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Singh P, Koka K, Alam MS, Mukherjee B. Management of Marcus Gunn jaw wink syndrome with tarsofrontalis sling vis a vis levator excision and frontalis sling: a comparative study. Orbit 2023; 42:52-58. [PMID: 35073218 DOI: 10.1080/01676830.2022.2025853] [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: 02/04/2023]
Abstract
PURPOSE To compare the results between tarsofrontalis sling (TFS) and levator palpebrae superioris (LPS) excision with TFS in cases of ptosis with Marcus Gunn jaw winking syndrome (MGJWS). METHOD A retrospective review of records of all patients undergoing either TFS (group A) or LPS excision along with TFS (group B) in cases of ptosis with MGJWS was done over the past 10 years and their results were compared. RESULTS The study included 73 patients (75 eyes). There were 36 patients (36 eyes) in group A and 37 patients (39 eyes) in group B. There was a significant reduction in the excursion due to MGJWS from 4.7 ± 1.49 to 1.91 ± 1.04 mm in group A (p = .001) and 4.65 ± 1.34 to 1.79 ± 0.98 mm in group B (p < .05). The reduction in excursion due to MGJWS and lagophthalmos were comparable in both groups. The mean follow-up in group A was 5.62 ± 6.94 (Range: 1-24) months and group B was 19.15 ± 29.16 (Range: 1-96) months (p = .01). CONCLUSION Both TFS and LPS excision with TFS is equally effective in dampening the eyelid excursion in MGJWS. Tarsofrontalis sling is a safe, easy and effective technique for MGJWS with lesser complication.
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Affiliation(s)
- Parinita Singh
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Kirthi Koka
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Md Shahid Alam
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, India
| | - Bipasha Mukherjee
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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Serefoglu Cabuk K, Asik Nacaroglu S, Ozturk Karabulut G, Fazil K, Arslan MS, Guler MG, Taskapili M. Muller muscle conjunctival resection or external levator advancement; a quantitative comparison of symmetry in unilateral ptosis. Eur J Ophthalmol 2021; 32:2125-2132. [PMID: 34704509 DOI: 10.1177/11206721211049057] [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: 11/17/2022]
Abstract
PURPOSE To compare muller muscle conjunctival resection (MMCR) and external levator advancement (ELA) in terms of objective and subjective symmetry in unilateral ptosis. METHODS The patients who underwent unilateral MMCR (group1, n = 25) and ELA (group2, n = 25) were reviewed retrospectively. With the written algorithm, margin reflex distance-1 (MRD1), localization of the contour peak, and the percentage of overlapping curvatures (POC) of both upper eyelid curves were calculated. Semi-automated measurements were compared with the manual measurements. The correlation between objective and subjective symmetry was evaluated. RESULTS Preoperative levator functions were similar in both groups (13.93 ± 3.25 mm and 13.3 ± 2.86 mm, respectively). We found strong correlations between manual and semi-automated measurements (ICC: 0.942, 95% CI = 0.924-0.956, p < 0.001). Preoperative MRD1 (2.15 ± 0.90 vs 1.51 ± 1.01, p = 0.022) and POC was lower in group 2 (66% vs 47.2%, p = 0.01). In the postoperative period, the increase in MRD1 and POC were similar in both groups (p = 0.2 and p = 0.7 respectively), and the contour peak displaced temporally (p < 0.01) providing a symmetric peak in both groups. Subjective symmetry increased as the difference in MRD1 between two eyes decreased (r = -0.456, p = 0.001), and POC increased (r = 0.396, p = 0.004). CONCLUSIONS Besides subjective symmetry, MMCR and ELA are equally effective in ensuring symmetry objectively, as measured with MRD1 and contour peak symmetry and POC in unilateral ptosis. POC may be used as a criterion of symmetry in the evaluation of ptosis.
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Affiliation(s)
- Kubra Serefoglu Cabuk
- 147017University of Health Sciences Beyoglu Eye Training and Research Hospital, Ophthalmic Plastic and Reconstructive Surgery, Istanbul, Turkey
| | - Senay Asik Nacaroglu
- 147017University of Health Sciences Beyoglu Eye Training and Research Hospital, Ophthalmic Plastic and Reconstructive Surgery, Istanbul, Turkey
| | - Gamze Ozturk Karabulut
- 147017University of Health Sciences Beyoglu Eye Training and Research Hospital, Ophthalmic Plastic and Reconstructive Surgery, Istanbul, Turkey
| | - Korhan Fazil
- 147017University of Health Sciences Beyoglu Eye Training and Research Hospital, Ophthalmic Plastic and Reconstructive Surgery, Istanbul, Turkey
| | - Mehmet Selcuk Arslan
- 52999Yildiz Technical University, Department of Mechatronics Engineering, Istanbul, Turkey
| | - Mehmet Guray Guler
- 52999Yildiz Technical University, Department of Industrial Engineering, Istanbul, Turkey
| | - Muhittin Taskapili
- 147017University of Health Sciences Beyoglu Eye Training and Research Hospital, Ophthalmic Plastic and Reconstructive Surgery, Istanbul, Turkey
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Patient reported psychosocial functioning following successful ptosis surgery. Eye (Lond) 2021; 36:1651-1655. [PMID: 34326499 PMCID: PMC9307808 DOI: 10.1038/s41433-021-01685-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 06/21/2021] [Accepted: 07/01/2021] [Indexed: 11/09/2022] Open
Abstract
Background Ptosis may result in increased anxiety, appearance-related distress and social avoidance, and impacts visual function. Previous work demonstrates the benefits of ptosis surgery for health-related quality of life, but there is a paucity of research comparing such outcomes before and after surgery. The aim of this study was to determine potential patient benefits in health-related quality of life, social dysfunction and anxiety following successful ptosis surgery using validated measures. Methods Adult ptosis correction surgery patients completed validated measures of appearance-related social anxiety and avoidance, anxiety and depression, and fear of negative evaluation pre-surgery. Following successful surgery, these measures were repeated post-discharge in addition to another health-related quality of life measure. Results Of 61 patients recruited, follow-up measures were sent to 33 and completed by 23. Paired samples t-tests demonstrated positive significant changes in appearance-related social distress pre-op m = 30.94, post-op m = 23.67 (t(17) = 3.46, 95% CI 2.84–11.72, p = 0.003), anxiety pre-op m = 7.6, post-op m = 4.9 (t(19) = 4.27, 95% CI 1.38–4.02, p < 0.001) and fear of negative evaluation pre-op m = 34.79, post-op m = 31.26 (t(18) = 2.47, 95% CI 0.52–6.53, p = 0.024). There was no significant difference in depression scores pre-op m = 3.6; post-op m = 3.2 (t(19) = 0.672, 65% CL −0.85 to 1.65, p = 0.510). In total, 85% of patients reported positive benefit to well-being following surgery. Conclusion Increasingly, evidence suggests ptosis surgery may benefit patient’s well-being, appearance-related social anxiety and avoidance, as well as improving visual function. These psychosocial benefits should be considered alongside functional benefits in the provision of ptosis surgery.
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Yang MK, Kim N, Choung HK, Khwarg SI. Effect of Congenital Lower Eyelid Epiblepharon Surgery on Asymmetric Margin Reflex Distance 1. Curr Eye Res 2020; 46:954-960. [PMID: 33249930 DOI: 10.1080/02713683.2020.1857781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: To investigate the characteristics of margin reflex distance 1 (MRD1) asymmetry in congenital lower eyelid epiblepharon and its resolution after surgical correction of epiblepharon.Methods: Among patients who underwent lower eyelid epiblepharon surgery from November 2015 to September 2017, patients with a preoperative MRD1 difference of more than 1.0 mm between the two eyes according to medical photographs were defined as having MRD1 asymmetry. A postoperative MRD1 difference of less than 1.0 mm between the two eyes was regarded as MRD1 asymmetry resolution. The preoperative MRD1 difference was compared between subgroups with resolved or sustained MRD1 asymmetry. Astigmatism and amblyopia were also assessed.Results: Among 432 patients, MRD1 asymmetry was observed in 24 patients (5.6%). MRD1 was always lower in the side with more extensive epiblepharon. At 6 months after surgery, the mean MRD1 difference between the two eyes was significantly decreased (1.8 ± 0.7 mm to 0.5 ± 0.8 mm, p < .001, paired t-test) and MRD1 asymmetry resolution occurred in 19 patients (79%). In the resolved MRD1 asymmetry group, the preoperative MRD1 difference was 2.0 mm or less and was significantly smaller than that in the sustained MRD1 asymmetry group (p = .010, Mann-Whitney U test). Six patients had preoperative aniso-astigmatism ≥ 1.50 D. Unilateral amblyopia presented in nine patients (38%) and improved within 1 year postoperatively.Conclusions: MRD1 asymmetry can be resolved after epiblepharon surgery, especially when the preoperative MRD1 difference is 2.0 mm or less. Unilateral amblyopia was frequent, but the treatment outcome was good.
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Affiliation(s)
- Min Kyu Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ho-Kyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Effect of Eyelid Crease Formation on Aesthetic Outcomes post Frontalis Suspension for Unilateral Ptosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2039. [PMID: 30859028 PMCID: PMC6382224 DOI: 10.1097/gox.0000000000002039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/26/2018] [Indexed: 12/03/2022]
Abstract
Background: The eyelid crease plays a very important role in determining eyelid symmetry. This study was performed to compare the cosmetic results post silicone rod frontalis suspension surgery, performed with and without eyelid crease formation, for correction of unilateral, congenital ptosis. Methods: Prospective, interventional study. One hundred patients with unilateral, congenital ptosis, with poor levator muscle action, operated on by a single facial plastic surgeon, over 5-year duration (2011–2016). Group I had 50 patients, who underwent silicone sling (Bvi Visitec) frontalis suspension surgery. Group II had 50 patients, who underwent frontalis suspension silicone sling (Bvi Visitec) surgery, in combination with eyelid crease formation and levator muscle excision (when required). The cosmetic outcomes were evaluated by the patients themselves and by 3 blinded physician observers and recorded objectively via a 5-point questionnaire, after a 1-year follow-up. Results: Patients in group II were much more satisfied than the patients in group I, as confirmed by the subjective and objective evaluations. Conclusion: The silicone sling frontalis suspension surgery, when combined with eyelid crease creation and levator excision procedure (when required), provides better symmetry, superior cosmesis, and excellent patient satisfaction.
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Sato D, Suga H, Ozaki M, Narita K, Shiraishi T, Harii K, Takushima A. Patient satisfaction after levator aponeurosis surgery for the treatment of involutional blepharoptosis. J Plast Reconstr Aesthet Surg 2018; 72:848-862. [PMID: 30579909 DOI: 10.1016/j.bjps.2018.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Daisuke Sato
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hirotaka Suga
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
| | - Mine Ozaki
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Keigo Narita
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomohiro Shiraishi
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Kiyonori Harii
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Akihiko Takushima
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
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Patient-reported outcome measurement in upper blepharoplasty: How to measure what the patient sees. J Plast Reconstr Aesthet Surg 2018; 71:1346-1351. [DOI: 10.1016/j.bjps.2018.05.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/15/2018] [Accepted: 05/28/2018] [Indexed: 11/20/2022]
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Two-dimensional analysis of palpebral opening in blepharoptosis: visual iris-pupil complex percentage by digital photography. Ann Plast Surg 2014; 72:375-80. [PMID: 24621784 DOI: 10.1097/sap.0b013e318269e4c9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The vertical dimension of the palpebral fissure and the marginal reflex distance are conventionally used to assess the amount or degree of blepharoptosis, and levator function is assessed by measuring total upper lid excursion between the extremes of down-gaze and up-gaze. However, these are 1-dimensional measures obtained with a ruler, and the results obtained are dependent on examiner skill. Digital photographs were obtained of 692 patients before and after upper blepharoplasty. Visual iris-pupil complex percentage (VIP) was measured in the 1,305 eyes by digital calculation using Adobe Photoshop CS3 (Adobe Systems, Inc). Perioperative eye images in primary gaze were evaluated independently by 2 surgeons, 2 nurses, and a graphic designer, and after excluding 50 eyes which were nonconcordant and 29 eyes which revealed retracted upper lids, the remaining 1,305 eyes were classified into 4 major groups, that is, into excellent (n = 415), good (n = 435), subclinical (n = 270), and prominent ptosis (n = 185) groups. In addition, eyes were subdivided into 5 types according to the iris-pupil complex position within the palpebral fissure. Visual iris-pupil complex percentages were from 85% to 94% in the excellent, from 78% to 84% in the good, from 70% to 77% in the subclinical ptosis, and below 70% in the prominent ptosis group. Patients in the subclinical or prominent ptosis eye group required surgery for blepharoptosis. Iris-pupil complex relation to the palpebral opening was classified into 5 eye types, namely, standard (n = 961), scleral (n = 266), sinking (n = 151), retracted (n = 3), and fish (n = 3). The authors devised a new prospective measurement method for assessing blepharoptosis in a clinical setting. Graphical comparisons between the devised method of measuring VIP and mathematical estimations showed that the devised method is easier, more practical, and more precise for measuring degree of blepharoptosis from general population trends, and that VIP also provides a useful objective index for evaluating the postoperative results of blepharoptosis.
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Prospective Audit of Ptosis Surgery at the Singapore National Eye Centre. Ophthalmic Plast Reconstr Surg 2013; 29:446-53. [DOI: 10.1097/iop.0b013e31829f3a35] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Yu-Wai-Man C, Smith FE, Firbank MJ, Guthrie G, Guthrie S, Gorman GS, Taylor RW, Turnbull DM, Griffiths PG, Blamire AM, Chinnery PF, Yu-Wai-Man P. Extraocular muscle atrophy and central nervous system involvement in chronic progressive external ophthalmoplegia. PLoS One 2013; 8:e75048. [PMID: 24086434 PMCID: PMC3785524 DOI: 10.1371/journal.pone.0075048] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 08/07/2013] [Indexed: 11/19/2022] Open
Abstract
Background Chronic progressive external ophthalmoplegia (CPEO) is a classical mitochondrial ocular disorder characterised by bilateral progressive ptosis and ophthalmoplegia. These ocular features can develop either in isolation or in association with other prominent neurological deficits (CPEO+). Molecularly, CPEO can be classified into two distinct genetic subgroups depending on whether patients harbour single, large-scale mitochondrial DNA (mtDNA) deletions or multiple mtDNA deletions secondary to a nuclear mutation disrupting mtDNA replication or repair. The aim of this magnetic resonance imaging (MRI) study was to investigate whether the ophthalmoplegia in CPEO is primarily myopathic in origin or whether there is evidence of contributory supranuclear pathway dysfunction. Methods Ten age-matched normal controls and twenty patients with CPEO were recruited nine patients with single, large-scale mtDNA deletions and eleven patients with multiple mtDNA deletions secondary to mutations in POLG, PEO1, OPA1, and RRM2B. All subjects underwent a standardised brain and orbital MRI protocol, together with proton magnetic resonance spectroscopy in two voxels located within the parietal white matter and the brainstem. Results There was evidence of significant extraocular muscle atrophy in patients with single or multiple mtDNA deletions compared with controls. There was no significant difference in metabolite concentrations between the patient and control groups in both the parietal white matter and brainstem voxels. Volumetric brain measurements revealed marked cortical and cerebellar atrophy among patients with CPEO+ phenotypes. Conclusion The results of this study support a primary myopathic aetiology for the progressive limitation of eye movements that develops in CPEO.
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Affiliation(s)
- Cynthia Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Fiona E. Smith
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael J. Firbank
- Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Grant Guthrie
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Stuart Guthrie
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Grainne S. Gorman
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert W. Taylor
- Wellcome Trust Centre for Mitochondrial Research, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Douglass M. Turnbull
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Philip G. Griffiths
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Andrew M. Blamire
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Patrick F. Chinnery
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Patrick Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Abstract
Currently, postoperative evaluation of aesthetic results of blepharoplasties mainly consists of subjective assessment by patients, surgeons, or others. We present an objective photo-assisted evaluation for preoperative planning and postoperative evaluation of blepharoplasties. Thirty-one female patients underwent aesthetic blepharoplasty. All types of blepharoplasties were included. An analysis of standardized pre- and postoperative photographs included measurements of eye fissure height, eye fissure width, lid sulcus height, upper lid height, upper iris coverage, scleral show, position of cornea to palpebra inferior, canthal tilt, an analysis of the architecture, and correction of wrinkles of the upper eyelid. Patients' satisfaction was investigated by a standardized questionnaire. All measured data showed postoperative changes to standard values. Upper eyelid wrinkles showed a significant decrease postoperatively. Most patients were highly satisfied with their results. The methods described in the present study help to evaluate the pre- and postoperative situation in blepharoplasty surgery.
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Greaves LC, Yu-Wai-Man P, Blakely EL, Krishnan KJ, Beadle NE, Kerin J, Barron MJ, Griffiths PG, Dickinson AJ, Turnbull DM, Taylor RW. Mitochondrial DNA defects and selective extraocular muscle involvement in CPEO. Invest Ophthalmol Vis Sci 2010; 51:3340-6. [PMID: 20164463 DOI: 10.1167/iovs.09-4659] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE. Chronic progressive external ophthalmoplegia (CPEO) is a prominent, and often the only, presentation among patients with mitochondrial diseases. The mechanisms underlying the preferential involvement of extraocular muscles (EOMs) in CPEO were explored in a comprehensive histologic and molecular genetic study, to define the extent of mitochondrial dysfunction in EOMs compared with that in skeletal muscle from the same patient. METHODS. A well-characterized cohort of 13 CPEO patients harboring a variety of primary and secondary mitochondrial (mt)DNA defects was studied. Mitochondrial enzyme function was determined in EOM and quadriceps muscle sections with cytochrome c oxidase (COX)/succinate dehydrogenase (SDH) histochemistry, and the mutation load in single muscle fibers was quantified by real-time PCR and PCR-RFLP assays. RESULTS. CPEO patients with mtDNA deletions had more COX-deficient fibers in EOM (41.6%) than in skeletal muscle (13.7%, P > 0.0001), and single-fiber analysis revealed a lower mutational threshold for COX deficiency in EOM. Patients with mtDNA point mutations had a less severe ocular phenotype, and there was no significant difference in the absolute level of COX deficiency or mutational threshold between these two muscle groups. CONCLUSIONS. The more pronounced mitochondrial biochemical defect and lower mutational threshold in EOM compared with skeletal muscle fibers provide an explanation of the selective muscle involvement in CPEO. The data also suggest that tissue-specific mechanisms are involved in the clonal expansion and expression of secondary mtDNA deletions in CPEO patients with nuclear genetic defects.
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Affiliation(s)
- Laura C Greaves
- Mitochondrial Research Group, Institute for Ageing and Health, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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Chong KKL, Fan DSP, Lai CHY, Rao SK, Lam PTH, Lam DSC. Unilateral ptosis correction with mersilene mesh frontalis sling in infants: thirteen-year follow-up report. Eye (Lond) 2009; 24:44-9. [PMID: 19300466 DOI: 10.1038/eye.2009.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess surgical, visual, refractive, and aesthetic outcomes 13 years after mersilene mesh frontalis sling (MMFS) operation for severe unilateral congenital ptosis performed in 10 infants before 1 year of age. METHODS Longitudinal follow-up of an interventional case series by structured ocular examinations, external photographs, and questionnaire-based interviews. RESULTS Mean age at surgery was 6.9+/-2.7 months. After a mean follow-up of 13.0+/-0.6 years, one patient (10%) had recurrent ptosis with the upper lid 2 mm below the superior limbus at 3 months postoperatively. Best-corrected visual acuities were within two Snellen lines between the two eyes in all patients. Astigmatic errors were 1.20+/-1.00 D and 1.10+/-1.70 D between operated and unoperated eyes. Four patients had 2 mm lid lag on down-gaze and one of them had 2 mm lagophthalmos. Mean satisfaction scores (scale of 1 to 100) for lid position, cosmesis, function, and to the procedure were 83.3+/-11.8, 77.0+/-22.9, 89.4+/-5.5, and 86.8+/-6.3, respectively. No case of overcorrection, sling extrusion, stitch granuloma, or exposure keratopathy was noted. CONCLUSIONS In view of the low recurrence rate (10%) and absence of serious complication or need for revision after 13 years, the use of MMFS seems effective and feasible in infants less than 1 year old. Achieving compatible long-term stability, satisfactory aesthetic, and visual outcomes, MMFS may offer an alternative to delaying operations for autogenous fascia lata harvesting in infants requiring early ptosis correction.
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Affiliation(s)
- K K L Chong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong, PRC
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