021.2006240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the incidence and risk factors for developing blepharoptosis after vitrectomy surgery. METHODS This prospective observational study conducted in patients who had vitrectomy surgery at the University of California, San Francisco. The patients' eyelids were photographed before, surgery and follow-up visits at 1 day, 1 week, 1 month, 3 months, and 6 months after surgery. Levator excursion (LE), palpebral fissure (PF) height and marginal reflex distance 1 (MRD1) changes from baseline were evaluated. Operative parameters associated with lid parameter changes were analyzed. RESULTS Thirty-eight eyes were enrolled in the study. Multivariate analysis performed for PF changes from pre-operative were -0.47 mm, 0.33 mm, and 0.09 mm at 1 week, 1 month and 6 months after surgery, respectively (p-value 0.1, 0.2, and 0.8). The mean change of LE from preoperative was -0.44 mm, -0.15 mm, and 0.35 mm at 1 week, 1 month and 6 months after surgery, respectively (p-value 0.3, 0.7 and 0.4). The reduction of MRD1 at 1 week, 1 month and 6 months after surgery were -0.08 mm, -0.13 mm and -0.01 mm, respectively (p = .003, p = .6 and 0.9). Triamcinolone usage was associated with reduction of MRD1 and LE. CONCLUSION Blepharoptosis presents most during the first week after surgery. The possibility of developing transient changes in eyelid position after vitrectomy surgery should be discussed with patients.
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Affiliation(s)
- Pear Pongsachareonnont
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Vitreoretinal Research Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kornwipa Hemarat
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Ronakorn Panjaphongse
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Department of Ophthalmology, Royal Thai Air Force, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Weifeng Liu
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, China
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Jay M Stewart
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
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Costa RHA, Castro ÁBBSD, Silva SDCE, Léda RM, Amorim RFBD. Comparação da fáscia lata, faixa de silicone e fio de polipropileno na cirurgia de suspensão frontal para correção de ptose palpebral grave. REVISTA BRASILEIRA DE OFTALMOLOGIA 2021. [DOI: 10.37039/1982.8551.20210055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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5
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Yang JW, Yeung L, Chu YC, Lin YH, Chen CT. Efficacy of modified levator muscle resection using Putterman ptosis clamp versus levator muscle resection for aponeurotic ptosis: A retrospective analysis. Asian J Surg 2021; 45:1535-1541. [PMID: 34686424 DOI: 10.1016/j.asjsur.2021.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/02/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES In recent years, a modified levator muscle resection using Putterman ptosis clamp was developed. We used a retrospective case-control study to compare the effects of the modified and traditional levator muscle resection methods. METHODS Patients with moderate-to-severe ptosis who underwent the traditional or modified method for levator muscle resection were divided into two groups: Group I received the traditional method in 2013 and Group II received the modified method using Putterman clamp in 2015. During each postoperative visit, in addition to imaging, changes in the margin reflex distance 1 (MRD 1), and adverse events were recorded. Surgical time and final result in the last follow-up were recorded. RESULTS Group I had 35 patients (54 eyes) and Group II had 33 patients (59 eyes). After the surgery, the MRD 1 in both groups was significantly improved at 1 week and at the final visit compared to baseline. Significant differences were observed in MRD 1 change at 1-week post-operation and the change at the final visit and the surgical time between Groups I and II (P < 0.05). Group II had a shorter surgical time than Group I. Compared with Group I (20.37%), the revision rate was lower in Group II (10.16%). CONCLUSIONS The modified levator muscle resection using Putterman ptosis clamp and traditional levator muscle resection can both improve ptosis. Comparison results showed that using Putterman ptosis clamp assisted in levator muscle surgery had shorter operation time, faster postoperative recovery, and lower revision rate than the traditional method. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Ju-Wen Yang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Kwei-shan, Taoyuan, Taiwan
| | - Ling Yeung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Kwei-shan, Taoyuan, Taiwan
| | - Yen-Chang Chu
- College of Medicine, Chang Gung University, Kwei-shan, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yun-Hsuan Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chien-Tzung Chen
- College of Medicine, Chang Gung University, Kwei-shan, Taoyuan, Taiwan; Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
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DOGAN S. OURS RESULTS OF WHITNALL SLING IN PATIENT WITH CONGENITAL MYOGENIC PTOSİS. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.946730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Amaç: Levator fonksiyonu kötü doğumsal üst gözkapağı düşüklüğünde whitnall askılama ameliyatı uyguladığımız hastaların klinik özelliklerini ve cerrahi sonuçlarını sunmak.
Yöntemler: XXX Hastanesi'nde 2003-2005 yıllarında whitnall askı cerrahisi uygulanan 11 hastanın 15 gözü çalışmaya alındı. Hastaların dördü kadın, yedisi erkek olup, yaşları 5 ile 40 yıl arasındaydı. Gözkapağı düşüklüğü dışında sistemik ve oküler patolojileri olanlar çalışmaya alınmadı. Tüm hastalarda anterior yaklaşımla kapak kıvrım insizyonu ile whitnall askı cerrahisi uygulandı. Üst gözkapağı konturunun düzenli olması, kapak çizgisinin simetrik olması şartıyla, tam düzeltme ve bir mm’den az kapak düşüklüğü olanlar ‘başarılı’, 1-2 mm kapak düşüklüğü olanlar ‘tatminkar’, iki mm den daha fazla kapak düşüklüğü olanlar ‘başarısız’ olarak değerlendirildi.
Bulgular: Ameliyat sonrası 6. ayda hiçbir hastada kapak kontür düzensizliği ve enfeksiyon gibi komplikasyonlar izlenmedi. Bir hastada iki mm'den fazla kapak düşüklüğü nedeni ile başarısız kabul edildi. Bir hasta ise 1-2 mm arasında kapak düşüklüğü olmasına rağmen optik aks açık olduğu için tatminkar olarak değerlendirildi. Dokuz hastanın 13 gözünde (%86.7) ise bir mm'nin altında kapak düşüklüğü vardı ve sonuç başarılı olarak değerlendirildi.
Sonuç: Kötü levator fonksiyonlu hastalarda whitnall askı cerrahisi başarı oranı yüksek ve komplikasyon oranı düşük bir tekniktir. Uzun dönem sonuçlar için karşılaştırmalı geniş serili prospektif çalışmalara ihtiyaç vardır.
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Affiliation(s)
- Semih DOGAN
- İSTANBUL GELİŞİM ÜNİVERSİTESİ, GELİŞİM MESLEK YÜKSEKOKULU, TIBBİ HİZMETLER VE TEKNİKLER BÖLÜMÜ
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7
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Vaca EE, Bricker JT, Alghoul MS. Current Upper Blepharoplasty and Ptosis Management Practice Patterns Among The Aesthetic Society Members. Aesthet Surg J 2021; 41:NP198-NP209. [PMID: 33346340 DOI: 10.1093/asj/sjaa369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients presenting for upper blepharoplasty can exhibit different aging patterns and we have anecdotally observed wide variability in upper blepharoplasty approaches among surgeons. However, upper blepharoplasty practice patterns have not been systematically analyzed among members of The Aesthetic Society. OBJECTIVES The aim of this study was to report upper blepharoplasty practice patterns, the recognition of different patient presenting features, and to assess the incidence and management of ptosis as reported by members of The Aesthetic Society. METHODS A 29-item electronic questionnaire was distributed to 1729 Aesthetic Society members with available email addresses. RESULTS In total, 214 Aesthetic Society members submitted the questionnaire, for a response rate of 12.4%. There was a significantly increased rate of volume preservation among surgeons with greater experience (≥10 years in practice) and a high-volume (≥100 cases in past 12 months) of upper blepharoplasty cases. Furthermore, high-volume upper blepharoplasty surgeons were significantly more likely to perform concomitant upper lid fat grafting (P = 0.03), browlift (P = 0.02), and ptosis repair (P = 0.01). Ninety-five percent of respondents reported a mild/moderate ptosis (MRD1 2 to <4mm) incidence of <25%. Among surgeons who perform ptosis repair, 97.4% utilize levator advancement or plication as their most commonly used technique. CONCLUSIONS High-volume upper blepharoplasty surgeons are more likely to preserve upper lid volume and perform concomitant browlift and ptosis repair. Our data suggest that different upper eyelid aging patterns and mild/moderate ptosis are underrecognized.
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Affiliation(s)
- Elbert E Vaca
- Division of Plastic & Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | | | - Mohammed S Alghoul
- Division of Plastic & Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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8
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Lee CC, Feng IJ, Lai HT, Huang SH, Kuo YR, Lai CS. The Epidemiology and Clinical Features of Blepharoptosis in Taiwanese Population. Aesthetic Plast Surg 2019; 43:964-972. [PMID: 30877447 DOI: 10.1007/s00266-019-01344-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Blepharoptosis describes a condition of low-lying upper eyelid that may affect individuals of all ages under various etiologies. It may be of congenital or acquired form by the timing of onset or be divided into myogenic, neurogenic, aponeurotic, or mechanical types according to the mechanism. Our goal was to report the characteristics of age-specific blepharoptosis and to analyze the association between levator function (LF) and ptosis severity of each ptosis subtype. MATERIALS AND METHODS The retrospective, single-center, cross-sectional study consisted of patients diagnosed with blepharoptosis in the plastic surgery practice at a medical center between September 2009 and May 2017. We reported patients' age at presentation, sex, laterality of ptosis, etiology, classification, and evaluation of ptosis including levator function and ptosis severity. RESULTS During a nine-year span of study, a total of 1975 eyelids of 1164 Taiwanese patients aged between 2 and 88 years were enrolled in the research (mean = 57.73 ± 13.41 years). The female-to-male ratio was 2.72 (95% confidence interval [CI]: p < 0.0001). Acquired blepharoptosis and bilateral blepharoptosis were more frequently observed (55.85%, p < 0.0001 and 69.67%, p < 0.0001, respectively). In age-specific relative incidence of blepharoptosis, myogenic ptosis was the majority in patients younger than 40 years. Early onset of aponeurotic ptosis was observed in young contact lenses wearers. Aponeurotic blepharoptosis was the predominant type of ptosis in the senior population older than 40 years (p < 0.0001). Among the subtypes, mechanical ptosis had the most preserved LF (p < 0.0001). LF and MRD1 had statistically positive correlations in all subtypes of blepharoptosis, in which neurogenic ptosis demonstrated the severest levator dysfunction for each millimeter in MRD1 reduction. CONCLUSIONS Of the 1164 Taiwanese patients, blepharoptosis had a higher propensity for female gender and the age between the second to fourth decades. Bilateral involvement of blepharoptosis with acquired type was frequently diagnosed. Myogenic ptosis had a preponderance in age younger than 40 years, while aponeurotic ptosis usually affects senile population. Many mild degree myogenic ptosis was simultaneously recognized in young-aged adults seeking aesthetic double eyelid surgery. Early onset of acquired aponeurotic ptosis was also observed in contact lens wearers given the trend of decorative contact lens use. Levator dysfunction was implicated in the pathology of not only myogenic ptosis but aponeurotic, mechanical, and neurogenic ptosis. Moreover, levator function of neurogenic ptosis was most severely impacted in each MRD1 reduction among all subtypes of blepharoptosis. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Chia-Chen Lee
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Jung Feng
- Department of Healthcare Administration and Medical Informatics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hsin-Ti Lai
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan
| | - Shu-Hung Huang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan
| | - Yur-Ren Kuo
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan
| | - Chung-Sheng Lai
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan.
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Abstract
Meticulous objective examination of a patient with blepharoptosis allows determining the tactics of surgical treatment. It depends on many factors, but main ones are blepharoptosis etiology, upper eyelids levator function, and ptosis degree. The estimation algorithm of objective examination of a patient with blepharoptosis is presented in this article.
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10
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Yeganeh A, Sinha KR, Fell D, Rootman DB. The effect of eyebrow stenting on the measurement of levator excursion in normal and ptotic eyelids. Orbit 2018; 38:353-356. [PMID: 30411993 DOI: 10.1080/01676830.2018.1537289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Levator function is classically estimated by measuring upper eyelid excursion (ULE) with digital brow stenting. The purpose of this study is to compare ULE with and without brow stenting in normal and ptotic eyelids. Methods: In this prospective observational study, normal and ptotic eyelids were recruited. Subjects were photographed with and without digital brow stenting in primary position, downgaze, and upgaze. Measurements were conducted on digital photographs. The primary outcome measure was ULE (distance travelled by the eyelid margin between downgaze and upgaze). Normal and ptosis (MRD1 ≤ 2.5 mm or asymmetry ≥ 1 mm) subgroups were defined. Independent one-way ANOVA and independent samples t-tests were performed. This study was powered to detect a 1 mm difference in the primary outcome measure, assuming SD = 1 mm, with alpha = 0.05 and beta-error = 0.95. Results: Twenty-eight normal eyelids of 22 subjects and 28 ptotic eyes of 18 subjects were included. Stenting significantly (p < 0.01) increased ULE in the overall sample (+0.9 mm) and in controls (+1.2 mm), but not (p > 0.05) in ptotic eyelids (+0.5 mm). Post hoc analysis revealed a beta-error of 0.08 in the latter. Conclusion: ULE was significantly higher with brow stenting in normal eyelids (approximately +1.2 mm) but not in ptotic eyelids, possibly due to increased levator tone secondary to increased effort in the coupled frontalis.
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Affiliation(s)
- Amir Yeganeh
- Northeast Ohio Medical University , Rootstown , OH , USA.,Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California , Los Angeles , CA , USA
| | - Kunal R Sinha
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California , Los Angeles , CA , USA.,David Geffen School of Medicine, University of California , Los Angeles , CA , USA
| | - David Fell
- David Geffen School of Medicine, University of California , Los Angeles , CA , USA.,Stony Brook University School of Medicine , New York , NY , USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California , Los Angeles , CA , USA.,Division of Orbital and Ophthalmic Plastic Surgery, Doheny Eye Center, University of California , Los Angeles , CA , USA
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Kim IA, Wu TJ, Byrne PJ. Paralytic Lagophthalmos: Comprehensive Approach to Management. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0219-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Rasiah S, Hardy TG, Elder JE, Ng CY, Lenake M, McNab AA. Aetiology of acquired blepharoptosis in young adults. Orbit 2017; 37:59-64. [PMID: 28876138 DOI: 10.1080/01676830.2017.1366528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To identify the causes of blepharoptosis in young adults, and explore cases that do not fit into current diagnostic categories. METHODS A retrospective cohort study of all patients aged 18-40 years ("young adults") with acquired blepharoptosis that presented to two specialist ocular plastics practices and a paediatric ophthalmologist over a period of up to 25 years. Each patient was classified according to diagnosis. Where the diagnosis was uncertain, the files were examined in detail to try and further establish a cause. RESULTS A total of 266 young adult patients were included. The most common causes of acquired blepharoptosis were trauma-related (28.2%) and anophthalmic blepharoptosis (19.9%). In 12.4% of the cases, a definite diagnosis could not be made. Of these, one-third had a history of soft contact lens use, a possible etiologic factor. CONCLUSIONS The cause of acquired blepharoptosis can usually be established by an appropriate history and examination, with additional diagnostic tests sometimes required. Nearly half of all young adult ptosis is related to trauma or acquired anophthalmos. Around one in eight young adults have blepharoptosis of unknown cause, a group warranting further study.
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Affiliation(s)
- Sulakshan Rasiah
- a Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia
| | - Thomas G Hardy
- a Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia.,b Royal Children's Hospital , Parkville , Victoria , Australia.,c Department of Surgery, University of Melbourne , Parkville , Victoria , Australia
| | - James E Elder
- b Royal Children's Hospital , Parkville , Victoria , Australia.,d Department of Paediatrics, University of Melbourne , Parkville , Victoria , Australia
| | - Cheng Y Ng
- b Royal Children's Hospital , Parkville , Victoria , Australia
| | - Mpopi Lenake
- a Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia
| | - Alan A McNab
- a Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia.,e Department of Ophthalmology, University of Melbourne , Parkville , Victoria , Australia.,f Centre for Eye Research Australia, East Melbourne , Victoria , Australia
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13
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Diplopia and Symblepharon Following Mueller’s Muscle Conjunctival Resection in Patients on Long-Term Multiple Antiglaucoma Medications. Ophthalmic Plast Reconstr Surg 2017; 33:S79-S82. [DOI: 10.1097/iop.0000000000000760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Iljin A, Zieliński T, Broniarczyk-Loba A, Antoszewski B. Evaluation of the complex treatment for congenital blepharoptosis. Plast Surg (Oakv) 2017; 24:183-186. [PMID: 28439507 DOI: 10.4172/plastic-surgery.1000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To evaluate the results of treatment of congenital blepharoptosis (CBP) using selected surgical methods; and to evaluate concomitant visual system disorders. METHODS Between 2001 and 2010, 52 children with CBP underwent surgical correction of CBP using the modified method of Mustarde, the original Mustarde method or frontal suspension at the Department of Plastic Surgery, Medical University of Lodz (Poland). Based on the results of ophthalmic and orthoptic examination, and standard measurements, postoperative differences in the position and symmetry of the upper eyelids, complications, and visual system abnormalities were analyzed. RESULTS Very good results were obtained in all patients with mild unilateral CBP. The results in patients with moderate and severe unilateral CBP, and in bilateral anomaly after correction using Mustarde's method or the modified Mustarde's method, were also very good. Complications included lagophthalmos (15.4%) and undercorrection (3.8%). Visual system disorders, mainly amblyopia, resulting from strabismus, astigmatism, anisometropia and CBP, were observed in 88.5% of patients. CONCLUSIONS Complex ophthalmic examination and measurements in individuals with CBP enable correct diagnosis, selection of appropriate treatment method and timing of surgical intervention. Postoperative results in patients with CBP supported the efficacy of the methods that shortened the levator palpebrae superioris. Supplementing with Mustarde's modified method contributed to an increase in the number of favourable postoperative results.
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Affiliation(s)
- Aleksandra Iljin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Łódź, Institute of Surgery
| | - Tomasz Zieliński
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Łódź, Institute of Surgery
| | - Anna Broniarczyk-Loba
- Binocular Vision Pathophysiology and Strabismus Department, Medical University of Łódź
| | - Bogusław Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Łódź, Institute of Surgery
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15
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Mota PM, Norris JH. Review on surgical management of ptosis and the use of phenylephrine: A national survey of British Oculoplastic Surgery Society (BOPSS) UK Consultants. Orbit 2016; 35:339-342. [PMID: 27599918 DOI: 10.1080/01676830.2016.1193547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We assess current practice using topical phenylephrine by British Oculoplastic Surgery Society (BOPSS) consultants in the surgical management of ptosis. All UK consultant BOPSS members were invited to participate in a web-based survey, consisting of 8 questions relating to the surgical management of adult primary involutional ptosis with normal levator function and the use of phenylephrine in the management of ptosis. 53 BOPSS consultants (43%) completed the survey, of which 76% perform anterior approach levator advancement as first-line surgery. Then, 40% of consultants routinely use phenylephrine unilaterally in the ptotic eye, with 90% using 2.5% as opposed to 10%. Also, 77% of consultants use topical phenylephrine to illustrate the predicted outcome of surgery for the patient's benefit and 65% modify their approach on the basis of the test. If phenylephrine raises the ptotic eyelid >2 mm, those using an anterior approach reduces to 13.6%, with majority using a posterior approach (86.4%). If phenylephrine induces no improvement, then 76% use an anterior approach. If phenylephrine induces a contralateral ptosis 79% of consultants will perform simultaneous bilateral surgery. A number of interesting trends were observed amongst BOPSS consultants in their surgical approach to ptosis based on the phenylephrine test. The majority of consultants will switch from anterior to posterior approach surgery when the phenylephrine test is strongly positive and will also perform bilateral surgery when a contralateral ptosis is induced with phenylephrine.
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Affiliation(s)
- Peter M Mota
- a Oxford Eye Hospital , John Radcliffe NHS Trust , Oxford , United Kingdom
| | - Jonathan H Norris
- a Oxford Eye Hospital , John Radcliffe NHS Trust , Oxford , United Kingdom
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16
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Iljin A, Zieliński T, Broniarczyk-Loba A, Antoszewski B. Evaluation of the complex treatment for congenital blepharoptosis. Plast Surg (Oakv) 2016. [DOI: 10.1177/229255031602400307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the results of treatment of congenital blepharoptosis (CBP) using selected surgical methods; and to evaluate concomitant visual system disorders. Methods Between 2001 and 2010, 52 children with CBP underwent surgical correction of CBP using the modified method of Mustarde, the original Mustarde method or frontal suspension at the Department of Plastic Surgery, Medical University of Lodz (Poland). Based on the results of ophthalmic and orthoptic examination, and standard measurements, postoperative differences in the position and symmetry of the upper eyelids, complications, and visual system abnormalities were analyzed. Results Very good results were obtained in all patients with mild unilateral CBP. The results in patients with moderate and severe unilateral CBP, and in bilateral anomaly after correction using Mustarde's method or the modified Mustarde's method, were also very good. Complications included lagophthalmos (15.4%) and undercorrection (3.8%). Visual system disorders, mainly amblyopia, resulting from strabismus, astigmatism, anisometropia and CBP, were observed in 88.5% of patients Conclusions Complex ophthalmic examination and measurements in individuals with CBP enable correct diagnosis, selection of appropriate treatment method and timing of surgical intervention. Postoperative results in patients with CBP supported the efficacy of the methods that shortened the levator palpebrae superioris. Supplementing with Mustarde's modified method contributed to an increase in the number of favourable postoperative results.
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Affiliation(s)
- Aleksandra Iljin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Łódź, Institute of Surgery
| | - Tomasz Zieliński
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Łódź, Institute of Surgery
| | - Anna Broniarczyk-Loba
- Binocular Vision Pathophysiology and Strabismus Department, Medical University of Łódź
| | - Bogusław Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Łódź, Institute of Surgery
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17
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Abstract
Blepharoptosis or drooping of upper eye lid is a common, but non-specific sign of neurological diseases which sometimes could herald a life-threatening disorder. First, the diagnosis of ptosis should be established by considering four clinical measurements: palpebral fissure height, marginal reflex distance, upper eyelid crease, and levator function test. The diagnostic categories of ptosis are scheduled as pseudo-ptosis, congenital, and acquired ptosis. Acquired causes include mechanical, myogenic, neuromuscular, neurogenic, and cerebral. Each category with diseases presenting with ptosis was described in detail. Considering some features, such as involvement of other cranial nerves, extraocular muscle, pupil size and reactivity, and unilateral or bilateral presentation of ptosis, could help to narrow the differential diagnosis.
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18
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Iljin A, Zieliński A, Lewandowicz E, Antoszewski B, Zieliński T. Evaluation of the Surgical Treatment for Congenital Blepharoptosis Using Mustarde's Modified Method. POLISH JOURNAL OF SURGERY 2016; 88:155-9. [PMID: 27428837 DOI: 10.1515/pjs-2016-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Indexed: 11/15/2022]
Abstract
UNLABELLED The aim of the study was evaluation of the results of surgical treatment of congenital blepharoptosis (CBP) using Mustarde's modified method. MATERIAL AND METHODS Between 2005-2014 forty eight children with CBP underwent surgical correction of CBP by Mustarde's modified method. Basing on the results of ophthalmic and orthoptic examination, and standard measurements, we estimated postoperative difference in the position and symmetry of the upper eyelids, and postoperative complications in our patients. RESULTS Very good results were obtained in all cases with mild, in 89.5% with moderate, and in 85.7% with severe unilateral CBP after correction by Mustarde's modified method. Lagophthalmos was seen in 6.25%, and undercorrection in 12.5% of cases. CONCLUSIONS 1. Mustarde's modified method allows for obtaining very good functional and aesthetic results in CBP patients. 2. Mustarde's modified method is a valuable supplemental surgical technique in CBP, and contributes to a low rate and small range of lagophthalmos.
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19
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Unilateral Blepharoptosis from Renal Cell Carcinoma. J Kidney Cancer VHL 2016; 3:11-15. [PMID: 28326282 PMCID: PMC5345509 DOI: 10.15586/jkcvhl.2016.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/19/2016] [Indexed: 12/02/2022] Open
Abstract
Blepharoptosis is the drooping or inferior displacement of the upper eyelid. Blepharoptosis can be either congenital or acquired. Tumour metastasis is one of the acquired causes of blepharoptosis. The lungs, locoregional lymph nodes, bone and liver are the usual sites of metastases of renal cell carcinoma (RCC); however, unusual locations of RCC have also been reported. Herein, we describe a case of a 47-year-old man with unilateral ptosis and blurred vision due to metastatic RCC. We describe the different causes of blepharopstosis, the path that led to the diagnosis, and how RCC can metastasize to unusual anatomical regions such as the orbit. Symptoms such as exophthalmos, lid edema, diplopia, ptosis, cranial nerve paralysis or blurred vision may mime a benign disease; however, they could also be the symptoms of a systemic malignancy.
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Moon KY, You IC, Ahn M. Eyelid Stretching Exercise Performed in Overcorrection after Levator Resection in Congenital Ptosis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.10.1635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ka Young Moon
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
| | - In Cheon You
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Min Ahn
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
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21
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Comparison of automated and manual perimetry in patients with blepharoptosis. Ophthalmic Plast Reconstr Surg 2014; 29:361-3. [PMID: 23924985 DOI: 10.1097/iop.0b013e31829a7288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare Goldmann manual perimetry and Humphrey automated perimetry for sensitivity in detecting visual field loss, efficiency, and patient preference. METHODS This prospective study compared Goldmann manual perimetry and Humphrey automated perimetry testing techniques in 20 consecutive preoperative blepharoptosis patients with unilateral or bilateral blepharoptosis with a marginal reflex distance of ≤+2.5 mm, no dermatochalasis overhanging the eyelid margin, and no superior visual field defects due to glaucoma, neurologic disease, or other causes. Main outcome measures included efficiency, patient preference, and sensitivity in detecting visual field loss. Institutional review board approval was obtained prior to the start of the study. RESULTS Goldmann perimetry had significantly shorter examination times (-Δ6.4 minutes, 95% confidence interval: 4.5-8.3, p < 0.001) and was preferred by most patients (70%). There was no statistically significant difference between the 2 techniques in detecting superior visual field loss at 90° meridian. CONCLUSIONS Goldmann manual perimetry for assessing visual field loss in blepharoptosis patients is more efficient than Humphrey automated perimetry and is preferred by patients. Both techniques are sensitive in detecting ptosis-related visual field loss.
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Kwon KA, Shipley RJ, Edirisinghe M, Ezra DG, Rose GE, Rayment AW, Best SM, Cameron RE. Microstructure and mechanical properties of synthetic brow-suspension materials. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 35:220-30. [DOI: 10.1016/j.msec.2013.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/02/2013] [Accepted: 10/29/2013] [Indexed: 11/17/2022]
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Effect of brow lifting using botulinum a toxin on upper eyelid height in patients with ptosis undergoing the frontal sling technique. Ann Plast Surg 2012; 70:175-9. [PMID: 22791060 DOI: 10.1097/sap.0b013e31823b680a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In this study, brow lifting with botulinum A toxin was performed on patients whose ptosis was corrected using the frontal sling technique, and the effects of this application on ptosis were investigated. Seven patients (with 12 eyelids) on whom the frontal sling procedure was performed using a tensor fascia lata graft were enrolled in the study. The patients underwent brow lifting using botulinum A toxin. Digital photographs of the patients were obtained before and 21 days after botulinum A injection. In digital imaging analysis, although a statistically significant elevation was detected in the eyelids and brows of the patients following botulinum A injection, it did not to lead to a significant difference in the degree of lagophthalmos. In the current study, this procedure was found to reduce the degree of ptosis without increasing the degree of lagophthalmos in patients who had previously undergone ptosis correction using the frontal sling.
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Choi S, Shin JH, Cheong Y, Lee HJ, Jin KH, Park HK. Nanostructural investigation of frontalis sling biomaterial surfaces. SCANNING 2011; 33:419-425. [PMID: 21538393 DOI: 10.1002/sca.20233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 04/05/2011] [Indexed: 05/30/2023]
Abstract
This study examined the nanostructural surface of three frontalis sling biomaterials: autogenous fascia lata, preserved fascia lata and silicone rod. The morphological characteristics of the sling biomaterial surfaces were examined qualitatively and quantitatively by scanning electron microscopy and atomic force microscopy, respectively. The autogenous fascia lata showed well-arranged nanostructures of parallel fascia collagen fibrils with clear 67 nm axial periodicity, whereas the preserved fascia lata showed tangled nanostructures of damaged collagen fibril bundles. The silicone rod showed a substantial amount of debris with some scratches and the smoothest roughness compared with the other sling biomaterials, followed by preserved fascia lata. Autogenous fascia lata showed the highest surface roughness. The association between the roughness and cell adhesion suggests that the nanostructure of autogenous fascia lata biomaterials is the best for frontalis sling and that of the silicone rod biomaterials is the worst.
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Affiliation(s)
- Samjin Choi
- Department of Biomedical Engineering & Healthcare Industry Research Institute, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Park SJ, Moon DE, Kim WY, Park JJ, Cho EJ, Yang SW. The Sphenopalatine Ganglion Radiofrequency Thermocoagulation on a Patient of CRPS with Facial Pain and Pruritus -A report of 2 cases-. Korean J Pain 2006. [DOI: 10.3344/kjp.2006.19.2.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Seung Jae Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Eon Moon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Young Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Ju Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Jeong Cho
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk-Woo Yang
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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