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Ghiam BK, Su RC, Orge F. Surgical Outcomes After Frontalis Suspension Using Expanded Polytetrafluoroethylene Sling for Congenital Ptosis. Cureus 2023; 15:e49020. [PMID: 38111459 PMCID: PMC10727487 DOI: 10.7759/cureus.49020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Purpose The purpose of the study is to assess short- and long-term functional outcomes after frontalis suspension using expanded polytetrafluoroethylene (ePTFE) sling for congenital ptosis repair. Methods A retrospective, observational case review was conducted on pediatric patients who underwent frontalis suspension using ePTFE sling from 2008 to 2020. Functional success was assessed by lid height, lid symmetry, and parental satisfaction with the cosmetic outcome. Clinical course and long-term functional outcomes after surgery were assessed. Results Twenty-one cases met the inclusion criteria and were assessed. The follow-up time ranged from 13 months to 11 years (mean: six years). Functional success after one surgery was 62% at early and late postoperative periods. Six of 21 cases (29%) required revisional surgery in the early postoperative period due to undercorrection. Three cases (14%) were complicated by infection and/or granuloma formation. There were no cases of ptosis recurrence in the long term if success was seen in the early postoperative period. Conclusion ePTFE slings remain an excellent option for severe congenital ptosis repair with frontalis sling, demonstrating long-term functional success, with satisfactory lid symmetry and acceptable cosmetic outcome. This is of important consideration in patients younger than three years of age, where autogenous materials may not be recommended. The need for early revisional surgery for undercorrection is not uncommon. The current authors also demonstrate a low but considerable risk for infection and/or granuloma formation.
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Affiliation(s)
- Benjamin K Ghiam
- Department of Ophthalmology, Roski Eye Institute, University of Southern California, Los Angeles, USA
| | - Robin C Su
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, USA
| | - Faruk Orge
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, USA
- Department of Ophthalmology and Visual Sciences, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, USA
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Bai JS, Song MJ, Li BT, Tian R. Timing of Surgery and Treatment Options for Congenital Ptosis in Children: A Narrative Review of the Literature. Aesthetic Plast Surg 2023; 47:226-234. [PMID: 36114384 DOI: 10.1007/s00266-022-03039-7] [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: 05/15/2022] [Accepted: 07/21/2022] [Indexed: 11/01/2022]
Abstract
Congenital ptosis has varying degrees of impact on the visual development or psychological health of a child depending on its severity. Some controversies and misconceptions remain regarding the management of congenital ptosis in children. Particularly, the accurate diagnosis of the severity of congenital ptosis in younger children, assessment of the visual developmental status of the child, optimal timing of surgery, and treatment choice are still issues in clinical practice that need to be explored. This report presents a comprehensive review of these aspects of the correction of congenital ptosis to provide a valuable reference for clinical practice. Our review shows that currently used surgical procedures for ptosis may result in over- or under-correction to varying degrees. The differences may be due to the physical condition and age of the child and the degree of cooperation during preoperative examination and assessment, resulting in inaccurate results. Alternatively, intraoperative swelling and bleeding may lead to errors in the values recorded by the surgeon. 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)
- Jian-Shu Bai
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China
| | - Mei-Jiao Song
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China
| | - Bing-Tao Li
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China
| | - Rui Tian
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China.
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Chan NSW, Young S, Yuen HK, Henson RD. Survey of ptosis practice patterns among surgeons in Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS). Orbit 2023; 42:42-51. [PMID: 34989292 DOI: 10.1080/01676830.2021.2021540] [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: 01/28/2023]
Abstract
OBJECTIVE To characterize the preferred ptosis practice patterns and variations among oculoplastic surgeons in the Asia-Pacific region. METHODS A web-based questionnaire was sent to both members and non-members registered under the Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS)'s email database. The survey included preoperative testing practices, surgical preferences for adult aponeurotic and congenital ptosis, various surgical techniques (anterior and posterior approach ptosis procedures, and frontalis sling procedures) and postoperative practices. RESULTS A total of 386 survey invitations were sent. There was a response rate of 68.7% from respondents from 20 countries in the Asia-Pacific region. There was variation in the preoperative evaluation and management of ptosis. Anterior approach ptosis surgery (96.6%) and frontalis sling procedures (86.8%) were performed by more surgeons than posterior approach ptosis surgery (47.2%). There was a deviation from the traditional frontalis sling procedures for patients with poor levator function. CONCLUSIONS Our survey results provide insight into the variation in the assessment and management of ptosis amongst oculoplastic surgeons in the Asia-Pacific region. It also demonstrates some differences between practice patterns in Asia-Pacific and America.
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Affiliation(s)
| | - Stephanie Young
- Department of Ophthalmology, National University Hospital, Singapore.,Eagle Eye Centre, Singapore
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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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Wang H, Liu Z, Li Y, Song L, Pang R, Yang J, Bai P. Modified conjoint fascial sheath suspension for the correction of severe congenital blepharoptosis in pediatric patients at different ages. Front Pediatr 2022; 10:954365. [PMID: 36340729 PMCID: PMC9634665 DOI: 10.3389/fped.2022.954365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/30/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the surgical outcomes of modified combined fascia sheath (CFS) and levator muscle (LM) complex suspension for the correction of severe congenital blepharoptosis in pediatric patients. METHODS Pediatric patients with severe congenital blepharoptosis were enrolled form July 2017 to July 2021. All patients were divided into two groups according to their age (group A ≤ 7 years; group B > 7 years) and received CFS + LM suspension surgery. Main surgical outcome indexes include margin reflex distance 1 (MRD1) and MRD1 regression. Postoperative complications such as lagophthalmos (LAG), conjunctival prolapse, exposure keratopathy and trichiasis were documented. RESULTS Fifty patients (60 eyes) were enrolled, including 17 patients (18 eyes) in group A and 33 patients (42 eyes) in group B. The MRD1 in group A was 3.06 ± 0.64 mm at 6 months after the operation, and the MRD1 in group B was 2.64 ± 0.69 mm 6 months postoperatively which is significantly lower than that of group A (P = 0. 044). At the last visit, however, the MRD1 in group A was 3.00 ± 0.69 mm and the MRD1 in group B was 2.64 ± 0.70 mm. There was no significant difference in MRD1 between two groups in long term (P = 0.255). Additionally, there were a variety of degrees of MRD1 regression, especially in the first month after the operation in both groups (both P < 0.001). Moreover, there were 9 cases of postoperative complications in group A and 13 cases in group B. The overall occurrence of postoperative complications in group A was significantly lower than that in groups B (χ 2 = 4.413, P = 0.036). CONCLUSIONS CFS + LM suspension, a modified CFS-based surgery, is an effective treatment for severe congenital blepharoptosis in pediatric patients. Moreover, CFS + LM suspension demonstrate excellent long-term outcomes, including good movement of the eyelid, satisfied eyelid closure and fewer postoperative complications.
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Affiliation(s)
- Huixing Wang
- Department of Ocular Plastic, Hebei Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Disease, Xingtai, China
| | - Zhaochuan Liu
- Department of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China
| | - Yadi Li
- Department of Ophthalmology, Affiliated Hospital of Yunnan University, Key Laboratory of Yunnan Province, Yunnan Eye Institute, Kunming, China
| | - Lihua Song
- Department of Ocular Plastic, Hebei Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Disease, Xingtai, China
| | - Runhui Pang
- Department of Ocular Plastic, Hebei Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Disease, Xingtai, China
| | - Jianwei Yang
- Department of Ocular Plastic, Hebei Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Disease, Xingtai, China
| | - Ping Bai
- Department of Ocular Plastic, Hebei Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Disease, Xingtai, China
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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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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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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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Outcomes of Frontalis Sling Versus Levator Resection in Patients With Monocular Elevation Deficiency Associated Ptosis. Ophthalmic Plast Reconstr Surg 2018; 35:251-255. [PMID: 30363005 DOI: 10.1097/iop.0000000000001221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare outcomes of frontalis sling (FS) silicone and levator resection (LR) in ptosis associated with monocular elevation deficiency. METHODS Retrospective interventional comparative case series of FS and LR in monocular elevation deficiency associated ptosis. Favorable outcome was defined as difference in margin reflex distance 1 of ≤1 mm between the 2 eyes in unilateral cases and margin reflex distance 1 of 4 mm in bilateral cases at last follow-up visit. RESULTS One hundred four eyes of 95 patients were included. Median age at surgery was 14 years, and the mean follow-up period was 19.75 ± 34.55 months. Ptosis was severe in 91 (87.5%) patients. Associated Marcus Gunn jaw-winking (MGJW) phenomenon was seen in 43 (42%) patients. Frontalis sling was performed in 76 (73%) and LR in 28 (27%). Mean pre- and postoperative margin reflex distance 1 were -1.27 ± 2.17 mm and 2.18 ± 1.49 mm (p < 0.0001). The mean improvement in margin reflex distance 1 was significantly more with FS (4.46 ± 2.19) compared with LR (1.85 + 2.5) (p < 0.0001). There were no cases of exposure keratopathy requiring reversal of surgery in either group. The number of resurgeries required was 42 (55%) in the FS group and 10 (36%) (p = 0.08) in the LR group. Favorable outcome was seen in 54 (71%) in FS group and 16 (57%) (p = 0.17) in LR group. CONCLUSIONS When compared with levator resection, frontalis suspension with silicone gives a better eyelid elevation but has greater regression requiring more resurgeries. In spite of a poor Bells phenomenon, exposure keratopathy is not a concern.
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Abstract
Unilateral congenital ptosis with poor levator function of ≤4 mm continues to be a difficult challenge for the oculoplastic surgeon. Surgical correction can be accomplished with unilateral frontalis suspension, maximal levator resection, or bilateral frontalis suspension with or without levator muscle excision of the normal eyelid. Bilateral frontalis suspension was proposed by Beard and Callahan to overcome the challenge of postoperative asymmetry, allowing symmetrical lagophthalmos on downgaze, postoperatively. However, most surgeons and patients prefer unilateral correction on the abnormal eyelid either with a frontalis suspension or maximal levator resection. Frontalis suspension may be performed through the various surgical techniques using different autogenous or exogenous materials. Autogenous fascia lata is considered the material of choice with low recurrence rates but carries the drawbacks of the difficulty of harvesting and postoperative morbidity from the second surgical site. Recent reports have suggested that maximal levator resection provides improved cosmesis, a more natural contour, and avoids brow scars. Although both treatments have shown to have similar success rates, there is much debate about what the most favorable method for treating severe unilateral ptosis. We review the literature on the various surgical treatments for unilateral severe congenital ptosis, including the rationale, advantages and disadvantages of each technique.
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Affiliation(s)
- Ju-Hyang Lee
- Department of Ophthalmology, Ulsan University Hospital, Ulsan University School of Medicine, Ulsan, Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hamama J, Khalfi L, Sabani H, El Khatib K. Frontalis suspension using autogenous temporal fascia by Fox technique. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:311-314. [PMID: 29499365 DOI: 10.1016/j.jormas.2018.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 02/05/2018] [Accepted: 02/21/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Severe ptosis of more than 4mm with poor levator function of less than 4mm is treated via the frontalis muscle suspension technique using autogenous temporal fascia. TECHNICAL NOTE The surgery was performed under general anaesthesia. The eyelid crease was incised and the tarsus exposed. An incision centered on the mid-pupillary level was then made just above the eyebrow with exposure of the frontalis muscle. The temporal fascia strip was sutured to the tarsus at three points. Every free end of the strip was then slid through the adjacent forehead subcutaneous tunnel to emerge together through the medial forehead incision. The eyelid crease was re-formed by suturing the skin with the graft. DISCUSSION Frontalis suspension using autologous material is a harmless procedure, which does not alter the upper eyelid structures. It is an effective procedure in the long-term.
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Affiliation(s)
- J Hamama
- Department of Oral and Facial Surgery, Mohammed V Teaching Armed Forces Hospital, BP, 10100 Rabat, Morocco; Faculty of Medicine and Pharmacy, University Mohammed V, Rabat 6203, Morocco.
| | - L Khalfi
- Department of Oral and Facial Surgery, Mohammed V Teaching Armed Forces Hospital, BP, 10100 Rabat, Morocco; Faculty of Medicine and Pharmacy, University Sidimohammed Ben Abdellah, Fes 1893, Morocco
| | - H Sabani
- Department of Oral and Facial Surgery, Mohammed V Teaching Armed Forces Hospital, BP, 10100 Rabat, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca 9167, Morocco
| | - K El Khatib
- Department of Oral and Facial Surgery, Mohammed V Teaching Armed Forces Hospital, BP, 10100 Rabat, Morocco; Faculty of Medicine and Pharmacy, University Mohammed V, Rabat 6203, Morocco
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Abstract
Congenital blepharoptosis, caused by levator muscle dysgenesis, presents at birth and may lead to disturbed visual development and function. Other causes of ptosis in pediatric patients can be myogenic, neurogenic, mechanical, or traumatic. Timely correction is, therefore, critical, and careful preoperative planning and intraoperative considerations are crucial to achieve optimal outcomes and minimize potential complications. The various surgical techniques, including the frontalis suspension or sling, levator resection and advancement, Müller's muscle conjunctival resection (the Putterman procedure), and modified Fasanella-Servat procedure are each associated with distinct indications, benefits, and drawbacks, necessitating a unique tailored approach to each surgical candidate.
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Affiliation(s)
- Kevin T Jubbal
- Department of Ophthalmology, Division of Oculoplastic and Reconstructive Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Katarzyna Kania
- Department of Ophthalmology, Division of Oculoplastic and Reconstructive Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Tara L Braun
- Department of Ophthalmology, Division of Oculoplastic and Reconstructive Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - William R Katowitz
- Department of Ophthalmology, Division of Oculoplastic and Reconstructive Surgery, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Douglas P Marx
- Department of Ophthalmology, Division of Oculoplastic and Reconstructive Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Analysis of the causes of recurrence after frontalis suspension using silicone rods for congenital ptosis. PLoS One 2017; 12:e0171769. [PMID: 28207846 PMCID: PMC5313185 DOI: 10.1371/journal.pone.0171769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/25/2017] [Indexed: 01/19/2023] Open
Abstract
Background Silicone rod is a commonly used synthetic suspension material in frontalis suspension surgery to correct blepharoptosis. The most challenging problem and a decisive drawback of the use of silicone rod is a considerable rate of ptosis recurrence after surgery. We examined patients with recurred ptosis and assessed the physical and micromorphological properties of implanted silicone rods to determine the causative mechanisms of recurred ptosis after frontalis suspension using silicone rod. Methods This is a prospective observational case series of 22 pediatric patients with recurred ptosis after frontalis suspension using silicone rods for congenital ptosis. Implanted silicone rods were observed and removed during the operation for correction of recurred ptosis. The removed silicone rods were physically and micromorphologically evaluated to determine the cause of recurrence. Results Pretarsal fixation positions migrated upward, whereas suprabrow fixation positions migrated downward during ptosis recurrence. The breaking strength of implanted silicone rods was reduced by approximately 50% during 3 years. Cracks, debris, and loss of homogenous structure with disintegration were observed on scanning electron micrographs of implanted silicone rods in patients with recurred ptosis. Preoperative severe degree of ptosis also contributed to recurred ptosis. Conclusions Recurrence of ptosis after frontalis suspension using silicone rod was associated with physical changes of implanted silicone rods, including positional migration, weakened tensile strength, and micromorphological changes in combination with patients’ characteristics.
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Pacella E, Mipatrini D, Pacella F, Amorelli G, Bottone A, Smaldone G, Turchetti P, La Torre G. Suspensory Materials for Surgery of Blepharoptosis: A Systematic Review of Observational Studies. PLoS One 2016; 11:e0160827. [PMID: 27631781 PMCID: PMC5025102 DOI: 10.1371/journal.pone.0160827] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 07/26/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Frontalis suspension surgery is considered the procedure of choice in cases of blepharoptosis. Among all the materials used in this type of surgery, ophthalmic and plastic surgeons prefer to use autologous Fascia Lata. However, during years, other autogenous and exogenous materials have been introduced. OBJECTIVES The aim of this study was therefore that of systematically reviewing the functional results and the rate of complications of different synthetic materials, as compared to autogenous Fascia Lata. The primary objective was to determine the rates of Successful Surgeries (SSs) of these materials. The secondary objective was to assess the onset of complications. The following materials were investigated: Fascia Lata, Mersilene, polytetrafluoroethylene (PTFE) and Silicon. DATA SOURCE AND METHODS Following the Prisma procedure, on January 30th, 2016 we used the following electronic databases to select the studies: MEDLINE and Scopus. RESULTS The search strategy retrieved 48 publications that met the eligibility criteria of the systematic review. All studies were non-comparative. PTFE (n = 5) showed the best rate of SSs among the materials compared (statistically significant). Surgeries performed with autogenous Fascia Lata (n = 19) had a 87% rate of success those performed with Mersilene (n = 12)had 92% and those performed with Silicon (n = 17)88%. PTFE had the best outcome, with 99% success rate. As for complications, surgeries performed with PTFE had a higher rate of suture infections (1.9%) as compared to Fascia Lata, but lower incidence for all other complications. CONCLUSIONS Although most studies were good quality cohort studies, the overall quality of this evidence should be regarded as low due to their non-comparative design. Our data suggest that PTFE seems to be the most valid alternative material for frontalis suspension surgery, with low recurrence rates and good cosmetic and functional results.
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Affiliation(s)
- Elena Pacella
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Daniele Mipatrini
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, Sapienza, University of Rome, Rome, Italy
| | - Fernanda Pacella
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
- * E-mail:
| | - Giulia Amorelli
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Andrea Bottone
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Gianpaolo Smaldone
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Paolo Turchetti
- National Institute for Health, Migration and Poverty (INMP/NIHMP), Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, Sapienza, University of Rome, Rome, Italy
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Lee JH, Aryasit O, Kim YD, Woo KI, Lee L, Johnson ON. Maximal levator resection in unilateral congenital ptosis with poor levator function. Br J Ophthalmol 2016; 101:740-746. [DOI: 10.1136/bjophthalmol-2016-309163] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/29/2016] [Accepted: 08/10/2016] [Indexed: 11/04/2022]
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17
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Mete A, Cagatay HH, Pamukcu C, Kimyon S, Saygılı O, Güngör K. Maximal Levator Muscle Resection for Primary Congenital Blepharoptosis with Poor Levator Function. Semin Ophthalmol 2015; 32:270-275. [DOI: 10.3109/08820538.2015.1068339] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alper Mete
- Department of Ophtalmology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Halil H. Cagatay
- Department of Ophthalmology, Kafkas University School of Medicine, Kars, Turkey
| | - Can Pamukcu
- Department of Ophthalmology, Hatem Hospital, Gaziantep, Turkey
| | - Sabit Kimyon
- Department of Ophtalmology, Şehitkamil State Hospital, Gaziantep, Turkey
| | - Oguzhan Saygılı
- Department of Ophtalmology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Kıvanç Güngör
- Department of Ophtalmology, Gaziantep University School of Medicine, Gaziantep, Turkey
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18
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Goel R, Jain S, Malik KPS, Nagpal S, AG A, Kumar S, Kishore D. Oculoplasty for general ophthalmologists. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1007129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Abstract
The management issues associated with pediatric ptosis begin with determining the etiology of the ptosis, and considering how the eyelid position affects the child's visual and psychosocial development. These ultimately determine if and when surgical management should be undertaken. Surgical challenges include the lack of intraoperative feedback regarding the dynamic eyelid height and contour under general anesthesia. When the eyelid elevators do not function or if there is little drive to lift the involved eyelid, obtaining good surgical outcomes can be extremely challenging. A plethora of surgical techniques and materials have been developed, each with their own benefits and drawbacks. Careful preoperative evaluation, planning and counseling can usually result in satisfactory surgical results with happy parents and patients. Families should always be aware that the child will need to be followed long term for visual development, ocular health, and they need to be counseled regarding the possibility of revision surgery.
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Affiliation(s)
- Ali Mokhtarzadeh
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, MMC 493, 420 Delaware St, SE, Minneapolis, MN, USA
| | - Andrew R Harrison
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, MMC 493, 420 Delaware St, SE, Minneapolis, MN, USA
- Department of Otolaryngology and Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
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Nucci P, Lembo A, Santangelo E, Fogagnolo P, Serafino M. Five-Year Follow-Up of a 30-Month Trial of Stability of Silicone Band Frontalis Suspension for the Treatment of Severe Unilateral Upper Eyelid Ptosis in Infants. Semin Ophthalmol 2014; 31:215-8. [PMID: 25068189 DOI: 10.3109/08820538.2014.936618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the five-year stability of frontalis suspension of the upper eyelid with a silicone band for the treatment of severe congenital ptosis in infants. METHODS Chart review of pediatric patients with a follow-up of five years after unilateral frontalis suspension with silicone band was reviewed. Margin-reflex distance (MRD) and corneal staining were measured at different follow-up visits. Data were analyzed by analysis of variance and t test for paired data. RESULTS Twenty pediatric patients were included in this retrospective study. MRD was severely reduced before surgery in all cases: it ranged from -1 mm to -4 mm (-2.4 ± 0.8 mm). After surgery, MRD increased to 2.9 ± 0.3 mm, and then progressively decreased by 0.6 mm within the first three months (p < 0.001); a further reduction of 0.2 mm, occurring between three and 12 months after surgery, was not statistically significant (p < 0.001). Between the 12-month and the five-year follow-up visits (one visit every six months), no changes in MRD were found for any patient. After the five-years visit, no substantial changes were recorded in 18 patients (90%); in two patients, a second surgery to improve the deterioration was necessary. Corneal staining, which was present in five patients (25%) during the first two postoperative weeks, disappeared over five years of follow-up. CONCLUSIONS During the five-year follow-up of this retrospective study, the frontalis suspension with a silicone band proved to be a stable procedure. After 30 months from the first observation, MRD values were stable, except for two patients that underwent a second surgery to stabilize the worsening ptosis.
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Affiliation(s)
- Paolo Nucci
- a University Eye Clinic San Giuseppe, San Giuseppe Hospital, University of Milan , Milan , Italy , and
| | - Andrea Lembo
- a University Eye Clinic San Giuseppe, San Giuseppe Hospital, University of Milan , Milan , Italy , and
| | - Elisabetta Santangelo
- a University Eye Clinic San Giuseppe, San Giuseppe Hospital, University of Milan , Milan , Italy , and
| | - Paolo Fogagnolo
- b Department of Medicine , Surgery and Odontology, Eye Clinic, Ospedale San Paolo, University of Milan , Milan , Italy
| | - Massimiliano Serafino
- a University Eye Clinic San Giuseppe, San Giuseppe Hospital, University of Milan , Milan , Italy , and
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Ibrahim HA, Sabry HN. The use of Whitnall's ligament for sling redirection in frontalis suspension ptosis surgery. Ophthalmic Plast Reconstr Surg 2014; 31:53-7. [PMID: 24896775 DOI: 10.1097/iop.0000000000000177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the cosmetic and functional outcome of a modified frontalis suspension technique when the sling force vector is redirected through Whitnall's ligament. METHODS Non-comparative retrospective study. Twenty-nine eyes of 23 patients with poor levator function of 4 mm or less. Patients underwent frontalis suspension with polytetrafluoroethylene (Gore-Tex) (PTFE). The sling was inserted in a single circular fashion through 3 brow incisions. An additional eyelid crease incision was created to allow the passage of the sling beneath Whitnalls' ligament, to permit securing the sling to the tarsus, to perform a limited blepharoplasty, and to reform the eyelid crease. Postoperatively, patients were followed up for at least 24 months. RESULTS All cases achieved elevation of the ptotic eyelid in the primary position. Three eyes of 2 patients had under correction in the primary gaze. Twenty-eight of 29 eyes retained the same level of eyelid elevation after 2 years of follow up. Symmetry in the primary gaze was achieved in 4 of 6 (67%) patients with bilateral ptosis and in 12 of 17 (71%) patients with unilateral ptosis. One patient had sling infection with granuloma formation. Lagophthalmos was common, but none developed exposure keratitis. CONCLUSIONS Frontalis suspention technique modified with redirecting the sling pulling force vector by passing beneath Whitnall's ligament can achieve a natural-looking eyelid in primary gaze and does not interfere with functional outcome.
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Zhou M, Jin R, Li Q, Duan Y, Huang L, Yu D. Frontalis muscle flap advancement for correction of severe ptosis under general anesthesia: modified surgical design with 162 cases in China. Aesthetic Plast Surg 2014; 38:503-9. [PMID: 24610114 DOI: 10.1007/s00266-014-0297-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 02/21/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Congenital blepharoptosis is a common pediatric disease. Frontalis muscle flap advancement is an effective surgical technique to treat patients with severe ptosis and poor levator function. However, since eye position changes under general anesthesia, it is necessary to adjust the position of the upper eyelid to achieve a better surgical outcome. METHODS A total of 162 children with severe congenital blepharoptosis underwent frontalis muscle flap advancement under general anesthesia. Patients were divided into two groups according to the different positions of eyelid suspension. The eyelid position of 82 children (96 eyes) in group A was adjusted to set at the superior limbus under general anesthesia, while the eyelid level of 80 children (94 eyes) in group B was adjusted according to the level labeled before anesthesia or the orthophoria level predicted using Krimsky's test. Lid level, ptosis recurrence, cosmetic appearance, and complications were evaluated 12 months after surgery. RESULTS Excellent functional and cosmetic results were achieved in 61 (63.5 %) children from group A and 85 (90.4 %) from group B. Fewer complications were observed in group B (36.5 vs. 9.6 %). CONCLUSION To achieve better surgical results after frontalis flap advancement for severe ptosis, it is necessary to adjust the eyelid level according to eye position changes that occur when the patient is under general anesthesia. 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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