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Ben Ishai M, Ben Artsi E, Shouchane-Blum K, Kramarz Dadon J, Avisar I. Semi-adjustable posterior approach for congenital ptosis repair- outcomes of local and general anesthesia. Eur J Ophthalmol 2024:11206721241247426. [PMID: 38602026 DOI: 10.1177/11206721241247426] [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: 04/12/2024]
Abstract
BACKGROUND To report a single center experience with semi-adjustable posterior approach levator plication ('levatorpexy') in patients with congenital ptosis. MATERIALS AND METHODS A retrospective study. All cases who underwent posterior approach levatorpexy for congenital ptosis between the years 2016 to 2022 were included. The primary outcome measures were margin-to-reflex distance 1 (MRD1) before and after surgery, upper eyelid contour, symmetry of upper eyelid height, complications, and surgical success. Surgery was successful if all the following criteria were met: A postoperative MRD1 of ≥2 mm and ≤4.5 mm, a satisfactory eyelid contour in the operated eyelid, and an inter-eyelid MRD1 asymmetry of ≤1 mm. Postoperative modifications in semi-adjustable techniques were considered in all cases. RESULTS Twenty-three eyelids of 21 patients were included, 11 were performed under general anesthesia, and 12 were performed under local anesthesia. The mean age of all patients was 24.1 years (8-47 years). The mean levator function was 11.2 (±2.11). Mean preoperative MRD1 was 1.05 mm and 1.41 for general and local anesthesia, respectively. Mean postoperative MRD1 was 3.33 mm and 3.37 mm for general and local anesthesia, respectively. Eighteen patients (85%) achieved the desired eyelid height and fulfilled our criteria for success. There were no complications reported in any of the groups. CONCLUSION Posterior approach levatorpexy is a safe and effective procedure for repairing congenital ptosis in patients with good levator function. This technique is suitable for young patients and those unable to undergo surgery under local anesthesia. This technique offers post-operative modification due to its semi-adjustable nature.
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Affiliation(s)
- Meydan Ben Ishai
- Ophthalmology Department, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Ben Artsi
- Ophthalmology Department, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karny Shouchane-Blum
- Ophthalmology Department, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Judith Kramarz Dadon
- Ophthalmology Department, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Avisar
- Ophthalmology Department, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fan J, Yan Y, Huang R, Guo R, Yang J. Temporal-fasciae-complex sheet suspension for correction of severe recurrent blepharoptosis. J Plast Reconstr Aesthet Surg 2023; 85:65-71. [PMID: 37478652 DOI: 10.1016/j.bjps.2023.04.027] [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: 10/30/2022] [Revised: 02/26/2023] [Accepted: 04/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Multiple surgical methods were performed to correct the blepharoptosis. However, the recurrence of blepharoptosis is not uncommon in clinical practice. The Temporal-Fasciae-Complex Sheet (TFC sheet) was an ideal autologous material in correcting the severe blepharoptosis. In the present retrospected study, we introduced our experience in the correction of severe recurrent blepharoptosis with the technique of TFC sheet suspension, and describe the follow-up results to illustrate its effectiveness and practicality. METHODS A total of 16 patients (23 eyes) with severe recurrent blepharoptosis were enrolled in this study. All the patients were performed with temporal-fasciae-complex sheet suspension surgeries for revision> 12 months after the primary surgeries by the same treatment group. The margin-to-reflex distance 1 (MRD1), correction effect, and eyelid symmetry were used to evaluate clinical outcomes. RESULTS 19 eyelids (82.6%) showed good correction results, and 5 eyelids (21.7%) showed fair correction results. The average value of preoperative-MRD1(pre-MRD1) was - 0.17 ± 0.97, and the average value of postoperative-MRD1(post-MRD1) was 4.01 ± 1.24. There was a statistically significant difference between pre-MRD1 and post-MRD1 (p < 0.0001). Good symmetry was observed in 13 patients (81.3%). All patients enrolled were satisfied with the surgical results. CONCLUSION The Temporal-Fasciae-Complex Sheet Suspension is an effective and safe method for correcting the recurrent blepharoptosis.
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Affiliation(s)
- Jincai Fan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Yucheng Yan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Rong Huang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Rui Guo
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jifan Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
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The 100 Most-Cited Manuscripts on Blepharoptosis: A Bibliometric analysis. J Craniofac Surg 2023; 34:485-488. [PMID: 35984041 DOI: 10.1097/scs.0000000000008902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We conducted a bibliometric analysis of blepharoptosis, obtained the top 100 most-cited articles, and then researched the characteristics of every article. MATERIALS AND METHODS The Web of Science Citation Index was utilized to identify articles related to blepharoptosis written in English published from 1900 to 2021 using predefined search terms. Then, the returned results were screened, and the top 100 most-cited articles were individually classified based on publication year, country of publication, source journal, total citations, authors' specialty, level of evidence, main subject, and type of study. RESULTS The 100 most-cited articles were published between 1948 and 2014. The number of citations/articles ranged from 49 to 743. Ophthalmology journals made the greatest contributions to landmark literature (n=61). The primary focus of these 100 studies was the surgical technique (n=41). The majority of them (n=52) only achieved level 4 evidence, as a high proportion of these articles were case series (n=52). The most common country of publication was the United States (n=59). CONCLUSIONS Our bibliometric analysis provides insight into the citation frequency of the most-cited articles on blepharoptosis. The landmark, highly cited articles that have shaped the landscape of blepharoptosis were identified. The results from these top 100 cited articles are helpful for present current surgical decision-making.
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Tan Y, Wang X, Fu J, Tang J, Xiang J, Tao L, Luo Y. Amblyopic astigmatism characteristics and surgical outcomes in younger children with severe congenital ptosis after frontalis suspension surgery. BMC Ophthalmol 2023; 23:54. [PMID: 36750792 PMCID: PMC9903475 DOI: 10.1186/s12886-023-02804-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND To examine the astigmatism characteristics and surgical outcomes in patients with unilateral severe congenital ptosis following frontalis suspension surgery. METHODS We included 53 congenital ptosis patients who underwent frontalis suspension surgery in Hunan Children's Hospital. Each patient underwent a refractive examination before and after surgery to assess astigmatism. We also evaluated the effects and complications associated with the procedure. RESULTS Degree of astigmatism in ptotic and fellow eyes was - 1.45 ± 0.59 D and - 0.66 ± 0.51 D before surgery. Ratio of severe astigmatism in ptotic and fellow eyes was 51.3 and 12.8%. The fellow eyes presented with with-the-rule astigmatism (WR; 71.8%) and against-the-rule astigmatism (AR; 20.5%) types, with no cases of oblique astigmatism (OA). Ptotic eyes demonstrated higher frequencies of AR (59.0%) and OA (10.2%) than did fellow eyes. Furthermore, the former showed increased astigmatism, followed by a gradual decrease at the 6-month, before significantly decreasing at the 1-year postoperatively. The ratio of postoperative AR and OA astigmatism cases in ptotic eyes decreased to 35.9 and 7.7% 1 month postoperatively. However, there was a postoperative increase in the WR ratio from 30.8 to 56.4% after 1 month. Kaplan-Meier survival analysis showed a success rate of 81.4% at 6 months and 62.9% at 12 months which was influenced by the following complications: suture reaction, epithelial keratopathy, infection and granuloma, lid lag, and recurrence. CONCLUSION Monocular congenital ptosis could develop severe astigmatism and higher frequency of AR or OA, early surgery may ameliorate astigmatic amblyopia.
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Affiliation(s)
- Yilan Tan
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Xilang Wang
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Jing Fu
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Jing Tang
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Jianbo Xiang
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Lijuan Tao
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Yulin Luo
- Department of Ophthalmology, Hunan Children's Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province, China.
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Evereklioglu C. Frontalis suspension by a minimally invasive "harvesting-stripping technique" for congenital blepharoptosis in children under 3-years-old. Eur J Ophthalmol 2023; 33:161-170. [PMID: 35668616 PMCID: PMC9834493 DOI: 10.1177/11206721221106133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To describe a minimally-invasive "harvesting-stripping technique" on a small segment of autogenous fascia lata (AFL) in small children with severe blepharoptosis under 3-years-old. METHODS A single-surgeon, uncontrolled surgical trial was designed for 25 eyelids of 18 small children (5 girls, 13 boys) with severe blepharoptosis. Single- and short-skin incisions (2-cm) were made on the thigh and a final 3X0.6-cm or 3.5X1-cm AFL segment was excised according to the ptosis laterality. The surface area of the harvested AFL was calculated and dissected for a final 9-cmX2-mm-long fascial strip for each eye. Functional and aesthetic outcomes of the upper eyelids were evaluated and the feasibility, effectivity and advantages of this novel approach in younger patients were assessed. RESULTS The mean age was 28.3 months (17-35) with a mean follow-up of 34.3 months (6-96). All eyelids achieved good or excellent functional and aesthetic results (except one), with no peri- or post-operative severe complications such as haemorrhage, wound infection, hypertrophied thigh scar, muscle prolapses, eyelid contour abnormalities, ptosis recurrence or overcorrection. CONCLUSIONS "Harvesting-stripping technique" with the AFL may be an alternative approach to correct severe upper blepharoptosis in small children under 3-years-old, which offers various benefits over conventional methods with non-autogenous materials.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Division of Oculoplastic, Orbital and Lacrimal Surgery & Paediatric Ophthalmology and Strabismus, Erciyes University, Medical Faculty, Kayseri, Turkey,Cem Evereklioglu, Erenkoy Mah., Komando Cad., 1465. Lavanta Sok., Yeditepe Villalari, 3/14, Melikgazi, Kayseri, Turkey.
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Landau Prat D, Ramakrishnan M, Zhao C, Revere K, Katowitz WR, Katowitz JA. Silicone sling frontalis suspension for congenital ptosis: Outcome of 174 consecutive cases. Clin Exp Ophthalmol 2022; 50:608-614. [PMID: 35610953 DOI: 10.1111/ceo.14112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/28/2022] [Accepted: 05/14/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Frontalis suspension (FS) is the treatment of choice in congenital ptosis with poor levator function. We report the surgical outcome of FS using a double triangle configuration of silicone slings in children. METHODS A retrospective cohort study of all paediatric patients with simple myogenic congenital ptosis repaired with FS over a 12-year period (2009-2020). Each silicone sling was secured by simple knots. Pre- and post-operative margin reflex distance (MRD1 ) measurements were determined from clinical photographs using ImageJ Software. Main outcome measures were improvement in eyelid height, eyelid asymmetry, reoperation rate and timing. RESULTS One hundred and thirty nine patients (174 eyes) were included, with 35 (25%) having bilateral surgery. Mean (±SD) age was 1.4 ± 1.9 years. Mean follow up time was 32 ± 20.5 months. Sixteen patients (11%) had a history of previous ptosis repair surgery. Mean MRD1 improved by an average of 1.5 mm. The final MRD1 in the group of patients who did not have a second procedure was a mean of 2.1 mm. The MRD1 difference between both eyes in all unilateral cases improved from 2.5 mm preoperatively to 1.2 mm at final visit (p < 0.001). In the 123 cases without a history of previous ptosis surgery, repeat ptosis repair was performed in 37 (30%) patients, 34.9 ± 19.9 months after the initial procedure. Overall, repeat repair was performed in 47 patients (34%). CONCLUSIONS Double triangle silicone sling frontalis suspension has a favourable outcome in two-thirds of paediatric patients with simple myogenic congenital ptosis. Failed cases can be addressed with a second repair, using either autogenous fascia lata or a second silicone sling.
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Affiliation(s)
- Daphna Landau Prat
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA.,The Sheba Talpiot Medical Leadership Program, Division of Ophthalmology, The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meera Ramakrishnan
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA
| | - Cindy Zhao
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA
| | - Karen Revere
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA
| | - William R Katowitz
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA
| | - James A Katowitz
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Pennsylvania, USA
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Wuthisiri W, Peou C, Lekskul A, Chokthaweesak W. Maximal Levator Resection Beyond Whitnall’s Ligament in Severe Simple Congenital Ptosis with Poor Levator Function. Clin Ophthalmol 2022; 16:441-452. [PMID: 35210749 PMCID: PMC8860395 DOI: 10.2147/opth.s340781] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the functional and cosmetic outcomes, as well as factors that influence surgical success of maximal levator resection beyond Whitnall’s ligament in patients with poor levator function (LF) and severe simple congenital ptosis. Methods This retrospective interventional study included patients with severe simple congenital ptosis and LF of ≤4 mm who had undergone maximal levator resection beyond Whitnall’s ligament with a minimum of 12 months follow-up. Postoperative marginal reflex distance-1 (MRD1) was assessed for functional outcomes as excellent, good, fair and poor. Eyelid contour and the difference in MRD1 between eyes were assessed for symmetrical cosmetic outcomes as excellent, good and poor. Demographic data, factors influencing surgical success and postoperative complications were analyzed. Results A total of 38 ptotic eyelids in 31 patients were included. Successful surgical outcomes (at least good functional and cosmetic outcomes) were achieved in 26 patients (83.87%) with the mean MRD1 of +3.61 ± 0.27 mm and +3.51 ± 0.17 mm at 1 week and 12 months after surgery, respectively. There were no significant differences in demographic and preoperative data between the successful and unsuccessful surgical outcome groups, mean preoperative ptosis measurements were 4.19 ± 0.20 mm versus 4.72 ± 0.36 mm (p = 0.242) and mean pre-operative LF were 3.16 ± 0.15 mm versus 2.29 ± 0.61 mm (p = 0.561), respectively. The only factor that significantly influenced the surgical success rate was the length of the resected levator muscle. The mean lengths in successful and unsuccessful groups were 18.15 ± 0.44 mm and 14.29 ± 0.94 mm, respectively (p = 0.011). Conclusion Maximal levator resection beyond Whitnall’s ligament is an effective procedure for severe simple congenital ptosis with poor LF. Refinement of surgical techniques and careful assessment of the optimal resected length for the levator muscle grants successful surgical outcomes.
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Affiliation(s)
- Wadakarn Wuthisiri
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Channy Peou
- Department of Ophthalmology International University, Phnom Penh, Cambodia
| | - Apatsa Lekskul
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Weerawan Chokthaweesak
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Weerawan Chokthaweesak, Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok, 10400, Thailand, Tel +66 2 201 2729, Fax +66 2 201 1516, Email
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Jones DL, Ma J, Yang M, Duong A, Richani K. Pediatric Ptosis: A Review of Less Common Causes. Int Ophthalmol Clin 2022; 62:177-202. [PMID: 34965234 DOI: 10.1097/iio.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Frontalis Suspension Using Autologous Fascia Lata in Children Under 3 Years Old. Ophthalmic Plast Reconstr Surg 2021; 37:377-380. [PMID: 33237671 DOI: 10.1097/iop.0000000000001882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze functional results and complications of the use of autologous fascia lata in frontalis suspension in children under 3 years old and to confirm its technical viability. METHODS A retrospective review of 8 patients (12 eyes) who underwent frontalis suspension using autologous fascia lata sling. RESULTS Twelve eyes of 8 patients were analyzed, with an average age of 1.8 ± 0.6 years. Preoperatively, the mean margin-to-reflex distance 1 was -0.17 ± 0.577 mm. Postoperatively the mean margin-to-reflex distance 1 was 2.66 ± 0.492 mm without any graft donor site or corneal complications. No recurrence was recorded in the follow-up period (mean follow-up period 28.5 ± 32.33 months). CONCLUSIONS Autologous fascia lata is an eligible material in frontalis suspension in children under 3 years old, despite the traditional oculoplastic dogma that advises against.
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Mohammed NM, Kamal MA, Abdelhafez MA, Diab MM. Single-triangle versus Fox pentagon frontalis suspension for unilateral severe congenital ptosis correction. J AAPOS 2020; 24:295.e1-295.e6. [PMID: 33045376 DOI: 10.1016/j.jaapos.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the functional and cosmetic outcomes of two different frontalis sling techniques for correction of severe unilateral congenital ptosis: single triangle and Fox pentagon techniques using expanded polytetrafluoroethylene (ePTFE) suture. METHODS This randomized controlled trial included 60 eyes of 60 patients with severe unilateral simple congenital ptosis and poor levator function (≤4 mm). Participants were randomly assigned for either single triangle or Fox pentagon frontalis suspension using ePTFE suture. Functional outcome measures were margin reflex distance (MRD1), palpebral fissure height (VFH), and lagophthalmos. Cosmetic outcome parameters (lid contour, lid crease, and height symmetry) were graded as 3 (excellent), 2 (good), or 1 (poor), with a minimum of 18 months' follow-up. RESULTS At final follow-up, there was a significant improvement in the MRD1 and VFH in both groups, with no statistical difference (P = 0.9). Both groups showed comparative cosmetic results regarding lid height symmetry, crease, and contour. The patients in the single-triangle group showed more rapid recovery of postoperative edema and lagopthalmos with less visible forehead scarring. There were no serious ePTFE sling-related complications. CONCLUSIONS In our study cohort, the single-triangle and Fox pentagon frontalis suspension techniques had similar outcomes with respect to MRD1 and VFH and comparable cosmetic results. However, the single-triangle technique avoids two forehead incisions and was associated with less postoperative edema, lagophthalmos, and scarring.
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Affiliation(s)
- Nora Mahmoud Mohammed
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Mahmoud Ahmed Kamal
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | | | - Mostafa Mohammed Diab
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt.
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11
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Young SM, Imagawa Y, Kim YD, Park JW, Jang J, Woo KI. Lagophthalmos after congenital ptosis surgery: comparison between maximal levator resection and frontalis sling operation. Eye (Lond) 2020; 35:1261-1267. [PMID: 32651544 DOI: 10.1038/s41433-020-1081-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES To compare postoperative lagophthalmos after maximal levator resection (MLR) and frontalis suspension (FS) in congenital ptosis patients with poor levator function (LF). METHODS A cross-sectional study was performed to compare postoperative outcomes in patients with preoperative LF ≤ 4 mm who had undergone MLR or FS at a single tertiary institution, and who had visited the outpatient clinic between February 2017 and August 2018. Main outcome measures were as follows: (1) Preoperative LF and margin reflex distance 1 (MRD1), (2) Postoperative MRD1, lagophthalmos and grade of superficial punctate keratopathy (SPK). RESULTS Our study comprised 152 eyelids of 122 patients. There were 71 eyelids in the MLR group and 81 eyelids in the FS group. The MLR group had comparable mean postoperative MRD1 (2.8 ± 0.8 mm) to the FS with autogenous fascia lata (AFL) group (3.0 ± 0.7 mm), while the FS with preserved fascia lata (PFL) group had the lowest mean postoperative MRD1 (2.2 ± 1.0 mm). The PFL group had significantly less lagophthalmos (0.6 ± 1.0 mm) than the AFL (1.9 ± 1.4 mm) and maximal levator resection (1.9 ± 1.7 mm) groups. In the MLR group, there was no significant difference in postoperative surgical measurements between the LF 0-2 mm group and LF 2.5-4 mm group in terms of exposure keratopathy, degree of lagophthalmos and MRD1. CONCLUSION MLR is an effective alternative to FS in congenital ptosis patients with poor levator function, with the risk of postoperative lagophthalmos related to postoperative MRD1 rather than preoperative LF.
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Affiliation(s)
- Stephanie Ming Young
- Ophthalmic Plastic and Reconstructive Surgery, Eagle Eye Centre, Singapore, Singapore
| | - Yukihiro Imagawa
- Department of Ophthalmology, Osaka Kaisei Hospital, Osaka, Japan
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Ji Woong Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jaeho Jang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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12
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Quaranta‐Leoni FM, Secondi R, Quaranta‐Leoni F, Nardoni S. Histological findings of levator muscle in unilateral congenital ptosis in different age groups. Acta Ophthalmol 2020; 98:e363-e367. [PMID: 31654462 DOI: 10.1111/aos.14284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/28/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the different degree of muscle atrophy in specimens of levator muscle of patients operated on for unilateral congenital ptosis, as related to the age of the patient. METHODS Histological analysis of the specimen of the levator muscle of 29 patients who underwent a unilateral levator muscle resection under the care of one surgeon was performed. The study population was divided into two different groups according to the timing of surgery: group 1 included 15 children operated on at 2 to 4 years, and group 2 included 14 children operated on at 4.1 to 11 years. RESULTS Levator muscle of 12 patients of group 1 showed mild degree of muscle atrophy, with striated muscle fibres separated by thin fibrous septa incorporating groups of cells with peripheral nuclei and non-hyalinized cytoplasm (Masson's trichrome stain). In eight cases of group 2, levator muscle showed instead severe atrophy, with discontinuous striated muscle fibres separated by thick fibrous septa including cells with centralization of nuclei, hyalinization of cytoplasm (Masson's trichrome stain) and fatty infiltration. CONCLUSION Myofibres found in specimens of levator muscle following levator resection for congenital ptosis show characteristics of a degenerative process. This study seems to demonstrate that atrophy in the levator muscle appears to be related to the age of the patient at surgery, as atrophy tends to be more evident in older children with congenital ptosis.
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Affiliation(s)
- Francesco M. Quaranta‐Leoni
- Oftalmoplastica Roma Rome Italy
- Orbital and Adnexal Service Department of Ophthalmology Villa Tiberia Hospital – GVM Care & Research Rome Italy
| | | | | | - Stefano Nardoni
- Department of Pathology San Filippo Neri Hospital Rome Italy
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Wagner MEH, Rotsch C, Hanus S, Essig H, Grunert R, Gellrich NC, Lichtenstein J. Feasibility of implants with superelastic behaviour for midface reconstruction. J Biomater Appl 2020; 34:1449-1457. [PMID: 32183582 DOI: 10.1177/0885328220911585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maximilian E H Wagner
- Department of Craniomaxillofacial Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Christian Rotsch
- Fraunhofer-Institut für Werkzeugmaschinen und Umformtechnik Institutsteil Dresden, Dresden, Germany
| | - Sibylle Hanus
- Sächsisches Textilforschungsinstitut eV, Chemnitz, Germany
| | - Harald Essig
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Ronny Grunert
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Craniomaxillofacial Surgery, University Hospital Schleswig Holstein Campus Kiel, Kiel, Germany
| | - Jürgen Lichtenstein
- Department of Craniomaxillofacial Surgery, University Hospital Schleswig Holstein Campus Kiel, Kiel, Germany
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Ural O, Mocan MC, Erdener U. Evaluation of All Causes of Visual Function Loss in Children With Congenital Blepharoptosis. J Pediatr Ophthalmol Strabismus 2020; 57:97-102. [PMID: 32203593 DOI: 10.3928/01913913-20200120-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/30/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the overall frequency of visual function loss in pediatric patients with congenital blepharoptosis. METHODS This retrospective study was conducted in a tertiary center. The clinical records of patients younger than 18 years who were diagnosed as having congenital blephroptosis, underwent surgery, and had at least 1 year of postoperative follow-up were evaluated. Visual acuity results, presence of structural eye abnormalities, presence and type of amblyopia and strabismus, and refractive errors were recorded. The Mann-Whitney U test, chi-square test, and stepwise regression analysis were used for statistical analyses. RESULTS The mean final visual acuity was 0.11 ± 0.23 logarithm of the minimum angle of resolution (logMAR) (range: 0.0 to 1.0 logMAR) at the final follow-up visit for 143 eyes of 123 patients (65 male and 58 female). In this cohort, 30 patients (24.4%) had amblyopia and 5 patients (4.1%) had visual loss related to structural eye pathology, amounting to a total of 35 patients (28.5%) with visual function loss. The mean final visual acuities of patients without amblyopia, patients with amblyopia, and patients with organic eye disorders were 0.01 ± 0.03, 0.29 ± 0.28, and 0.55 ± 0.42 logMAR, respectively. Severe blepharoptosis (≥ 4 mm) was present in 25 patients (83.3%) with amblyopia. Deprivational amblyopia was detected in 25 of 36 eyes (69.4%) with amblyopia. Independent risk factors associated with final visual acuity were presence of amblyopia at presentation (correlation coefficient [ß] ± standard error [SE] = -0.29 ± 0.04; P < .001), anisometropia (ß ± SE = -0.27 ± 0.06; P < .001), and ptosis severity (ß ± SE = -0.09 ± 0.04; P = .012). Visual impairment (visual acuity < 20/40) persisted in 11.9% of eyes at the final follow-up. CONCLUSIONS Visual function loss was present in one-third of pediatric patients with congenital blepharoptosis. Both amblyopia and structural eye disorders contribute to visual impairment in this patient population. Structural eye pathology contributes independently to 4.1% of visual loss in this clinical setting. [J Pediatr Ophthalmol Strabismus. 2020;57(2):97-102.].
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Affiliation(s)
- Yun Jin Kim
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Selangor, Malaysia
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16
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Unilateral Levator Aponeurosis Excision for Marcus Gunn Syndrome and Risk Factors of Residual Jaw Winking. J Ophthalmol 2019; 2019:2058047. [PMID: 31781375 PMCID: PMC6875030 DOI: 10.1155/2019/2058047] [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: 05/12/2019] [Accepted: 10/17/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the association of ptosis, levator, and jaw winking in Marcus Gunn jaw-winking synkinesis (MGJWS), and the risk factor of preservation and outcomes of the unilateral levator excision and frontalis suspension. Methods Clinical features of MGJWS case series from 2011 to 2018 were retrospectively reviewed. Association between jaw winking and ptosis/levator function was statistically analyzed. The patients underwent unilateral levator excision and frontalis suspension using silicone rod or autogenous fascia lata. Clinical outcomes were evaluated in operated patients and the independent risk factors of residual jaw winking were investigated after a long follow-up. Results There were 42 MGJWS patients in 2011 to 2018, accounting for 2.87% of all congenital blepharoptosis. 80% of mild jaw winking was accompanied with mild ptosis and fair levator function, and moderate-to-severe jaw winking was often accompanied with moderate-to-severe ptosis and poor levator function (P < 0.05). Ptosis showed a strong association with excursion of jaw winking (R = 0.785, P < 0.01). Jaw winking was resolved in all 34 operated patients with good correction of ptosis. Severity of jaw winking is an independent risk factor for the residual synkinesis after surgery. Severe preoperative jaw winking had an 18.05 times increased risk of postoperative residual synkinesis compared with moderate jaw winking (P < 0.05). Conclusions In MGJWS eyelid excursion of jaw winking has a direct correlation with ptosis and dysfunction of levator muscle. Unilateral levator aponeurosis excision and frontalis suspension is an efficient approach for MGJWS. Severe jaw winking is a risk factor of residual eyelid synkinesis after surgery.
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Joly A, Croise B, Travers N, Listrat A, Pare A, Laure B. Management of isolated and complex craniosynostosis residual deformities: What are the maxillofacial tools? Neurochirurgie 2019; 65:295-301. [DOI: 10.1016/j.neuchi.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 10/26/2022]
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Shi A, Levin AV. Ophthalmologic findings in the Cornelia de Lange syndrome. Ophthalmic Genet 2019; 40:1-6. [PMID: 30767692 DOI: 10.1080/13816810.2019.1571617] [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: 10/27/2022]
Abstract
BACKGROUND Cornelia de Lange syndrome (CdLS) is a congenital disorder characterized by multisystem abnormalities, including distinct ophthalmologic findings. In recent years, advances in molecular genetics have begun to provide new insight into the characterization of these clinical features and the genetic basis of the syndrome. MATERIALS AND METHODS We included 37 articles that were identified through an electronic search in PubMed and through the reference lists of previously conducted reviews. Studies of 30 or more patients were used to report frequencies of common and less common findings. Genotype-phenotype studies were used to provide additional information when available. RESULTS Ocular anomalies are present in most patients with CdLS. Common findings include long eyelashes, synophrys, hirsutism of the eyebrows, peripapillary pigment ring, and myopia. Less common findings include hyperopia, ptosis, blepharitis, short palpebral fissure length, down-slanting palpebral fissures, mild microcornea, strabismus, nystagmus, and optic nerve abnormalities. CONCLUSIONS This review provides a comprehensive summary of the ophthalmologic findings in CdLS. Mutations in certain genes may be associated with specific ocular abnormalities, although future genotype studies are needed to further characterize these relationships.
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Affiliation(s)
- Angell Shi
- a Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , Pennsylvania , USA
| | - Alex V Levin
- a Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , Pennsylvania , USA.,b Pediatric Ophthalmology and Ocular Genetics , Wills Eye Hospital , Philadelphia , Pennsylvania , USA
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