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Ben Ishai M, Ben Artsi E, Shouchane-Blum K, Kramarz Dadon J, Avisar I. Semi-adjustable posterior approach for congenital ptosis repair- outcomes of local and general anesthesia. Eur J Ophthalmol 2024:11206721241247426. [PMID: 38602026 DOI: 10.1177/11206721241247426] [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: 04/12/2024]
Abstract
BACKGROUND To report a single center experience with semi-adjustable posterior approach levator plication ('levatorpexy') in patients with congenital ptosis. MATERIALS AND METHODS A retrospective study. All cases who underwent posterior approach levatorpexy for congenital ptosis between the years 2016 to 2022 were included. The primary outcome measures were margin-to-reflex distance 1 (MRD1) before and after surgery, upper eyelid contour, symmetry of upper eyelid height, complications, and surgical success. Surgery was successful if all the following criteria were met: A postoperative MRD1 of ≥2 mm and ≤4.5 mm, a satisfactory eyelid contour in the operated eyelid, and an inter-eyelid MRD1 asymmetry of ≤1 mm. Postoperative modifications in semi-adjustable techniques were considered in all cases. RESULTS Twenty-three eyelids of 21 patients were included, 11 were performed under general anesthesia, and 12 were performed under local anesthesia. The mean age of all patients was 24.1 years (8-47 years). The mean levator function was 11.2 (±2.11). Mean preoperative MRD1 was 1.05 mm and 1.41 for general and local anesthesia, respectively. Mean postoperative MRD1 was 3.33 mm and 3.37 mm for general and local anesthesia, respectively. Eighteen patients (85%) achieved the desired eyelid height and fulfilled our criteria for success. There were no complications reported in any of the groups. CONCLUSION Posterior approach levatorpexy is a safe and effective procedure for repairing congenital ptosis in patients with good levator function. This technique is suitable for young patients and those unable to undergo surgery under local anesthesia. This technique offers post-operative modification due to its semi-adjustable nature.
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Affiliation(s)
- Meydan Ben Ishai
- Ophthalmology Department, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Ben Artsi
- Ophthalmology Department, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karny Shouchane-Blum
- Ophthalmology Department, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Judith Kramarz Dadon
- Ophthalmology Department, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Avisar
- Ophthalmology Department, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bapty J, Schulz CB, Makuloluwe S, MacLean H. Novel use of an autologous scleral button graft to close the anterior defect in evisceration surgery. Orbit 2023; 42:579-586. [PMID: 36794802 DOI: 10.1080/01676830.2023.2175876] [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: 12/18/2022] [Accepted: 01/28/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE To present an alternative evisceration technique with long-term follow-up data. This technique involves the insertion of an acrylic implant into a modified scleral shell which is closed using an autologous scleral graft. METHODS This was a retrospective analysis of eviscerations performed in a district-general hospital in the UK. All patients underwent conventional ocular evisceration after total keratectomy. A full thickness scleral graft is harvested from the posterior sclera, using an internal approach, with an 8 mm dermatological punch. An 18-20 mm acrylic implant is placed into the shell, and the scleral graft is used to close the anterior defect. Demographic characteristics, implant size and type, and cosmetic results from pictures of all patients were recorded. All patients were invited for a review to measure motility, eyelid height, patient recorded satisfaction and complications. RESULTS Of the five patients identified, one had since died. The remaining four attended a review in person. The mean time between surgery and review was 48 months. The mean implant size was 19 mm. There were no cases of implant extrusion or infection. All four had a <1 mm asymmetry in measured eyelid height and ≥5 mm horizontal gaze motility. All patients self-reported "good" cosmesis. An independent assessment identified "mild asymmetry" in two cases and "moderate" in the other two. CONCLUSION Evisceration with this novel autologous scleral graft technique restores volume in the anterior orbit with good cosmetic results, and with no cases of implant exposure reported in this small case series. This technique should be compared prospectively to established techniques.
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Affiliation(s)
- James Bapty
- Department of Ophthalmology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Christopher B Schulz
- Department of Ophthalmology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Sarith Makuloluwe
- Department of Ophthalmology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Hunter MacLean
- Department of Ophthalmology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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Pushker N, Agrawal S, Meel R, Kashyap S, Sen S, Bajaj MS. Transconjunctival excision of external angular dermoid cyst: A novel approach. J Plast Reconstr Aesthet Surg 2023; 83:431-437. [PMID: 37315491 DOI: 10.1016/j.bjps.2023.04.078] [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: 07/06/2022] [Revised: 01/15/2023] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To excise external angular dermoid cyst (EADC) by transconjunctival approach and compare the surgical outcomes with the standard transcutaneous approach. DESIGN This was a prospective, pilot, interventional, comparative study. METHODS Patients with EADC with no or minimal fixity to the underlying bone on palpation and limited to eyelid were recruited. Patients were randomized into 2 groups; group 1 included patients with transcutaneous approach, and group 2 included patients with transconjunctival approach. The parameters assessed were intraoperative complications, duration and ease of surgery, postoperative complications, and overall satisfaction. RESULTS Six children with a painless, round lesion in outer aspect of eyelid were recruited in each group. None of the patients had any intraoperative or postoperative complications, including dysfunction of eyelid contour and fold, persistence or late occurrence of lateral eyelid droop, excessive or recurrence of swelling, and ocular surface problems, especially in group 2, but a skin scar though hidden was inevitable in group 1. The duration of surgery was comparable with better ease of surgery in group 1 and a gradual learning curve in group 2. The overall satisfaction scores were significantly better in group 2 (p < 0.0001). In group 1, parents of 5 of 6 patients had to be reassured that the skin scar will fade with time. CONCLUSION Transconjunctival excision of EADC is a viable and novel approach in patients with mobile cyst that is limited to the eyelid with no obvious bony fossa. Main limitations of the approach are that it requires surgical expertize, provides less surgical space, and has a gradual learning curve.
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Affiliation(s)
- Neelam Pushker
- Oculoplasty & Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Agrawal
- Oculoplasty & Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Rachna Meel
- Oculoplasty & Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Oculoplasty & Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sen
- Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep S Bajaj
- Oculoplasty & Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Nigam C, Bladen JC. Re: Peri-operative management of ophthalmic patients on anti-thrombotic agents: a literature review. Eye (Lond) 2021; 35:1519. [PMID: 32541888 PMCID: PMC8182811 DOI: 10.1038/s41433-020-1014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Chandni Nigam
- West Kent Eye Centre, Kings College NHS Trust, London, UK.
| | - J C Bladen
- West Kent Eye Centre, Kings College NHS Trust, London, UK
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The main prognostic factors influencing the results of the superior tarsal muscle resection in patients with blepharoptosis. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov25740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Transconjunctival methods of ptosis correction gain popularity nowadays. The wide use of the technique is limited because of the lack of clear recommendations regarding the volume of the resection, especially in patients with negative phenylephrine test.
Purpose. To assess the influence of main predictive factors on superior tarsal muscle (STM) resection result.
Materials and methods. Patients were divided into two groups according to the result of phenylephrine test (PE). Patients with positive results were included in the first group, with negative and weak results in the second group. All patients underwent STM resection according our new algorithm.
Results. The result of STM resection was influenced by PE test and intraoperative white line motility test (WLM), but not by levator function and the amount of superior tarsal muscle resection.
Conclusions. PE and WLM tests play main role in choosing a method for blepharoptosis correcting.
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Pandey N, Singh S. Outcomes of posterior approach surgery in various types and grades of upper eyelid blepharoptosis in Indian eyes. Middle East Afr J Ophthalmol 2021; 28:216-220. [PMID: 35719286 PMCID: PMC9198536 DOI: 10.4103/meajo.meajo_472_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/27/2021] [Accepted: 03/24/2022] [Indexed: 11/04/2022] Open
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Matsuda H, Sakai T, Takahashi Y, Nakano T. Surgical outcomes of the anterior versus posterior approach for advancement of the levator aponeurosis in Japanese patients. J Plast Reconstr Aesthet Surg 2020; 73:2001-2009. [PMID: 32912723 DOI: 10.1016/j.bjps.2020.08.051] [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: 06/22/2019] [Revised: 02/29/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the surgical outcomes of the anterior and posterior approaches for advancement of the levator aponeurosis for aponeurotic blepharoptosis in relation to levator function (LF). METHODS This retrospective study included 223 eyelids from 125 patients with aponeurotic blepharoptosis. The anterior approach was used for 115 eyelids from 65 patients (anterior group), while the posterior approach was used in 108 eyelids from 60 patients (posterior group). Patients were subdivided into two groups in accordance with their LF (fair: 5-10 mm; good: > 10 mm). Functional success was defined as a margin reflex distance of 2-5 mm without serious complications at 3 months postoperatively. Cosmetic success was defined as the achievement of ≤ 1 mm laterality of the upper eyelid height, ≤ 2 mm laterality of the pretarsal show, and eyelid contour symmetry at 3 months postoperatively. RESULTS The functional success rates of the anterior and posterior groups were comparable for patients with good LF (78.9% vs 87.7%, p = 0.228), whereas it was better in the posterior group (85.7%) than the anterior group (64.1%) in the total group (p = 0.022) and in patients with fair LF (p = 0.031). The posterior group achieved better cosmetic success than the anterior group regarding upper eyelid height symmetry (p = 0.042) and pretarsal show (p = 0.012). No serious complications occurred during follow-up. CONCLUSIONS The posterior approach achieved better functional and cosmetic outcomes than the anterior approach, indicating that the posterior approach is more useful in patients with aponeurotic blepharoptosis, particularly for those with only fair LF.
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Affiliation(s)
- Hiromichi Matsuda
- Department of Ophthalmology, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo 105-8471, Japan; Department of Ophthalmology, Daisan Hospital, The Jikei University School of Medicine, Komae, Tokyo, Japan.
| | - Tsutomu Sakai
- Department of Ophthalmology, Daisan Hospital, The Jikei University School of Medicine, Komae, Tokyo, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo 105-8471, Japan
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Conjunctival Sparing Ptosis Correction by White-Line Advancement Technique. J Ophthalmol 2020; 2020:9021848. [PMID: 32733700 PMCID: PMC7378591 DOI: 10.1155/2020/9021848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/16/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To describe a modified technique of white line advancement posterior ptosis surgery and to report the success rate of the procedure. Methods A retrospective case series of 60 patients who presented with ptosis with good levator function. The success rate was defined as an MRD1 of greater than or equal to 3.5 mm, symmetrical eyelid position with an intereyelid height asymmetry of ≤1 mm, and a satisfactory eyelid contour at 3 months follow-up. Results Sixty patients (91 eyelids) met the inclusion criteria. Mild postoperative complications occurred in 11 patients that resolved without surgical intervention. Seven patients had recurrence of ptosis: four patients had early recurrence and 3 had late recurrence. The success rate was 88.33% with an average follow-up of 9 months. Conclusion This procedure is a promising technique in cosmetic and functional ptosis correction. The advantage of this posterior approach procedure is that there is no conjunctival resection; it is suitable for young patients who do not have excess eyelid skin. The procedure is quick with a short recovery period. Additionally, it can be combined with another procedure and in different pathology.
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Matsuda H, Kabata Y, Takahashi Y, Hanzawa Y, Nakano T. Influence of epinephrine contained in local anesthetics on upper eyelid height in transconjunctival blepharoptosis surgery. Graefes Arch Clin Exp Ophthalmol 2020; 258:1287-1292. [PMID: 32103334 DOI: 10.1007/s00417-020-04627-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/02/2020] [Accepted: 02/12/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To examine the influence of epinephrine contained in local anesthetic on upper eyelid height in transconjunctival aponeurotic repair for aponeurotic blepharoptosis. METHODS This retrospective study included 164 eyelids from 94 patients with aponeurotic blepharoptosis. Patients were divided according to the use of local anesthetic with (group A, n = 108) or without 1:100000 epinephrine (group B, n = 56). Margin reflex distance-1 (MRD-1) was measured before and after local anesthesia, and before, during, and 3 months after surgery. Change in MRD-1a (∆MRD-1a) was calculated by subtracting the postanesthetic MRD-1 value from the preanesthetic value, and we defined ∆MRD-1b by subtracting the postoperative 3-month MRD-1 value from the intraoperative value. RESULTS ∆MRD-1a was positive in group A (0.57 ± 0.63 mm) and negative in group B (- 0.50 ± 0.45 mm; p < 0.001). Postoperative MRD-1 decreased significantly from intraoperative MRD-1 in group A (P < 0.001), although there was no significant difference between intraoperative and postoperative MRD-1 in group B (p = 0.255). The magnitude of ∆MRD-1b in group A (- 0.86 ± 0.63) was larger than that in group B (- 0.23 ± 0.26; p < 0.001). CONCLUSIONS Epinephrine stimulates Müller's muscle during surgery, which leads to postoperative upper eyelid droop after the disappearance of the epinephrine effect. Using local anesthetics without epinephrine may allow more accurate estimation of postoperative eyelid height in transconjunctival aponeurotic repair.
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Affiliation(s)
- Hiromichi Matsuda
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, 105-8471, Japan.
| | - Yoshiaki Kabata
- Department of Ophthalmology, Daisan Hospital, The Jikei University School of Medicine, Komae, Tokyo, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Yuri Hanzawa
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, 105-8471, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, Jikei University School of Medicine, Tokyo, 105-8471, Japan
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10
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Ullrich K, Malhotra R. How far we have come: A review of the evolution of posterior approach ptosis surgery. Clin Exp Ophthalmol 2019; 47:1082-1087. [PMID: 31215150 DOI: 10.1111/ceo.13574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/12/2019] [Accepted: 06/15/2019] [Indexed: 11/27/2022]
Abstract
We revisit the evolution of posterior approach ptosis surgery. We address the early attempts at ptosis surgery, assess the more modern approach by de Blaskovics, followed by the division into "open sky" and "closed" techniques. The simultaneous developments occurring in America and Europe are described, along with refinement of surgical approaches such as conjunctival-sparing posterior approach ptosis surgery.
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Affiliation(s)
- Katja Ullrich
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, West Sussex, UK
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, West Sussex, UK
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11
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Schulz CB, Nicholson R, Penwarden A, Parkin B. Anterior approach white line advancement: technique and long-term outcomes in the correction of blepharoptosis. Eye (Lond) 2017; 31:1716-1723. [PMID: 28799556 DOI: 10.1038/eye.2017.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/09/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeAnterior approach white line advancement presents a novel surgical option for correction of blepharoptosis. The technique draws on several advantages of other approaches. The aim of this study was to present outcomes using this technique at a minimum follow-up of 18 months.Patients and methodsParticipants having undergone anterior approach white line advancement ptosis correction at a single institution were retrospectively recruited at a minimum of 18 months' follow-up. A total of 18 independent eyelid measurements were recorded at final review. Outcomes included long-term rate of surgical success, upper eyelid margin-reflex distance (MRD1) at both early and late post-operative follow-up, inter-eyelid asymmetry, complications, re-operation rate, patient satisfaction, and quality-of-life improvement using the Glasgow Benefit Inventory (GBI). Pre- and post-operative MRD1, as well as inter-eyelid asymmetry, were compared using a two-tailed t-test.ResultsIn total, 82 eyelids of 47 participants were included with a mean follow-up of 2.3 years (range 1.5-3.7). Surgical success was achieved in 91.5%, with a final mean MRD1 of 3.5 mm (95% confidence 3.2-3.7). An increase of 2.4 mm (2.1-2.8) in eyelid height was observed between baseline and long-term follow-up (P<0.0001). No significant change was observed between early and late post-operative follow-up. Pre-operative asymmetry was reduced from 1.0 mm (0.7-1.3) to 0.4 mm (0.3-0.5; P<0.0001). Patient satisfaction was 95.7% with a mean GBI score of +21.8 (13.2-30.3).ConclusionsAnterior approach white line advancement presents an excellent option for patients undergoing ptosis correction with favourable long-term results. Comparisons are made with other techniques with respect to anatomical, functional, and surgical factors.
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Affiliation(s)
- C B Schulz
- Eye Unit, Salisbury District Hospital, Salisbury, UK
| | - R Nicholson
- Eye Unit, Royal Hampshire County Hospital, Winchester, UK
| | - A Penwarden
- Eye Unit, Royal Bournemouth Hospital, Bournemouth, UK
| | - B Parkin
- Eye Unit, Royal Bournemouth Hospital, Bournemouth, UK
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Antus Z, Salam A, Horvath E, Malhotra R. Outcomes for severe aponeurotic ptosis using posterior approach white-line advancement ptosis surgery. Eye (Lond) 2017; 32:81-86. [PMID: 28776587 DOI: 10.1038/eye.2017.128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 05/22/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeThe purpose of the study was to report the outcome of posterior approach white-line advancement surgery for severe involutional aponeurotic ptosis.Patients and methodsThis was a retrospective review of an interventional case series of all patients undergoing surgery for severe involutional aponeurotic ptosis during a 42-month period at a single center. The inclusion criteria were severe involutional ptosis (upper eyelid margin reflex distance (MRD) ≤1 mm) undergoing posterior approach surgery. There was minimum 3-month follow-up. The main outcome measures were type of ptosis (primary or recurrent), preoperative margin reflex distance, levator function and eyelid skin crease height, presence of visible iris sign (VIS), documented unusual intraoperative findings, postoperative complications, and follow-up time.ResultsOf the 836 procedures for ptosis, 122 procedures (76 patients) met the inclusion criteria for this study. Mean postoperative follow-up was 28 (median 18, range 12-98) weeks. Success rates were 80.3% (98/122) overall, 81.5% (66/81) in the non-VIS group, and 78% (32/41) in the VIS group. There was no significant difference between the two groups (P=0.411). Failures were due to undercorrection, with <2 mm MRD in 75% (18/24), overcorrection with >4.5 mm MRD in 16.7% (4/24), and inter-eyelid height asymmetry of >1 mm in 8.3% (2/122).ConclusionsOutcomes of ptosis surgery for severe aponeurotic ptosis using a posterior approach white-line advancement are comparable to, and possibly better than, anterior approach in eyelids with VIS.
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Affiliation(s)
- Z Antus
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - A Salam
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - E Horvath
- Cardiovascular Disease Prevention Foundation, Budapest, Hungary
| | - R Malhotra
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
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Yamaguchi H, Tanaka T, Toyoshima D, Maruyama A, Ichinose A, Nagase H. Bilateral blepharoptosis in a juvenile. Brain Dev 2017; 39:452-454. [PMID: 28087085 DOI: 10.1016/j.braindev.2016.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/22/2016] [Accepted: 12/25/2016] [Indexed: 11/18/2022]
Abstract
In adults, aponeurotic blepharoptosis is the most common type of ptosis. However, myogenic ptosis is the predominant cause, and bilateral aponeurotic ptosis is very rare among children. Here, we report a previously healthy 10-year-old Japanese girl with bilateral aponeurotic blepharoptosis who presented initially with bilateral blepharoptosis for about 4years. This case report shows that history taking and careful observation of the patient lead to an accurate diagnosis, and aponeurotic ptosis should be considered in the differential diagnosis of bilateral blepharoptosis among children.
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Affiliation(s)
- Hiroshi Yamaguchi
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
| | - Tsukasa Tanaka
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Daisaku Toyoshima
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Akihiro Ichinose
- Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hiroaki Nagase
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
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Takahashi Y, Nakano T, Ikeda H, Miyazaki H, Malhotra R, Kakizaki H. Post-Levator Aponeurosis Fat Pad. J Craniofac Surg 2016; 27:2171-2172. [PMID: 28005782 DOI: 10.1097/scs.0000000000003088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to examine the superoinferior extension of the post-levator aponeurosis fat pad in the upper eyelids of Japanese cadavers. Twenty-six upper eyelids (12 right and 14 left) from 15 Japanese cadavers (6 men and 9 women; average age at death, 82.1 years) were used in this experimental anatomical study. After an orbital exenteration, the tissues were cut sagittally through the center of the orbit, and the superoinferior extension of the post-levator aponerosis fat pad was microscopically examined on the sections. Consequently, the fat pad superiorly reached the myotendinous junction between the levator aponeurosis and the levator palpebrae superioris (LPS) muscle in 17 eyelids with the nonbranching LPS muscle. The fat pad extended to the roots of the superior and inferior branches of the LPS muscle in the other 9 eyelids with the branching LPS muscle. Inferiorly, the fat pad was limited to the conjunctival fornix in 13 eyelids, but reached the tarsal plate in the other 13 eyelids. This study showed anatomical variation in the superoinferior extension of the post-levator aponerosis fat pad in Japanese cadavers.
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Affiliation(s)
- Yasuhiro Takahashi
- *Department of Oculopalstic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital†Department of Anatomy‡Department of Pathology, Aichi Medical University, Nagakute, Aichi§Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama, Japan
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
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15
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Oculoplastic considerations in patients with glaucoma. Surv Ophthalmol 2016; 61:718-725. [DOI: 10.1016/j.survophthal.2016.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 11/22/2022]
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16
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Tu LC, Wu MC, Chu HL, Chiang YP, Kuo CL, Li HY, Chang CC. Surface electromyography analysis of blepharoptosis correction by transconjunctival incisions. J Electromyogr Kinesiol 2016; 28:23-30. [PMID: 26990614 DOI: 10.1016/j.jelekin.2016.02.009] [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: 04/30/2015] [Revised: 01/29/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022] Open
Abstract
Upper eyelid movement depends on the antagonistic actions of orbicularis oculi muscle and levator aponeurosis. Blepharoptosis is an abnormal drooping of upper eyelid margin with the eye in primary position of gaze. Transconjunctival incisions for upper eyelid ptosis correction have been a well-developed technique. Conventional prognosis however depends on clinical observations and lacks of quantitatively analysis for the eyelid muscle controlling. This study examines the possibility of using the assessments of temporal correlation in surface electromyography (SEMG) as a quantitative description for the change of muscle controlling after operation. Eyelid SEMG was measured from patients with blepharoptosis preoperatively and postoperatively, as well as, for comparative study, from young and aged normal subjects. The data were analyzed using the detrended fluctuation analysis method. The results show that the temporal correlation of the SEMG signals can be characterized by two indices associated with the correlation properties in short and long time scales demarcated at 3ms, corresponding to the time scale of neural response. Aging causes degradation of the correlation properties at both time scales, and patient group likely possess more serious correlation degradation in long-time regime which was improved moderately by the ptosis corrections. We propose that the temporal correlation in SEMG signals may be regarded as an indicator for evaluating the performance of eyelid muscle controlling in postoperative recovery.
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Affiliation(s)
- Lung-Chen Tu
- Department of Biology Science and Technology, National Chiao Tung University, Hsinchu, Taiwan; Department of Plastic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ming-Chya Wu
- Research Center for Adaptive Data Analysis, National Central University, Chungli, Taiwan; Institute of Physics, Academia Sinica, Taipei, Taiwan.
| | - Hsueh-Liang Chu
- Department of Biology Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Yi-Pin Chiang
- Department of Rehabilitation, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chih-Lin Kuo
- Department of Rehabilitation, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsing-Yuan Li
- Department of Biology Science and Technology, National Chiao Tung University, Hsinchu, Taiwan; Department of Pediatrics, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
| | - Chia-Ching Chang
- Department of Biology Science and Technology, National Chiao Tung University, Hsinchu, Taiwan; Institute of Physics, Academia Sinica, Taipei, Taiwan.
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Anterior Approach White-Line Advancement: A Hybrid Technique for Ptosis Correction. Ophthalmic Plast Reconstr Surg 2015; 31:478-81. [PMID: 26325380 DOI: 10.1097/iop.0000000000000543] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the technique of anterior approach white-line advancement for correction of ptosis. METHODS Retrospective review of consecutive cases that underwent anterior approach white-line advancement for correction of aponeurotic ptosis. In this technique, the posterior surface of the levator aponeurosis (white line) is accessed through a skin crease incision (anterior approach) and advanced toward the tarsal plate. Surgery was considered successful if the following 3 criteria were simultaneously met: postoperative upper margin reflex distance of ≥2 and ≤4.5 mm, inter-eyelid height asymmetry of ≤1 mm, and satisfactory eyelid contour. Written informed consent was obtained from all the patients and the study was HIPPA compliant. RESULTS Twenty patients (29 eyelids) were included in this study. Mean postoperative follow up was 1.25 months (1 to 6 months). Mean preoperative margin reflex distance was 0.38 mm (-1 to 2 mm) and the mean postoperative margin reflex distance was 3.16 mm (2 to 4 mm). Eighteen patients (90%) fulfilled the criteria set for success. The patients rated the outcome of surgery as follows: 80% completely satisfied and 20% significantly improved. CONCLUSION Anterior approach white-line advancement is a hybrid technique that incorporates the principles of both anterior and posterior approach ptosis correction techniques. The posterior surface of levator aponeurosis (white line) is exposed and advanced toward the superior border of tarsal plate with minimal disruption of eyelid anatomy including the orbital septum and preaponeurotic fat pad. Hence, this technique can achieve superior cosmetic results similar to a posterior approach procedure, without the need for a conjunctival incision.
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Ng DS, Chan E, Ko ST. Minimal incision posterior approach levator plication for aponeurotic ptosis. Eye (Lond) 2015; 29:483-91. [PMID: 25613849 DOI: 10.1038/eye.2014.318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/25/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the efficacy and predictability of a minimal incision posterior approach levator plication technique for correction of involutional ptosis. METHOD Retrospective chart review of patients with involutional aponeurotic ptosis underwent minimal incision posterior approach levator plication technique between August 2013 and June 2014 by a single surgeon. The upper lid was double everted, and the conjunctiva and Muller's muscle layers were incised vertically until the levator aponeurosis could be identified. The incision(s) was similar to performing incision and curettage of chalazion, except that the site was above the tarsal plate and extended towards the fornix. Then insertion of aponeurosis was dissected away from the anterior tarsal surface, and the more superiorly located levator was plicated on it with double arm suture(s). No tissue was excised in this procedure. Surgical success was defined as a postoperative margin reflex distance (MRD)>2 mm and<4.5 mm, interlid height<1 mm and satisfactory contour. RESULTS Forty-four lids of 27 patients were included. Preoperative mean MRD was 0.48 +/- 0.56 mm. Severe ptosis of MRD<1 mm was present in 34/44 patients (77.3%). The postoperative mean MRD was 2.49 +/- 0.53 mm, and mean improvement was 2.02 +/- 0.61 mm, which was statistically significant (P<0.001). The overall success rate was 38/44 (86.4%). CONCLUSIONS Minimal incision posterior approach to levator plication was effective for the correction of aponeurotic ptosis with moderate to good levator function.
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Affiliation(s)
- D S Ng
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - E Chan
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - S T Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
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Al-Abbadi Z, Sagili S, Malhotra R. Outcomes of posterior-approach 'levatorpexy' in congenital ptosis repair. Br J Ophthalmol 2014; 98:1686-90. [PMID: 24993104 DOI: 10.1136/bjophthalmol-2014-305159] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE We describe a minimally invasive technique and report our experience of posterior approach levator plication ('levatorpexy') for congenital ptosis. STUDY DESIGN Retrospective review. PARTICIPANTS Consecutive series of 16 patients. MATERIALS AND METHODS Posterior approach levatorpexy was performed for congenital ptosis under general anaesthesia. This surgical procedure involves exposing the posterior surface of the levator muscle through a transconjunctival approach. The levator muscle is advanced and plicated using a suture passed through its posterior surface, partial-thickness, to tarsal plate and tied on the skin. No tissue (conjunctiva, Muller's muscle, levator) are excised during this procedure. MAIN OUTCOME MEASURES Data collected included margin reflex distance (MRD1), symmetry of eyelid height, contour and complications. Surgery was considered successful if the following three criteria were simultaneously met: A postoperative MRD1 of ≥2 mm and ≤4.5 mm, inter-eyelid height asymmetry of ≤1 mm, and satisfactory eyelid contour. RESULTS Mean age was 9.1 years (range 3-26 years). Mean postoperative follow-up was 8.1 months (4-24 months). Preoperative phenylephrine test was positive in 81% of patients. Mean levator function was 11 mm (5-15 mm). Mean preoperative MRD1 was 1.5 mm and the mean postoperative MRD1 was 2.6 mm. Fourteen patients (87%) achieved the desired eyelid height and fulfilled our criteria set for success. CONCLUSIONS Posterior approach levatorpexy appears to be a safe and effective procedure for correction of congenital ptosis particularly with moderate or better levator function.
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Affiliation(s)
- Zaid Al-Abbadi
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, West Sussex, UK
| | - Suresh Sagili
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, West Sussex, UK
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, West Sussex, UK
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Marcet MM, Meyer DR, Greenwald MJ, Roth S, Selva D. Proximal Tarsal Attachments of the Levator Aponeurosis. Ophthalmology 2013; 120:1924-9. [DOI: 10.1016/j.ophtha.2013.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 02/08/2013] [Accepted: 02/12/2013] [Indexed: 11/26/2022] Open
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Abstract
PURPOSE To describe and evaluate a modified technique for blepharoptosis repair via Müller's muscle-conjunctival resection. METHODS An observational case series is reported. Records of 29 consecutive patients (42 eyelids) with blepharoptosis undergoing internal ptosis repair between January 2008 and December 2010 were reviewed including detailed preoperative and postoperative evaluations, eyelid measurements, surgical outcome, and complications. The procedure performed was a modified Müller's muscle-conjunctival resection with simple measurements, no traction sutures, a double-opposing mattress suture, and single external knot. Main outcome measures included success of ptosis repair surgery defined by improvement in margin reflex distance, symmetry of upper eyelid position, and incidence of complications. RESULTS The described modified Müller's muscle-conjunctival resection procedure achieved improvement in eyelid position in all patients with mean margin reflex distance change of 2.3 mm (p < 0.001). No patient experienced significant complications, and all procedures resulted in objective eyelid symmetry (within 1 mm) and satisfactory cosmetic appearance. CONCLUSIONS The procedure described is an efficient, safe, and successful technique for internal blepharoptosis repair.
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Re: "Mueller's muscle-conjunctival resection in the treatment of congenital ptosis". Ophthalmic Plast Reconstr Surg 2012; 28:157. [PMID: 22410669 DOI: 10.1097/iop.0b013e318248eae2] [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]
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Malhotra R, Salam A. Outcomes of adult aponeurotic ptosis repair under general anaesthesia by a posterior approach white-line levator advancement. Orbit 2011; 31:7-12. [PMID: 22029827 DOI: 10.3109/01676830.2011.628434] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Aponeurotic ptosis surgery is conventionally performed under local anaesthetic to allow adjustment of eyelid height and contour. This may not be possible where general anaesthesia (GA) is required. PURPOSE We describe our experience using a tranconjunctival posterior approach "white-line" levator advancement (WLA) in patients undergoing aponeurotic ptosis correction under a GA. MATERIALS AND METHODS Retrospective review of a consecutive series of 20 patients with primary aponeurotic ptosis undergoing posterior approach WLA ptosis repair under GA. The procedure involves exposing the posterior surface of the levator aponeurosis and advancement through tarsus onto its anterior surface if exposed already, or to skin. All patients underwent pre- and postoperative photographs and final outcomes were assessed at minimum 3 months. Outcome measures included pre- and post-marginal reflex distance (MRD), symmetry of height, contour, fold and complications including dry eye. RESULTS Twenty patients undergoing 40 procedures were included. Mean age was 58 (22-87) years. Mean preoperative MRD was 1.3. Preoperative phenylephrine test was positive all patients. The mean postoperative MRD was 3.5 mm. Although all 20 patients achieved their desired lid height and contour, one patient had a 2 mm asymmetry, with a final success rate of 95% (19/20 patients). CONCLUSION We suggest that a posterior approach white-line advancement is an ideal technique to correct even severe aponeurotic ptosis in patients requiring surgery under GA. Preoperative positive phenylephrine test is a good predictor of postoperative height and contour without the need for per-operative adjustment. Précis: Aponeurotic ptosis surgery for patients under general anaesthesia using a simple posterior approach white-line advancement achieves predictability of lid height, symmetry and contour and is an ideal option for phenylephrine-positive ptosis.
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Affiliation(s)
- Raman Malhotra
- Corneo-plastic Unit, Queen Victoria Hospital, East Grinstead , West Sussex , UK
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