Double Eyelid Tape as a Treatment Option for Severe Ptosis in Patients With Myotonic Dystrophy Type 1

An Adjustable Magnetic Levator Prosthesis for Customizable Eyelid Reanimation in Severe Blepharoptosis II: Randomized Evaluation of Angular Translation

Purpose

Examine the effect of force modulation via angular translation of a static magnetic field for customizable treatment of severe blepharoptosis.

Methods

Prototype adjustable-force magnetic levator prostheses (aMLP) consisted of a spectacle-mounted magnet in rotatable housing and small eyelid-attached magnets embedded in a biocompatible polymer. Interpalpebral fissure (IPF) of 17 participants with severe blepharoptosis was continuously measured for one minute at five spectacle magnet angles, with order randomized and participant and data analyst masked. The hypothesis that angular position affected opening IPF (o-IPF), minimum blink IPF (m-IPF), and comfort ratings (1-10) was tested.

Results

The aMLP improved o-IPF from 4.5 mm without the device to 6.2 mm on the lowest force setting (P < 0.001) and 7.1 mm on the highest setting (P < 0.001) and allowed for complete volitional blink regardless of setting (average m-IPF 0.4 mm and no change with aMLP; P = 0.76). Spontaneous blink without the device (2.0 mm) was affected on the highest force setting (m-IPF 3.9 mm; P < 0.001) but only marginally so on the lowest setting (3.0 mm; P = 0.06). Comfort (7.6/10) did not vary with the angle (P > 0.36). Profile analysis found substantial individual responses to angle (P < 0.001), confirming the value of customization.

Conclusions

Angular translation provided adjustable force, which had a statistically and clinically meaningful impact on eye opening and the completeness of the spontaneous blink. This quantitative evidence supports continued use of the angular translation mechanism for force adjustment in the customizable magnetic correction of severe blepharoptosis.

Translational Relevance

Evidence for the benefit of customizable magnetic force via angular translation in a larger sample of participants than reported previously.

The Effect of Elastic Eyelid Band Application on Bilateral Severe Ptosis in a Patient With Bilateral Incomplete Claude's Syndrome: A Case Report

Patients with brainstem stroke can present with various oculomotor disorders, including ptosis. Neurogenic ptosis, which results from total or partial dysfunction of the third cranial nerve and/or the Müller muscle, can significantly restrict activities of daily living and participation in rehabilitation. Therefore, surgical intervention is an effective therapeutic strategy. However, owing to complications associated with incomplete eyelid closure, such as exposure keratitis and corneal injury, patients with neurogenic ptosis should first be observed, as natural recovery without surgery can be expected despite a poor prognosis. We reported the case of a 66-year-old woman with bilateral Claude syndrome who presented with severe bilateral ptosis, quadriparesis, and cognitive impairment after a bilateral midbrain infarction. After 3 months of intensive rehabilitation using soft elastic eyelid bands, her ptosis improved without the need for eyelid bands and visual field significantly increased, with improved functional level to the point of walking independently without assistance. This report demonstrates the potential advantages of the simple yet effective nonsurgical intervention of a soft elastic eyelid band for ptosis to restore significant functional gains in patients with severe bilateral ptosis after acute stroke.

The myotonic dystrophy type 1 drug development pipeline: 2022 edition

The beginning of the 20th decade has witnessed an increase in drug development programs for myotonic dystrophy type 1 (DM1). We have collected nearly 20 candidate drugs with accomplished preclinical and clinical phases, updating our previous drug development pipeline review with new entries and relevant milestones for pre-existing candidates. Three interventional first-in-human clinical trials got underway with distinct drug classes, namely AOC 1001 and DYNE-101 nucleic acid-based therapies, and the small molecule pitolisant, which joins the race toward market authorization with other repurposed drugs, including tideglusib, metformin, or mexiletine, already in clinical evaluation. Furthermore, newly disclosed promising preclinical data for several additional nucleic-acid therapeutic candidates and a CRISPR-based approach, as well as the advent into the pipeline of novel therapeutic programs, increase the plausibility of success in the demanding task of providing valid treatments to patients with DM1.