1
|
Kim H, Jung J, Choi SW, Yun CW, Lee W. Eyebrow lifting using multidirectional absorbable thread. J Cosmet Dermatol 2023; 22:2780-2784. [PMID: 37060183 DOI: 10.1111/jocd.15771] [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: 02/13/2023] [Revised: 03/16/2023] [Accepted: 03/29/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Thread lifting is a common procedure in minimally invasive esthetic techniques and can also be used to raise the drooping soft tissue of the forehead by vertically inserting threads into the forehead. AIMS This study aimed to examine the effect of forehead thread lifting on enhancing upper eyelid opening. METHODS Fifteen patients were included in this study, all of whom underwent eyebrow thread lifting with MINT LIFT® UP. Photographs of the patients were taken before, immediately after, and 1 and 12 weeks after surgery. Changes in the position of the eyebrows and eyelids were measured. The paired t-test was used to determine the statistical significance of differences. RESULTS At 1 week after surgery, the eyebrows were at a lower level compared with before surgery, and no significant changes in eye-opening were observed. However, at 12 weeks after surgery, the eyebrows and upper eyelids were both significantly elevated when compared to the preoperative state. CONCLUSIONS Eyebrow lifting can be performed using multidirectional thread lifting.
Collapse
Affiliation(s)
| | - Jinwoo Jung
- View Plastic Surgery, Seoul, Republic of Korea
| | | | | | - Won Lee
- Yonsei E1 Plastic Surgery Clinic, Anyang, Republic of Korea
| |
Collapse
|
2
|
Eshraghi B, Pourazizi M, Taghian A, Chaibakhsh S, Aghajani A. The Prevalence of Undiagnosed Ptosis Among Candidates for Upper Eyelid Blepharoplasty. Aesthet Surg J Open Forum 2023; 5:ojad079. [PMID: 37694225 PMCID: PMC10489084 DOI: 10.1093/asjof/ojad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Background Because upper eyelid blepharoplasty has become a popular aesthetic facial surgery, surgeons should be aware that age-related changes in the eyelid are not confined to skin laxity and orbital fat prolapse. Objectives This study was designed to assess the prevalence of undiagnosed ptosis among blepharoplasty candidates as one of the causes of unsatisfactory surgical results. Methods From December 2018 to December 2022, blepharoplasty candidates were meticulously assessed for their upper eyelid and eyebrow position. Patients who were aware of their ptosis were excluded, and the other patients were classified as mild, moderate, or severe ptotic based on margin reflex distance 1. The eyebrow height was also assessed in the mid-pupillary line to assess the relationship between the severity of ptosis and eyebrow asymmetry. Results The authors found that 13.7% of the 2530 blepharoplasty candidates in this study had undiagnosed ptosis. Most of these patients had mild ptosis (85.5%), and they were significantly older than nonptotic patients. The rate of prevalence of ptosis was significantly higher in patients with eyebrow asymmetry (75.3% vs 3.7%); however, the severity of ptosis was not associated with the severity of eyebrow asymmetry. Conclusions Ptosis should be cautiously looked for and addressed for treatment in candidates for upper blepharoplasty. In most patients with masked ptosis, the severity of eyelid drooping is mild and could remain undiagnosed until after the surgery and cause unsatisfactory aesthetic results. The presence of eyebrow asymmetry could be a key feature to unmask an undiagnosed ptosis. Level of Evidence 3
Collapse
Affiliation(s)
| | | | | | | | - Ali Aghajani
- Corresponding Author: Dr Ali Aghajani, Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| |
Collapse
|
3
|
Custer PL, Maamari RN, Huecker JB, Gordon MO. Eyebrow Position Before and After Enucleation. Ophthalmic Plast Reconstr Surg 2022; 38:438-443. [DOI: 10.1097/iop.0000000000002145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
4
|
Quaranta-Leoni FM, Fiorino MG, Quaranta-Leoni F, Di Marino M. Anophthalmic Socket Syndrome: Prevalence, Impact and Management Strategies. Clin Ophthalmol 2021; 15:3267-3281. [PMID: 34393477 PMCID: PMC8354770 DOI: 10.2147/opth.s325652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Anophthalmic socket syndrome determines functional deficits and facial deformities, and may lead to poor psychological outcomes. This review aims to comprehensively evaluate the features of the syndrome, based on literature review and authors’ clinical and surgical experience. An electronic database (PubMed,MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on anophthalmic socket syndrome was performed. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Different types of orbital implants were evaluated; the management of implant exposure was examined; different orbital volume enhancement procedures such as secondary implantation, subperiosteal implants and the use of fillers in anophthalmic patients were described; the problems related to socket contraction were outlined; the treatment options for chronic anophthalmic socket pain and phantom eye syndrome were assessed; the most recent advances in the management of congenital anophthalmia were described. Current clinical evidence does not support a specific orbital implant; late exposure of porous implants may be due to pegging, which currently is seldom used; filler absorption in the orbit appears to be faster than in the dermis, and repeated treatments could be a potential source of inflammation; socket contraction results in significant functional and psychological disability, and management is challenging. Patients affected by anophthalmic socket pain and phantom eye syndrome need specific counseling. It is auspicable to use a standardized protocol to treat children affected by clinical congenital anophthalmia; dermis fat graft is a suitable option in these patients as it helps continued socket expansion. Dermis fat graft can also address the volume deficit in case of explantation of exposed implants and in contracted sockets in both children and adults. Appropriate clinical care is essential, as adequate prosthesis wearing improves the quality of life of anophthalmic patients.
Collapse
Affiliation(s)
- Francesco M Quaranta-Leoni
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy.,Oftalmoplastica Roma, Rome, 00197, Italy
| | - Maria Grazia Fiorino
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy
| | | | - Matteo Di Marino
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy
| |
Collapse
|
5
|
Wong MB, Maamari RN, Couch SM. Contralateral eyelid elevation following unilateral upper eyelid retraction repair. Orbit 2021; 41:452-456. [PMID: 34030599 DOI: 10.1080/01676830.2021.1931352] [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: 10/21/2022]
Abstract
Purpose: To report the influence of unilateral upper eyelid retraction repair on the upper eyelid position of the contralateral, non-operative side.Methods: An IRB-approved retrospective chart review was performed to identify patients who underwent unilateral upper eyelid retraction repair. Patient demographics, etiology of upper eyelid retraction, previous surgeries, and periocular measurements from pre-operative and follow-up visits were reviewed.Results: Thirteen patients who underwent unilateral upper eyelid retraction repair due to thyroid eye disease or iatrogenic retraction secondary to ptosis repair demonstrated an elevation in contralateral eyelid height post-operatively. The mean pre-operative MRD-1 was 6.6 mm in the operative eye and 2.6 mm in the contralateral eye. All patients demonstrated a decreased MRD-1 in the operative eye (mean change: -2.6 mm [-38.4%]; standard deviation [SD]: 1.2 mm) and an increased MRD-1 in the contralateral eye (mean change: +1.3 mm [+62.4%]; SD: 0.6 mm) following unilateral upper eyelid retraction repair. The mean post-operative MRD-1 measurements were 4.0 mm ± 0.5 mm and 3.9 mm ± 0.6 mm in the operative and contralateral eyes, respectively.Conclusions: Unilateral upper eyelid retraction repair may induce an elevation of the contralateral upper eyelid position in some patients. The findings in this report may support unilateral intervention in patients with upper lid retraction, especially in the setting of contralateral blepharoptosis.
Collapse
Affiliation(s)
- Michael B Wong
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Robi N Maamari
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Steven M Couch
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
6
|
Ophthalmic Surgeries and Systemic Medical Conditions Associated With the Development of Involutional Ptosis. Ophthalmic Plast Reconstr Surg 2021; 37:133-137. [PMID: 32427726 DOI: 10.1097/iop.0000000000001707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the associations between systemic medical conditions and types of ocular surgery and the development of aponeurotic ptosis. METHODS In this case-control observational cohort study, the relative prevalence of involutional ptosis in a large population of adult patients was assessed. Deidentified patient data from a 10-year time period was obtained from the electronic medical records of 5 large academic medical centers. Patients were selected based on ICD9 and ICD10 codes for involutional ptosis. Control patients were age and gender matched and randomly selected from a general adult population. Systemic comorbidities were determined based on ICD9 and ICD10 codes, and prior ocular surgeries based on CPT codes. The influence of systemic comorbidities and ocular surgery was examined utilizing logistic regression analysis. RESULTS The study cohort consisted of 8297 adult patients with involutional blepharoptosis and 13,128 matched controls. The average age was 65 years. The 3 significant risk factors for developing ptosis were ocular surgery, hyperthyroidism, and type II diabetes with odds ratios of 4.2, 2.5, and 1.45, respectively (p < 0.05). Strabismus, cornea, and glaucoma surgeries were more highly associated with developing ptosis (p < 0.05). Strabismus surgery had the greatest odds ratio of 3.37, followed by cornea surgery at 2.31, and glaucoma surgery at 1.56. CONCLUSIONS Involutional ptosis is likely a multifactorial process. This study demonstrates that risk factors for the development of ptosis include ocular surgery, specifically strabismus, cornea, and glaucoma surgery, as well as hyperthyroidism and type II diabetes.
Collapse
|
7
|
North VS, Tran AQ, Lisman RD. Commentary on: Current Upper Blepharoplasty and Ptosis Management Practice Patterns Among The Aesthetic Society Members. Aesthet Surg J 2021; 41:NP210-NP213. [PMID: 33615331 DOI: 10.1093/asj/sjab096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Victoria S North
- Division of Ophthalmic Plastic Surgery, Manhattan Eye, Ear and Throat Hospital/Northwell Health, New York, NY, USA
| | - Ann Q Tran
- Division of Ophthalmic Plastic Surgery, Manhattan Eye, Ear and Throat Hospital/Northwell Health, New York, NY, USA
| | - Richard D Lisman
- Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
8
|
Histologic Evaluation of Nonvisual Afferent Sensory Upper Eyelid Proprioception. Ophthalmic Plast Reconstr Surg 2021; 36:7-12. [PMID: 31743289 DOI: 10.1097/iop.0000000000001424] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Recent research has suggested a possible role for proprioception in ipsilateral frontalis activation in the setting of ptosis; however, there has not been any robust histologic or anatomic evidence to support this theory. To further elucidate proprioceptive structures in the eyelid, this investigation uses validated histologic techniques to explore the presence of proprioceptive structures or afferent neural networks in the Levator Palpebrae Superioris (LPS) and Müller muscle. METHODS Müller muscle and LPS samples were evaluated by a laboratory with extensive experience with the histology of extraocular muscle proprioception. Immunofluorescence and confocal laser scanning microscopy were used to analyze the tissue samples. RESULTS Thirty-four Müller muscle samples and 10 LPS samples were analyzed. Golgi tendon bodies and muscle spindles were not identified in the Müller muscle and LPS samples. This result is expected in the Müller muscle given that these structures are not typically present in smooth muscle, but noteworthy in the skeletal muscle of the LPS. Previously undescribed synaptophysin-positive free nerve terminals within the intermuscular connective tissue of the Müller muscle were identified. CONCLUSIONS The nerve terminals identified are anatomically consistent with free nerve endings present in the extraocular muscles that have been implicated in proprioception. These findings advance our current knowledge of the ultrastructure of Müller muscle and the LPS and suggest a possible mechanism for proprioception in the upper eyelid that may have a role in ipsilateral brow elevation in the setting of ptosis.The authors describe proprioception in the upper eyelid: A histologic analysis.
Collapse
|
9
|
Cohen LM, Rootman DB. Blepharoptosis Repair: External Versus Posterior Approach Surgery: Why I Select One over the Other. Facial Plast Surg Clin North Am 2021; 29:195-208. [PMID: 33906756 DOI: 10.1016/j.fsc.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ptosis surgery is performed via an anterior/external or posterior/internal approach, primarily defined by the eyelid elevator muscle surgically addressed: the levator complex anteriorly or Muller muscle posteriorly. Posterior ptosis surgery via Muller muscle conjunctival resection is an excellent first choice for cases of mild to moderate ptosis with good levator function, as it is predictable, provides a reliable cosmetic outcome, requires no patient cooperation during surgery, portends a lower rate of reoperation, and rarely leads to lagophthalmos and/or eyelid retraction postoperatively. External levator resection is preferred in patients with severe ocular surface/cicatricial conjunctival disease, shortened fornices, and lesser levator function.
Collapse
Affiliation(s)
- Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California Los Angeles, Los Angeles, 300 Stein Plaza, Los Angeles, CA 90095, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California Los Angeles, Los Angeles, 300 Stein Plaza, Los Angeles, CA 90095, USA.
| |
Collapse
|
10
|
Leshno A, Smadar L, Kapelushnik N, Serlin T, Prat D, Priel A, Ben Simon GJ, Sagiv O. New insight into the physiologic function of Müller's muscle. Exp Eye Res 2020; 202:108336. [PMID: 33130032 DOI: 10.1016/j.exer.2020.108336] [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: 07/22/2020] [Revised: 10/06/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Müller's muscle is a sympathetically innervated smooth muscle which serves as an accessory upper eyelid retractor. Its physiologic function and purpose have not yet been clearly defined. We hypothesize that sympathetic innervation to Müller's muscle serves to adjust the upper eyelid's position to variations in pupil size in response to changes in light intensity. METHODS This is a single center cross-sectional study. Healthy volunteers were asked to fixate on a distant non-accommodative target, and a video scan of the anterior segment was performed for each subject's right eye using the Heidelberg Spectralis® optical coherence tomography scanner in infrared mode. The video was taken both in photopic and scotopic conditions, recording the resultant transition of the pupil and eyelids. The pupil diameter (PD), upper eyelid margin-to-reflex distance (MRD1), lower eyelid margin-to-reflex distance (MRD2), and vertical palpebral fissure height (PFH) were measured. RESULTS Thirty-three healthy volunteers (19 women, 57.6%) with a median age of 40 years (range 30-58) were included. The mean PD under photopic conditions increased significantly under scotopic conditions, from 3483 ± 521 μm to 6135 ± 703 μm, respectively (P < 0.0001). An increase in MRD1 was observed following transition from light to dark, with a mean change of 348 ± 311 μm (P < 0.0001). There was no significant change in MRD2. CONCLUSIONS Upper eyelid retraction occurs after transition from photopic to scotopic conditions. This movement suggests the existence of an "eyelid-light reflex" involving Müller's muscle that adjusts the position of the eyelids as the pupil dilates under scotopic conditions.
Collapse
Affiliation(s)
- Ari Leshno
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lital Smadar
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Kapelushnik
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Serlin
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Prat
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Priel
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy J Ben Simon
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Sagiv
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
11
|
Hering's Law of the Frontal Facial Branch. Plast Reconstr Surg 2019; 144:519e. [PMID: 31461063 DOI: 10.1097/prs.0000000000005973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Frontalis Muscle Contraction and the Role of Visual Deprivation and Eyelid Proprioception. Ophthalmic Plast Reconstr Surg 2019; 34:552-556. [PMID: 29547467 DOI: 10.1097/iop.0000000000001096] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine if frontalis muscle contraction can be induced by manipulating visual and eyelid proprioceptive inputs through simulating visual deprivation and ptosis. METHODS Volunteers without prior eyelid or forehead pathologic study were recruited for this nonrandomized, prospective study. Baseline and study phase brow positions were documented. The first phase was to simulate visual deprivation and the second to simulate ptosis. The dominant eye was used for each phase. As a proxy to simulate visual field deprivation, a black contact lens was placed on the eye, which reduced vision to light perception. As a proxy to simulate ptosis, an external eyelid weight was placed on the upper eyelid. Brow position ratios were calculated at various points along the brow and statistical analysis was performed. RESULTS Fifteen subjects participated. The average brow position ratio was 1.00 ± 0.08 for the visual deprivation group, which was not different from baseline (p = 0.86). The average brow position ratio for the external eyelid weight group was 1.13 ± 0.07, which was statistically significant compared with baseline and the visual deprivation group (p < 0.001). CONCLUSIONS Inducing visual deprivation with a black contact lens does not lead to a change in brow position. However, placing an external eyelid weight does lead brow elevation, with an average increase of 13% from baseline. This suggests a likely role for proprioceptive or sensory inputs in frontalis muscle contraction in the setting of eyelid ptosis.
Collapse
|
13
|
The Relationship Between Eyebrow and Eyelid Position in Patients With Ptosis, Dermatochalasis and Controls. Ophthalmic Plast Reconstr Surg 2019; 35:85-90. [DOI: 10.1097/iop.0000000000001178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Reply re: “Frontalis Muscle Contraction and the Role of Visual Deprivation and Eyelid Proprioception”. Ophthalmic Plast Reconstr Surg 2018; 34:498. [DOI: 10.1097/iop.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
15
|
Change in Eyelid Position Following Muller's Muscle Conjunctival Resection With a Standard Versus Variable Resection Length. Ophthalmic Plast Reconstr Surg 2018; 34:355-360. [PMID: 28914711 DOI: 10.1097/iop.0000000000000997] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study compares the use of a standard 7 mm resection length to a variable 4:1 ratio of resection length to desired elevation nomogram when performing Muller's muscle conjunctival resection surgery. METHODS In this cross-sectional case control study, 2 groups were defined. The first underwent Muller's muscle conjunctival resection surgery with a standard 7 mm resection length and the second underwent the same surgery with a variable resection length determined by a 4:1 ratio of resection length to desired elevation nomogram. Groups were matched for age (within 5 years) and sex. Pre- and postoperative photographs were measured digitally. Change in upper marginal reflex distance 1 (MRD1) and final MRD1 were the primary outcome measures. The study was powered to detect a 1 mm difference in MRD1 to a beta error of 0.95. RESULTS No significant preoperative differences between the groups were noted. No significant difference in final MRD1 (0.1 mm; p = 0.74) or change in MRD1 (0.2 mm; p = 0.52) was noted. Mean resection length to elevation ratios were 3.9:1 for standard group and 4.3:1 for the variable group (p = 0.54). CONCLUSION The authors were not able to detect a significant difference in final MRD1 or change in MRD1 for patients undergoing Muller's muscle conjunctival resection surgery with standard or variable resection lengths. These results tend to argue against a purely mechanical mechanism for Muller's muscle conjunctival resection surgery.
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW To review recent advances on the mechanisms and management of acquired aponeurotic blepharoptosis. RECENT FINDINGS Recent advances over the past year have focused on refining well known methods of ptosis repair, expanding and modifying techniques to treat difficult and more severe conditions, and uncovering the biomechanical and neurostimulatory mechanisms of ptosis and its repair. SUMMARY Innovations in ptosis repair are discussed in the context of current treatment paradigms.
Collapse
|
17
|
Thorne AW, Chundury RV, Perry JD, Rootman DB. Relationship between ocular dominance and brow position in patients with blepharoptosis. Orbit 2017; 37:145-148. [PMID: 29053045 DOI: 10.1080/01676830.2017.1383464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aims to determine if ocular dominance plays a role in predicting compensatory eyebrow elevation in cases of ptosis. METHODS This retrospective observational cohort study screened all individuals presenting to two tertiary oculoplastics practices with complaints of ptosis for entry. Primary position photographs were obtained. Ocular dominance was assessed via a modified Porta test. Ptosis was defined in bilateral cases as marginal reflex distance of <2.5 mm in both eyes and in unilateral cases as either an MRD1 < 2.5 mm or MRD1 of >1 mm lower on one side. Asymmetry in brow height was defined as a difference of >1 mm. Chi square and t-tests were performed. RESULTS Sixty-eight patients from the both tertiary practices met inclusion criteria (37 male, 31 female). Concordance between the higher brow and the dominant side was 50.0% (n = 22, p > 0.05). Mean brow height on the dominant side (15.5 mm) was not statistically different than brow height on the non-dominant side (15.3 mm, p > 0.05). The concordance between the higher brow and the lower MRD1 eyelid was not significant (45.5%, n = 20, p > 0.05). The difference in mean brow height between the lower and higher MRD1 eyes was not significantly different (-0.11 mm; p > 0.05). This also held true when restricted to unilateral cases (0.28; p > 0.05). CONCLUSIONS Although asymmetric brow elevation can be noted in patients with ptosis, ocular dominance does not appear to be concordant with this asymmetry. Additionally, brow height does not appear to be concordant with MRD1 in cases of ptosis.
Collapse
Affiliation(s)
- Andrew W Thorne
- a Division of Orbital and Ophthalmic Plastic Surgery , Stein Eye Institute, University of California , Los Angeles , CA , USA
| | - Rao V Chundury
- b Department of Ophthalmology , Cole Eye Institute, Cleveland Clinic , Beachwood , OH , USA
| | - Julian D Perry
- b Department of Ophthalmology , Cole Eye Institute, Cleveland Clinic , Beachwood , OH , USA
| | - Daniel B Rootman
- c Division of Orbital and Ophthalmic Plastic Surgery , Stein and Doheny Eye Institutes, University of California , Los Angeles , CA , USA
| |
Collapse
|
18
|
|
19
|
Surgical rehabilitation for anophthalmic sockets devoid of orbital implant. J Craniomaxillofac Surg 2017; 45:672-677. [PMID: 28318922 DOI: 10.1016/j.jcms.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/16/2016] [Accepted: 02/06/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine the necessity of rehabilitative surgical procedures for no implant anophthalmic sockets, and predictive factors of corrective operations after secondary orbital implantation. MATERIAL AND METHODS Nineteen unilateral anophthalmic patients without orbital implant were included. The distance of eyebrow, upper eyelid margin, and lower eyelid margin from the horizontal medial canthal line (BM, UM, and LM, respectively) was measured using photographs. The anophthalmic orbit anatomy was compared with that of the healthy side using CT scans. RESULTS Five (26.3%) patients showed satisfactory results with the secondary implantation alone. Fourteen (74%) patients needed additional surgeries for ptosis, shallow inferior fornix, enophthalmos, or lower eyelid malposition. Separated superior muscle complex and prominent intermuscular septum connecting the levator and the lateral rectus muscles were noticeable in CT scans. Predictive factors for ptosis surgery included longer BM (p = 0.04), shorter distance from the superior orbital wall to the upper margin of the prosthesis (p < 0.01), and a longer height of the prosthesis (p = 0.04). CONCLUSION Most patients needed multiple operations after secondary implantation for rehabilitation. Additional ptosis operation may be required for patients with a high brow on the anophthalmic side, a vertically long prosthesis, and an impinged prosthesis against the superior orbital wall.
Collapse
|