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Medel R, Scherrer E, Castaño Fernández-Vega L, Racana JI, Cordero C, Paños Palacios MI, Vasquez LM. Lambda-double-fixation for medial epicanthoplasty in Blepharophimosis - Ptosis - Epicanthus Inversus Syndrome. Orbit 2024:1-7. [PMID: 38511676 DOI: 10.1080/01676830.2024.2328259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE This study aims to describe a novel approach to medial epicanthoplasty in patients with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) and evaluate the surgical outcome of this technique. METHODS A retrospective, noncomparative, interventional case series involving 22 BPES patients who underwent medial epicanthoplasty using the Lambda-Double-Fixation technique (LDFT) performed by a single surgeon. Pre- and postoperative measurements of inner intercanthal distance (DIC) and horizontal palpebral fissure (HPFL) were recorded. Concurrent or staged ptosis surgery and lateral cantholysis, along with any complications, were documented. RESULTS The mean age of the patients was 2.9 ± 2.2 years. Preoperatively, the mean DIC measured 34.0 ± 2.7 mm, significantly reducing to 23.7 ± 2.1 mm postoperatively (p < 0.001). A notable increase in mean HPFL was observed in both eyes postoperatively: right eye form 18.4 ± 2.4 mm to 23.7 ± 1.8 mm (p < 0.001) and left eye from 18.3 ± 2.4 mm to 23.8 ± 1.9 mm (p < 0.001). Postoperative scars were barely visible in all patients. CONCLUSION LDFT is a simple and reproducible technique for medial epicanthoplasty in BPES. Our results affirm that LDFT induces a physiologically concave reshaping of the medial canthal region, optimizing access to the peritarsal zone and ensuring a secure fixation of the new canthus. These benefits lead to a reduction in ICD and an increase in HPFL, leading to a cosmetically appealing postoperative outcome.
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Affiliation(s)
- Ramón Medel
- Ophthalmic Plastic Surgery Department, Quirón Teknon Hospital, Barcelona, Spain
- Oclanda, Ophthalmic Plastic Surgery and Aesthetics Department, OClanda Oculoplástica y Estética Facial, Barcelona, Spain
- Ophthalmic Plastic Surgery Department, Medel Eye Hub, Malaga, Spain
| | - Elena Scherrer
- Ophthalmic Plastic Surgery Department, Quirón Teknon Hospital, Barcelona, Spain
- Oclanda, Ophthalmic Plastic Surgery and Aesthetics Department, OClanda Oculoplástica y Estética Facial, Barcelona, Spain
- Ophthalmic Plastic Surgery Department, Medel Eye Hub, Malaga, Spain
| | - Lucía Castaño Fernández-Vega
- Ophthalmic Plastic Surgery Department, Quirón Teknon Hospital, Barcelona, Spain
- Oclanda, Ophthalmic Plastic Surgery and Aesthetics Department, OClanda Oculoplástica y Estética Facial, Barcelona, Spain
- Ophthalmic Plastic Surgery Department, Medel Eye Hub, Malaga, Spain
| | - Juan Ignacio Racana
- Oclanda, Ophthalmic Plastic Surgery and Aesthetics Department, OClanda Oculoplástica y Estética Facial, Barcelona, Spain
- Ophthalmic Plastic Surgery Department, Medel Eye Hub, Malaga, Spain
| | - Claudia Cordero
- Oclanda, Ophthalmic Plastic Surgery and Aesthetics Department, OClanda Oculoplástica y Estética Facial, Barcelona, Spain
- Ophthalmic Plastic Surgery Department, Medel Eye Hub, Malaga, Spain
| | - María Inmaculada Paños Palacios
- Oclanda, Ophthalmic Plastic Surgery and Aesthetics Department, OClanda Oculoplástica y Estética Facial, Barcelona, Spain
- Ophthalmic Plastic Surgery Department, Medel Eye Hub, Malaga, Spain
| | - Luz Maria Vasquez
- Ophthalmic Plastic Surgery Department, Quirón Teknon Hospital, Barcelona, Spain
- Oclanda, Ophthalmic Plastic Surgery and Aesthetics Department, OClanda Oculoplástica y Estética Facial, Barcelona, Spain
- Ophthalmic Plastic Surgery Department, Medel Eye Hub, Malaga, Spain
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The Genetic and Clinical Features of FOXL2-Related Blepharophimosis, Ptosis and Epicanthus Inversus Syndrome. Genes (Basel) 2021; 12:genes12030364. [PMID: 33806295 PMCID: PMC7998575 DOI: 10.3390/genes12030364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/25/2021] [Indexed: 12/28/2022] Open
Abstract
Blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES) is a craniofacial disorder caused by heterozygous variants of the forkhead box L2 (FOXL2) gene. It shows autosomal dominant inheritance but can also occur sporadically. Depending on the mutation, two phenotypic subtypes have been described, both involving the same craniofacial features: type I, which is associated with premature ovarian failure (POF), and type II, which has no systemic features. The genotype-phenotype correlation is not fully understood, but it has been hypothesised that type I BPES involves more severe loss of function variants spanning the whole gene. Type II BPES has been linked to frameshift mutations that result in elongation of the protein rather than complete loss of function. A mutational hotspot has been identified within the poly-alanine domain, although the exact function of this region is still unknown. However, the BPES subtype cannot be determined genetically, necessitating informed genetic counselling and careful discussion of family planning advice in view of the associated POF particularly as the patient may still be a child. Following puberty, female patients should be referred for ovarian reserve and response assessment. Oculofacial features can be managed with surgical intervention and regular monitoring to prevent amblyopia.
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Delle Fave M, Cordonnier M, Polyanina M, Kallay O. Management of congenital lacrimal gland agenesis in a patient with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). J Fr Ophtalmol 2021; 44:e159-e161. [PMID: 33423812 DOI: 10.1016/j.jfo.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Delle Fave
- Service d'ophtalmologie, Université libre de Bruxelles, hôpital Érasme, route de Lennik 808, 1070 Bruxelles, Belgium.
| | - M Cordonnier
- Service d'ophtalmologie, Université libre de Bruxelles, hôpital Érasme, route de Lennik 808, 1070 Bruxelles, Belgium
| | - M Polyanina
- Service d'ophtalmologie, centre médical de l'Alliance, avenue du Japon 2, 1420 Braine-l'Alleud, Belgium
| | - O Kallay
- Service d'ophtalmologie, centre médical de l'Alliance, avenue du Japon 2, 1420 Braine-l'Alleud, Belgium
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Ben Abdesslem N, Knani L, Mili W, Mahjoub A, Ben Rayana N, Ghorbel M, Mahjoub H. [Management of blepharophimosis, ptosis, epicanthus inversus syndrome at a referral center in Tunisia]. J Fr Ophtalmol 2020; 44:53-62. [PMID: 33279286 DOI: 10.1016/j.jfo.2020.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/17/2020] [Accepted: 03/11/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Blepharophimosis ptosis epicanthus inversus syndrome (BPES) is a rare congenital hereditary abnormality. It includes complex orbital-palpebral malformations, causing aesthetic and functional ramifications. Management of BPES requires two steps : diagnosis and treatment. PATIENTS AND METHODS We performed a retrospective descriptive study of 44 patients (88 eyelids) with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). In our series, we opted for two-stage surgery in 28 cases : epicanthus-telecanthus surgery followed by ptosis surgery. Simultaneous surgery was performed in 5 cases. RESULTS The mean age at the first visit was 6 years (6.1±6.4). The mean age of our patients at the time of the first surgery was 6.6 years. Epicanthus surgery was performed in 35 cases. The two techniques used to correct epicanthus were Y-V plasty in 30 cases (85.7%, n=35) and Y-V+double Z plasty in 5 cases (14.3%, n=35). Correction of the telecanthus was performed at the same time by a medial canthal tendon plication in 31 cases (88.6%, n=35) or transnasal canthopexy in 4 cases (11.4%, n=35). The mean age at the time of ptosis surgery was 7.23 years (±6.25), ranging from 8 months to 27 years. Ptosis surgery was performed in 41 cases (79 eyelids), of which 3 patients underwent unilateral ptosis surgery due to asymmetrical ptosis. The techniques used were levator resection in 64 eyelids and frontal suspension in 15 eyelids. CONCLUSION BPES is often clinically diagnosed. The difficulty in management lies in the complex surgery required. There is no established consensus regarding surgical techniques or the timing of the surgeries.
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Affiliation(s)
- N Ben Abdesslem
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie.
| | - L Knani
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
| | - W Mili
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
| | - A Mahjoub
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
| | - N Ben Rayana
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
| | - M Ghorbel
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
| | - H Mahjoub
- Service d'ophtalmologie de Sousse, place du Maghreb Arabe, avenue Léopold Senghor, 4053 Sousse, Tunisie
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Zhang JY, Zhu XW, Ding X, Lin M, Li J. Prevalence of amblyopia in congenital blepharoptosis: a systematic review and Meta-analysis. Int J Ophthalmol 2019; 12:1187-1193. [PMID: 31341812 DOI: 10.18240/ijo.2019.07.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/05/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To conduct a systematic review and Meta-analysis of the published literature to evaluate the pooled prevalence rate of amblyopia in patients with congenital ptosis. METHODS We searched the PubMed, Embase, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Data, and Chongqing VIP databases for studies reporting the prevalence of amblyopia in patients with congenital ptosis. The reference lists of relevant studies were scanned. Heterogeneity of effect sizes across studies was tested. We calculated prevalence ratios to compare prevalence estimates for different causes of amblyopia in patients with congenital ptosis, as well as for different geographical regions, year of publication and sample size in subgroup analyses. A systematic review and Meta-analysis were performed. RESULTS We identified 29 eligible surveys with a total population of 2436. Prevalence rates of amblyopia ranged from 13.8% to 69%. We noted substantial heterogeneity in prevalence estimates for amblyopia in congenital ptosis (Cochran's χ 2 significant at P<0.0001; I 2=90%). The pooled prevalence using random-effects models of 29 studies was 32.8% (95%CI: 27.3%-38.4%) in the overall population. Compared to the overall pooled prevalence, amblyopia prevalence was higher in studies in which only subjects with blepharophimosis syndrome were included. CONCLUSION We confirm that nearly one-third of congenital ptosis patients are suffering from or at risk for amblyopia. Patients with blepharophimosis syndrome are more likely to develop amblyopia. The identification and management of amblyopia should be integral to the treatment of congenital ptosis.
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Affiliation(s)
- Jia-Ying Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Xiao-Wei Zhu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Xia Ding
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Ming Lin
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Jin Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
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Guo F, Ning G. [Effectiveness of upper eyelid rotation flap via blepharoplasty incision for correction of mild to moderate epicanthus]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:203-206. [PMID: 30739416 DOI: 10.7507/1002-1892.201805097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate an modified epicanthoplasty which can reduce epicanthic scar in blepharoplasty with mild to moderate epicanthus, by using upper eyelid rotation flap via blepharoplasty incision. Methods A clinical data of 34 patients with mild and moderate epicanthus (trial group), who were treated with blepharoplasty and epicanthoplasty by using upper eyelid rotation flap, between July 2016 and October 2017, was retrospectively analyzed. And 38 patients who were treated with blepharoplasty and epicanthoplasty by using traditional "Z" plastic method were recruited as control group. There was no significant difference in age and degree of epicanthus between 2 groups ( P>0.05). The lengths of palpebral fissure were measured at preoperation and at 6 days and 6 months after operation, and the length difference between pre- and post-operation was calculated to evaluate the improvement degree. The effectiveness was evaluated with reference to the scale of epicanthus orthopedics. Results All incisions of 2 groups healed by first intention, and all patients were followed up 6 months. The epicanthi of 2 groups were significantly corrected. The inner canthus of trial group had no incision; and there were scars at inner canthus of control group, with obvious hyperplasia in 6 cases. The improvement degree of the length of palpebral fissure in trial group and control group were 3.63%±0.07%, 3.70%±0.05% and 4.64%±0.09%, 4.46%±0.10% at 6 days and 6 months after operation, respectively. There was no significant difference between 2 groups ( t=0.005, P=0.996; t=0.287, P=0.871). The effectiveness was excellent in 20 cases, good in 12 cases, and poor in 2 cases in trial group, with an excellent and good rate of 94.12%; meanwhile, the effectiveness was excellent in 16 cases, good in 16 cases, and poor in 6 cases in control group, with an excellent and good rate of 84.21%. There was no significant difference between 2 groups ( χ 2=0.796, P=0.372). Conclusion The modified epicanthoplasty by using upper eyelid rotation flap via blepharoplasty incision can significantly reduce epicanthic scar with simple operation and satisfactory effectiveness.
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Affiliation(s)
- Fangfang Guo
- Department of Plastic and Reconstruction Surgery, Zhongda Hospital, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Guansen Ning
- Department of Plastic and Reconstruction Surgery, Zhongda Hospital, Southeast University, Nanjing Jiangsu, 210009,
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Frontalis–Orbicularis Muscle Advancement for Correction of Upper Eyelid Ptosis: A Systematic Literature Review. Ophthalmic Plast Reconstr Surg 2018; 34:510-515. [DOI: 10.1097/iop.0000000000001145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lacrimal Gland Involvement in Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome. Ophthalmology 2017; 124:399-406. [DOI: 10.1016/j.ophtha.2016.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 11/18/2022] Open
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[Palpebral malformations in children]. ANN CHIR PLAST ESTH 2016; 61:462-479. [PMID: 27545653 DOI: 10.1016/j.anplas.2016.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/20/2016] [Indexed: 11/22/2022]
Abstract
Palpebral malformations can be isolated or associated with a craniofacial disorder. Their assessment is based on clinical examination; additional investigations are mainly done to characterize craniofacial syndromes. In case of extrapalpebral lesions or complex craniofacial pathology, genetic testing must be performed. Some isolated malformations will only need a simple follow-up; others must have specific treatment, undertaken following a precise timing, taking into account child and anatomical structures' growth and the possible consequences of the malformation on the eye and child's sight (degree of urgency). When dealing with these malformations, there are two main risks to be taken into consideration: corneal irritation due to lagophtalmos and amblyopia owing to visual axis obstruction, anisometropia or strabismus.
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