A Study of Histopathologic Evaluation and Clinical Correlation for Isolated Congenital Myogenic Ptosis and Aponeurotic Ptosis

Eyelid Malpositions as Complication of Pregnancy

Eyelid malpositions as a complication of pregnancy, in the absence of associated trauma or injury, are rarely encountered. There are limited published reports on this phenomenon or subsequent surgical repair. We present the case of a 38-year-old female who experienced 3 separate episodes of eyelid malpositions, each occurring independently during 3 otherwise uncomplicated pregnancies, which persisted until surgical correction. Histological analysis of the patient's conjunctiva and tarsus revealed degeneration and loss of elastic tissue, crucial for eyelid anatomy. Surgical repair was performed in each instance, resulting in excellent cosmetic, anatomic, and visual outcomes.

Levator palpebralis superioris histopathologic findings in congenital ptosis and surgical outcome after its resection: Is there any association?

PURPOSE

To evaluate the histopathologic findings of Levator palpebralis superioris (LPS) muscle biopsy after LPS resection for treatment of congenital ptosis and its possible relation with surgical outcomes.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 4 Given name: [Seyed Mohsen] Last name [Rafizadeh]. Author 6 Given name: [Seyed Ali] Last name [Sonbolestan].Also, kindly confirm the details in the metadata are correct.The author names and the sequence are correct.

METHODS

Congenital ptosis patients were enrolled in this retrospective study. All of them underwent full ophthalmologic examination included of Margin-reflex distance 1 (MRD-1) and LPS function measurement preoperatively. The patients were followed for 3 months for the postoperative period and after that the measurements were repeated. Histologic parameters including percentages of fat, striated and smooth muscle, and fibrous tissue. The histopathologic findings and their possible correlation with the measurements are analyzed.

RESULTS

Sixty-seven patients with unilateral congenital ptosis were enrolled. 45 patients (67.2%) were males. The mean age of patients was 16.10 ± 11.18 years. The patients' MRD-1 was improved significantly from 0.82 ± 1.26 mm to 3.85 ± 1.25 mm after LPS resection (P = 0.000). The success rate was 80.3%. There were no correlations between MRD change and histopathologic tissue percentages but significant correlation was found between success of surgery and fibrous tissue percentage of resected sample (P = 0.033).

CONCLUSIONS

The histopathology of the LPS may be useful in prediction of surgical outcome after LPS resection in congenital ptosis patients. The percentage of fibrous tissue play an important role.

A Focus on Myasthenic Ptosis: The Interface of Medical and Surgical Treatment

Ocular ptosis, or drooping of the upper eyelid, has diverse etiologies, including neurologic and non-neurologic causes. Aponeurotic ptosis is a common cause in the elderly and traumatic or mechanical causes can affect any age, mimicking a neurologic cause. The neurologic causes are diverse but especially arise peripherally from pathologies affecting the nerve, neuromuscular junction, and muscles. The choice of treatment depends on the particular cause, but surgical intervention can also be an option in appropriately selected neurological patients whose ptosis remains embarrassing despite the best medical treatment. Myasthenia gravis, an autoimmune disorder targeting the neuromuscular junction, is a significant cause of ocular ptosis. The treatment is mainly by symptomatic and immunosuppressive medications, but surgical interventions, such as blepharoplasty, may be considered in some cases of socially embarrassing ptosis.

Application of Surgery Combined With Platelet-Rich Plasma in the Correction of Mild to Moderate Blepharoptosis

OBJECTIVES

To explore the effect of surgery combined with platelet-rich plasma (PRP) in the correction of mild to moderate blepharoptosis.

METHODS

A retrospective study was conducted on 36 patients with bilateral mild to moderate blepharoptosis from January 2021 to January 2023, which were corrected by surgery combined with local multi-point injection of PRP. The postoperative effect was observed, and the incidence of postoperative complications and patient satisfaction were calculated.

RESULTS

Postoperative follow-up was 3 months to 2 years. Thirty-five cases of blepharoptosis were well corrected; 1 case (2.8%) had insufficient correction and was corrected by reoperation. There were no obvious complications such as incomplete closure, conjunctival prolapse, and exposed keratitis in 36 patients. All patients were satisfied.

CONCLUSION

Surgery combined with PRP is effective in the correction of mild to moderate blepharoptosis with few complications and high satisfaction. As far as we know, this is the first time to apply PRP in the correction of blepharoptosis, which may provide a new idea for the clinical treatment of blepharoptosis and is worth popularizing.

The Recurrence of Ptosis after Correction Surgery Is Associated with Refractive Error

Background and objectives: Previous studies on ptosis recurrence after correction surgery have tended to focus on postoperative complications, surgical methods and suspension materials, few have mentioned refractive error. This research is to investigate the potential relation between refractive error and recurrence after correction surgery in pediatric patients with simple congenital ptosis. Materials and Methods: We conducted a retrospective analysis of data from patients with simple congenital ptosis who were treated at Zhongshan Ophthalmic Center (ZOC) between 2017 and 2020. In total, 111 eyelids of 85 patients without surgery-related complications who underwent frontalis muscle flap suspension (FMFS) for simple congenital ptosis were included. Postoperative changes in eyelid height were assessed. Cycloplegic refraction was assessed before surgery and during the follow-up period (every 3 months after surgery). Recurrence in the postoperative period was defined as a marginal reflex distance 1 (MRD1) of <1 mm. Results: There were 16 recurrence and 69 non-recurrence cases, with no statistically significant differences, in terms of patient age at the time of surgery, patient sex, or preoperative MRD1, between the recurrence and non-recurrence groups. The postoperative cylindrical diopter (adjusted odds ratio [OR] = 0.432, p = 0.005), laterality (adjusted OR = 0.202, p = 0.006), and preoperative MRD1 (adjusted OR = 0.617, p = 0.019) were associated with ptosis recurrence after surgery. Differences between the recurrence and non-recurrence groups in spherical diopter and spherical equivalent (SE) before and after surgery were not statistically significant. In addition, preoperative refractive error and postoperative spherical diopter were not significantly associated with ptosis recurrence after correction surgery. Conclusions: Ptosis recurrence after FMFS in pediatric cases of congenital ptosis is associated with refractive error. Timely refractive correction and amblyopia treatment may help to reduce ptosis recurrence.

Reduced mitochondrial fission and impaired energy metabolism in human primary skeletal muscle cells of Megaconial Congenital Muscular Dystrophy

Megaconial Congenital Muscular Dystrophy (CMD) is a rare autosomal recessive disorder characterized by enlarged mitochondria located mainly at the periphery of muscle fibers and caused by mutations in the Choline Kinase Beta (CHKB) gene. Although the pathogenesis of this disease is not well understood, there is accumulating evidence for the presence of mitochondrial dysfunction. In this study, we aimed to investigate whether imbalanced mitochondrial dynamics affects mitochondrial function and bioenergetic efficiency in skeletal muscle cells of Megaconial CMD. Immunofluorescence, confocal and transmission electron microscopy studies revealed impaired mitochondrial network, morphology, and localization in primary skeletal muscle cells of Megaconial CMD. The organelle disruption was specific only to skeletal muscle cells grown in culture. The expression levels of mitochondrial fission proteins (DRP1, MFF, FIS1) were found to be decreased significantly in both primary skeletal muscle cells and tissue sections of Megaconial CMD by Western blotting and/or immunofluorescence analysis. The metabolomic and fluxomic analysis, which were performed in Megaconial CMD for the first time, revealed decreased levels of phosphonucleotides, Krebs cycle intermediates, ATP, and altered energy metabolism pathways. Our results indicate that reduced mitochondrial fission and altered mitochondrial energy metabolism contribute to mitochondrial dysmorphology and dysfunction in the pathogenesis of Megaconial CMD.