1
|
McCoskey M, Yoon MK. Traumatic Ptosis. Int Ophthalmol Clin 2024; 64:1-9. [PMID: 38525978 DOI: 10.1097/iio.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
|
2
|
Hankinson J, Shuaib A. Surgical management of oculomotor nerve palsy - a review of the literature. Eur J Ophthalmol 2024:11206721241229758. [PMID: 38303488 DOI: 10.1177/11206721241229758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
We aim to review the surgical management techniques available for patients with oculomotor nerve (OMN) palsy, compare and contrast the approaches and subsequent outcomes. A search of the literature was carried out to yield all papers relevant to the topic, and a wide spectrum of surgical techniques were identified. These included: muscle shortening and lengthening procedures, muscle transposition, globe fixation and ptosis surgery. Patients often require a synergistic combination of these techniques. Strabismus surgery for OMN palsy can be approached through a variety of different techniques to improve the quality of life, independence and aesthetics for the patient.
Collapse
Affiliation(s)
- Jake Hankinson
- Barts and The London School of Medicine and Dentistry, London, UK
| | | |
Collapse
|
3
|
Abstract
Drooping of the upper eyelid margin, aka blepharoptosis or "ptosis", is common. Whether the ptosis is severe or mild, congenital or acquired, aponeurotic or neuropathic or myopathic, proper management always begins with a detailed history and evaluation of the patient. The information gathered will direct the surgeon in choosing the technique most likely to give the best result. This article will briefly review common causes of ptosis, the evaluation of the ptosis patient as well as the two most common types of surgical intervention.
Collapse
Affiliation(s)
- Ron Pelton
- Surgery, Penrose-St Francis Health Services, Colorado Springs, United States
| |
Collapse
|
4
|
Hung JY, Chen KW, Perera C, Chiu HK, Hsu CR, Myung D, Luo AC, Fuh CS, Liao SL, Kossler AL. An Outperforming Artificial Intelligence Model to Identify Referable Blepharoptosis for General Practitioners. J Pers Med 2022; 12:jpm12020283. [PMID: 35207771 PMCID: PMC8877622 DOI: 10.3390/jpm12020283] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 02/05/2023] Open
Abstract
The aim of this study is to develop an AI model that accurately identifies referable blepharoptosis automatically and to compare the AI model’s performance to a group of non-ophthalmic physicians. In total, 1000 retrospective single-eye images from tertiary oculoplastic clinics were labeled by three oculoplastic surgeons as having either ptosis, including true and pseudoptosis, or a healthy eyelid. A convolutional neural network (CNN) was trained for binary classification. The same dataset was used in testing three non-ophthalmic physicians. The CNN model achieved a sensitivity of 92% and a specificity of 88%, compared with the non-ophthalmic physician group, which achieved a mean sensitivity of 72% and a mean specificity of 82.67%. The AI model showed better performance than the non-ophthalmic physician group in identifying referable blepharoptosis, including true and pseudoptosis, correctly. Therefore, artificial intelligence-aided tools have the potential to assist in the diagnosis and referral of blepharoptosis for general practitioners.
Collapse
Affiliation(s)
- Ju-Yi Hung
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan;
| | - Ke-Wei Chen
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City 70101, Taiwan
| | - Chandrashan Perera
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
| | - Hsu-Kuang Chiu
- Computer Science, Stanford University, Stanford, CA 94305, USA;
| | - Cherng-Ru Hsu
- Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - David Myung
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
| | - An-Chun Luo
- Department of Electronic and Optoelectronic System Research Laboratories, Industrial Technology Research Institute, Hsinchu 31040, Taiwan;
| | - Chiou-Shann Fuh
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan;
| | - Shu-Lang Liao
- Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan
- College of Medicine, National Taiwan University, Taipei 10617, Taiwan
- Correspondence: (S.-L.L.); (A.L.K.)
| | - Andrea Lora Kossler
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
- Correspondence: (S.-L.L.); (A.L.K.)
| |
Collapse
|
5
|
Choi YM, Kim N. Frontalis Sling Using a Silicone Rod for Ptosis in Third Nerve Palsy: Cosmesis Versus Safety. KOREAN JOURNAL OF OPHTHALMOLOGY 2022; 36:159-167. [PMID: 35067023 PMCID: PMC9013560 DOI: 10.3341/kjo.2021.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/13/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose To evaluate the results of the frontalis sling operation using a silicone rod for the correction of ptosis in patients with third nerve palsy with a focus on corneal safety. Methods Patients with third nerve palsy who underwent the frontalis sling operation using a silicone rod between 2008 and 2019 were included in this study. The medical records of all patients were reviewed, and their clinical characteristics and postoperative outcomes were analyzed. In this retrospective, interventional case series, the main outcome measures were eyelid contour, eyelid height by margin reflex distance, and corneal status. Results Twenty-four eyes of 18 patients (12 male and six female patients) were included. The mean age at the time of surgery was 35.1 years (range, 5–64 years). Twelve patients underwent a unilateral ptosis operation, and six patients received a bilateral ptosis operation. The mean follow-up period was 32.1 months (range, 2–87 months). Most patients (21 of 24 eyes, 88%) showed poor Bell’s phenomenon on preoperative examination. Satisfactory eyelid height and eyelid contour were achieved in almost all patients (mean postoperative margin reflex distance, +1.2 mm) postoperatively. Although corneal erosions were detected for several months in eight of 24 eyes after surgery, these findings were well controlled medically with artificial tear eye drops and ointments. Conclusions Frontalis sling surgery using a silicone rod can safely and effectively correct ptosis without severe corneal complications in patients with third nerve palsy. Our study outlines a new method to define the postoperative safety outcome by specifically focusing on categorized corneal status.
Collapse
Affiliation(s)
- Yong Min Choi
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
6
|
Wu P, Ma J, Zhang T, Ma D. Advances in the genetics of congenital ptosis. Ophthalmic Res 2021; 65:131-139. [PMID: 34969027 DOI: 10.1159/000521575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/09/2021] [Indexed: 11/19/2022]
Abstract
Congenital ptosis, a birth defects presents at birth or by 1 year of age, is characterized by the drooping of the upper eyelid. either in isolation (non-syndromic) or with many different systemic disorders (syndromic). The estimated prevalence of ptosis (congenital & acquired) ranges from 0.79 to 1.99 per 10,000 people in different populations, and it is more prevalent in males. The underlying pathogenesis of congenital ptosis are myogenic and neurogenic, related to the development of muscles and nerves. Although most cases are sporadic, there are familial transmission characteristics, including autosomal dominant, recessive mode and X-linkage inheritance patterns. Moreover, some forms are due to chromosomal aberrations and mutations and deletions in mitochondrial DNA. Genes involved in simple congenital ptosis are ZFHX4 and COL25A1. The clinical aspects of various syndromes involving congenital ptosis are partly caused by single gene mutations. However, the pathogenesis of congenital ptosis is not fully understood. We review the reported epidemiology, genetics and clinical features of congenital ptosis and associated syndromes here.
Collapse
Affiliation(s)
- Peixuan Wu
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China,
| | - Jing Ma
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Tianyu Zhang
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Duan Ma
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
- Research Center for Birth Defects, Children's Hospital, Fudan University, Shanghai, China
| |
Collapse
|
7
|
Medel Jiménez R, Sánchez España JC, Visa Nassarre J, Ayala Barroso E, Pueyo Ferrer A, Tapia Bahamondes A, Vasquez LM. Transcaruncular rectus tendon fixation to the orbit and frontalis flap for complete third nerve palsy. Orbit 2018. [PMID: 29543543 DOI: 10.1080/01676830.2018.1449224] [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: 10/17/2022]
Abstract
PURPOSE To describe our experience and outcomes managing complete third cranial nerve palsy. METHODS This was a retrospective analysis of the clinical records of 7 consecutive patients treated at our centre for unilateral third nerve palsy over the period 2010-2016. We describe our surgical approach using a frontalis muscle flap to correct the eyelid ptosis associated with medial fixation of the rectus muscle tendon to the orbit to correct the horizontal deviation. RESULTS The seven patients, four women and three men, were of mean age of 44 ± 19 years [18-75 years]. Follow up was 29 ± 31 months [5-82 months]. In the preoperative exam, exotropia in prism diopters (PD) was -70 ± -28 PD [-30 to -90 PD]. At the end of follow up, this was reduced to -11 ± -14 PD [0 to -30 PD]. Preoperative marginal reflex distance 1 (MRD1) was -4 ± 1 mm [-3 to -5 mm] and palpebral fissure height (PFH) was 0.5 ± 1 mm [0-2 mm]. Surgical undercorrection was the target in all patients due to the absent or poor Bell's phenomenon. At the end of follow up, MRD1 was 2.5 ± 0.5 mm [2-3 mm] and PFH was 7 ± 1 mm [6-8 mm]. Cosmetic and functional results were good in all patients. CONCLUSIONS Medial fixation of the rectus muscle tendon to the orbit associated with a frontalis muscle flap is a valid option for the treatment of exotropia and ptosis in patients with third cranial nerve palsy.
Collapse
Affiliation(s)
- Ramón Medel Jiménez
- a Oculoplastic Department, Instituto de Microcirugía Ocular (IMO) , Barcelona , Spain
| | - Juan C Sánchez España
- a Oculoplastic Department, Instituto de Microcirugía Ocular (IMO) , Barcelona , Spain
| | - José Visa Nassarre
- b Department of Strabismus , Instituto de Microcirugía Ocular (IMO) , Barcelona , Spain
| | - Eva Ayala Barroso
- a Oculoplastic Department, Instituto de Microcirugía Ocular (IMO) , Barcelona , Spain
| | - Alfredo Pueyo Ferrer
- c Oculoplastic Department , Hospital Universitario Valle De Hebrón , Barcelona , Spain
| | | | - Luz M Vasquez
- a Oculoplastic Department, Instituto de Microcirugía Ocular (IMO) , Barcelona , Spain
| |
Collapse
|
8
|
Jacobs SM, Tyring AJ, Amadi AJ. Traumatic Ptosis: Evaluation of Etiology, Management and Prognosis. J Ophthalmic Vis Res 2018; 13:447-452. [PMID: 30479715 PMCID: PMC6210876 DOI: 10.4103/jovr.jovr_148_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: To investigate whether a systematic approach to subgrouping traumatic ptosis according to etiology can allow for better tailoring of prognosis and treatment. Methods: Retrospective chart review of patients with trauma-related blepharoptosis managed by Oculoplastic surgery specialists at an academic medical center from January 1995 to November 2015. Injury mechanism, eyelid position and function, interventions, and outcomes were reviewed. Results: Of 648 patients treated for blepharoptosis, 55 (8.5%) were traumatic. Careful review revealed 4 subcategories of traumatic ptosis cases: aponeurotic (n = 16), myogenic (n = 18), neurogenic (n = 7), and mechanical (n = 14). Margin reflex distance (MRD1) at presentation was significantly worse for the myogenic subtype (-0.59 mm, SD ±2.09, P = 0.046). The aponeurotic subtype had the best average levator function at presentation (14.29 mm, SD ±2.05), while myogenic had the worst (8.41 mm, SD ±4.94) (P = 0.004). Thirty-five (63.6%) patients were managed surgically. Final MRD1 was significantly different for each subtype (P = 0.163), with aponeurotic 2.63 mm (SD ±1.01), myogenic 1.29 mm (SD ±2.24), neurogenic 1.79 mm (SD ±2.48), and mechanical 2.31 mm (SD ±1.18). There was a significant increase in MRD1 from presentation to final follow up across all groups (P < 0.05). Conclusion: Traumatic ptosis is heterogenous. Systematically evaluating traumatic ptosis cases by trauma mechanism can guide decisions about prognosis and management. Two-thirds of cases were treated surgically, with most patients responding well to conjunctiva-Müller resection or external levator advancement. While all subgroups demonstrated improvement in MRD1 at final follow up, aponeurotic cases had the best prognosis, while myogenic fared the worst and required the longest for maximal recovery.
Collapse
Affiliation(s)
- Sarah Mireles Jacobs
- Department of Ophthalmology, University of Alabama Birmingham, Birmingham, Alabama, USA.,Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Ariel J Tyring
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Arash J Amadi
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA.,Seattle Face and Skin, Seattle, Washington, USA
| |
Collapse
|
9
|
Ho YF, Wu SY, Tsai YJ. Factors Associated With Surgical Outcomes in Congenital Ptosis: A 10-Year Study of 319 Cases. Am J Ophthalmol 2017; 175:173-182. [PMID: 28040525 DOI: 10.1016/j.ajo.2016.12.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the 10-year results of surgery for congenital ptosis and identify factors associated with excellent outcomes and recurrence. DESIGN Retrospective, interventional case series. METHODS A retrospective analysis was conducted of 319 patients who underwent surgical correction at a tertiary medical center for congenital ptosis. The main outcome measures were postoperative surgical outcomes and recurrence rates. Excellent lid height was assessed as a marginal reflex distance (MRD) greater than 3 mm. Recurrence was defined as a lid height less than 50% of the initial postoperative lid height. RESULTS The overall surgical success rate was 97.2%. On multivariate analysis, 3 factors were significantly associated with a greater probability of achieving excellent lid height: treatment using levator muscle resection (LMR) (adjusted odds ratio [OR], 1.76; P = .04), better preoperative MRD (adjusted OR, 2.21; P < .001), and absence of Marcus Gunn (jaw-winking) syndrome (adjusted OR, 0.12; P = .01). For recurrence, 7 significant risk factors were identified: children less than 1 year old (adjusted OR, 4.92; P = .02), poorer preoperative MRD (adjusted OR, 0.64; P = .04), poorer postoperative MRD (adjusted OR, 0.32; P < .001), treatment with frontalis suspension (FS) (adjusted OR, 5.86; P < .001), wound infection (adjusted OR, 9.45; P = .02), postoperative entropion (adjusted OR, 11.25; P = .003), and conjunctival prolapse (adjusted OR, 7.10; P = .03). Kaplan-Meier analysis showed that the 1-, 5-, and 10-year recurrence-free rates were 97.3% ± 1.2%, 80.5% ± 4.4%, and 76.7% ± 5.6%, respectively, for the LMR group and 90.9% ± 3.1%, 42.9% ± 8.1%, and 20.8% ± 10.1%, respectively, for the FS group (P < .001, log-rank test). CONCLUSIONS Surgical treatment of congenital ptosis had a high success rate. Identifying the risk factors and taking appropriate measures may result in better surgical outcomes and less recurrence. Our retrospective study showed that the likelihood of achieving excellent outcomes with lower recurrence rates was higher with LMR than with FS. However, a prospective randomized study is necessary to clarify their efficacy.
Collapse
|
10
|
Abstract
Blepharoptosis or drooping of upper eye lid is a common, but non-specific sign of neurological diseases which sometimes could herald a life-threatening disorder. First, the diagnosis of ptosis should be established by considering four clinical measurements: palpebral fissure height, marginal reflex distance, upper eyelid crease, and levator function test. The diagnostic categories of ptosis are scheduled as pseudo-ptosis, congenital, and acquired ptosis. Acquired causes include mechanical, myogenic, neuromuscular, neurogenic, and cerebral. Each category with diseases presenting with ptosis was described in detail. Considering some features, such as involvement of other cranial nerves, extraocular muscle, pupil size and reactivity, and unilateral or bilateral presentation of ptosis, could help to narrow the differential diagnosis.
Collapse
|
11
|
Superior Oblique Anterior Transposition with Horizontal Recti Recession-Resection for Total Third-Nerve Palsy. J Ophthalmol 2015; 2015:780139. [PMID: 26640703 PMCID: PMC4658404 DOI: 10.1155/2015/780139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 11/19/2022] Open
Abstract
Aims. To report the results of lateral rectus muscle recession, medial rectus muscle resection, and superior oblique muscle transposition in the restoration and maintenance of ocular alignment in primary position for patients with total third-nerve palsy. Methods. The medical records of patients who underwent surgery between March 2007 and September 2011 for total third-nerve palsy were reviewed. All patients underwent a preoperative assessment, including a detailed ophthalmologic examination. Results. A total of 6 patients (age range, 14–45 years) were included. The median preoperative horizontal deviation was 67.5 Prism Diopter (PD) (interquartile range [IQR] 57.5–70) and vertical deviation was 13.5 PD (IQR 10–20). The median postoperative horizontal residual exodeviation was 8.0 PD (IQR 1–16), and the vertical deviation was 0 PD (IQR 0–4). The median correction of hypotropia following superior oblique transposition was 13.5 ± 2.9 PD (range, 10–16). All cases were vertically aligned within 5 PD. Four of the six cases were aligned within 10 PD of the horizontal deviation. Adduction and head posture were improved in all patients. All patients gained new area of binocular single vision in the primary position after the operation. Conclusion. Lateral rectus recession, medial rectus resection, and superior oblique transposition may be used to achieve satisfactory cosmetic and functional results in total third-nerve palsy.
Collapse
|