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Prinz J, Hartmann K, Migliorini F, Hamesch K, Walter P, Fuest M, Kuerten D. Efficacy of allogenous fascia lata grafts in the management of lower eyelid retraction. Int Ophthalmol 2023; 43:4729-4737. [PMID: 37721702 PMCID: PMC10724318 DOI: 10.1007/s10792-023-02873-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/26/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To report on the use of allogenous fascia lata (FL) grafts in patients with lower eyelid retraction (LER). METHODS In this retrospective study, a consecutive series of 27 patients (39 eyes) with LER who underwent lower eyelid elevation with FL was included. Examinations including measurement of the palpebral fissure vertical height (PFVH), the inferior scleral show distance, the margin reflex distance 2 (MRD 2), and the evaluation of conjunctival hyperemia were conducted at baseline and after a mean postoperative time of 25.9 ± 25.5 (5.0-81.0, median 13.0, last follow-up) months in all patients. RESULTS At the last follow-up, a significant reduction of the PFVH (11.3 ± 1.7 versus 12.8 ± 2.1 at baseline, p < 0.001), the inferior scleral show distance (0.7 ± 1.0 mm versus 2.1 ± 1.1 at baseline, p < 0.001), and the MRD 2 (6.4 ± 0.9 versus 7.8 ± 1.3 at baseline, p < 0.001) occurred. The conjunctival hyperemia grading score (McMonnies) was significantly reduced (1.8 ± 0.7) at the last follow-up compared to baseline (2.6 ± 0.6, p < 0.001). No case of ectropion or entropion was observed at the last follow-up visit. CONCLUSION In this case series, lower eyelid elevation with FL grafts as a spacer led to a significant reduction of the PFVH, MRD 2, inferior scleral show distance, and conjunctival hyperemia. No severe surgery-related complications occurred.
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Affiliation(s)
- Julia Prinz
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Kathi Hartmann
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | | | - Karim Hamesch
- Department of Gastroenterology and Hepatology, RWTH Aachen University, Aachen, Germany
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - David Kuerten
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Tirandazi P, Nadeau M, Woods RL, Paschalis EI, Houston KE. An Adjustable Magnetic Levator Prosthesis for Customizable Eyelid Reanimation in Severe Blepharoptosis II: Randomized Evaluation of Angular Translation. Transl Vis Sci Technol 2023; 12:1. [PMID: 38038607 PMCID: PMC10697171 DOI: 10.1167/tvst.12.12.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/05/2023] [Indexed: 12/02/2023] Open
Abstract
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.
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Affiliation(s)
- Pooyan Tirandazi
- Schepens Eye Research Institute, Massachusetts Eye and Ear, and Harvard Medical School, Boston, MA, USA
| | - Melanie Nadeau
- Schepens Eye Research Institute, Massachusetts Eye and Ear, and Harvard Medical School, Boston, MA, USA
| | - Russell L. Woods
- Schepens Eye Research Institute, Massachusetts Eye and Ear, and Harvard Medical School, Boston, MA, USA
- Boston Childrens Hospital, Boston, MA, USA
| | - Eleftherios I. Paschalis
- Schepens Eye Research Institute, Massachusetts Eye and Ear, and Harvard Medical School, Boston, MA, USA
| | - Kevin E. Houston
- Schepens Eye Research Institute, Massachusetts Eye and Ear, and Harvard Medical School, Boston, MA, USA
- University of Massachusetts Chan Medical School, Departments of Neurology and Ophthalmology, Worcester, MA, USA
- Central Western Massachusetts Veterans Affairs, Optometry Service, MA, USA
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Yue Q, Fu A, Wang T. Efficacy and Safety of Surgical Procedures for Congenital Moderate and Severe Blepharoptosis: A Network Meta-analysis. J Craniofac Surg 2023; 34:2363-2368. [PMID: 37768088 DOI: 10.1097/scs.0000000000009753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/19/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND There are various surgical approaches to treat congenital moderate and severe blepharoptosis (CMSBP), but their efficacy and safety remain unclear owing to a lack of high-level evidence. This network meta-analysis aimed to evaluate the efficacy and safety of 3 classical operations: and their modifications frontal muscle flap suspension (FMS), levator palpebrae muscle shortening (LMS), conjoint fascial sheath suspension (CFSS), and modified CFSS. METHODS We searched the PubMed, MEDLINE, Cochrane Library, CNKI, and Wanfang databases until March 2022. A Bayesian network meta-analysis was conducted for the 5 most common treatments. Outcome indicators were the number of patients with good correction and adverse events. RESULTS Twenty-one studies were included, with 2402 eyes in 1863 patients. Five surgical methods were evaluated: FMS, LMS, CFSS, and conjoint fascial sheath suspension combined with levator muscle shortening (CFSS+LMS), or with levator palpebrae muscle composite flap suspension (CFS+L). Meta-analysis indicated that CFSS is more effective than LMS and FMS, but inferior to CFSS+LMS and CFS+L. Efficacy rates of CFSS+LMS and CFS+L were comparable. Frontal muscle flap suspension was more effective than LMS. Safety data meta-analysis found CFSS safer than FMS and LMS but with more complications than CFSS+LMS and CFS+L. Complication rates were comparable between CFS+L and CFSS+LMS, and also for FMS and LMS. CONCLUSIONS When correcting CMSBP, CFSS+LMS, and CFS+L may be better therapeutic strategies for effectiveness and safety. Conjoint fascial sheath suspension also yielded good surgical effects. Plastic surgeons should be cautious about LMS and FMS. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Qiang Yue
- Department of Cervicofacial Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Ao Fu
- Department of Oncoplastic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tailing Wang
- Department of Cervicofacial Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
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Lee TY, Kim HK, Choi DI. Reducing the Volume of Upper Eyelids in East Asians Increases Vertical Palpebral Height. Aesthetic Plast Surg 2023; 47:1835-1842. [PMID: 37014413 DOI: 10.1007/s00266-023-03333-y] [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: 12/09/2022] [Accepted: 03/19/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Correcting puffy eyelids is important for improving the first impression. The puffiness is most predictable corrected by tissue resection and fat excision. Fold asymmetry, overcorrection, and recurrence can sometimes occur after levator aponeurosis manipulation. The objective of this study was to introduce a method of volume-controlled blepharoptosis correction (VC) without levator manipulation. METHODS The medical records of patients who had undergone upper blepharoplasty between 2017 and 2022 were retrospectively reviewed. Questionnaires, digital photographs, and charts were used to evaluate the surgical outcomes and complications. The degree of levator function was graded as poor, fair, good, or very good. Levator function must be above good (>8 mm) to employ the VC method. Poor and fair grades of levator function were excluded because they require levator aponeurosis manipulation. The margin to reflex distance (MRD) 1 was assessed preoperatively, 2 weeks postoperatively, and at follow-up visits. RESULTS Postoperative satisfaction was 4.3 ± 0.8 with no postoperative discomfort (0%), and the duration of swelling was 10.1 ± 2.0 days. Regarding other complications, no fold asymmetry (0%) was observed, although hematoma formation was observed in 1 (2.9%) patient in the VC group. Significant differences were observed in the changes in palpebral fissure height over time (p < 0.001). CONCLUSIONS VC can effectively correct puffy eyelids and create natural-looking, beautiful, and thin eyelids. Thus, VC is associated with higher patient satisfaction and surgical longevity without serious complications. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Tae-Yul Lee
- Department of Plastic Surgery, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
| | - Hyung-Kyu Kim
- Department of Plastic Surgery, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
| | - Dong-Il Choi
- Gangnam-Seoyon Plastic Surgery Clinic, 421 Samyoung Building, Gangnam-daero, Seocho-Gu, Seoul, 06614, Republic of Korea.
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Mangan MS, Tekcan H, Yurttaser Ocak S, Ozcelik Kose A, Balci S, Ercalik NY, Imamoglu S. Müller Muscle-Conjunctival Resection for Treatment of Contralateral Ptosis following Unilateral External Levator Advancement. Plast Reconstr Surg 2023; 152:533-539. [PMID: 36827478 DOI: 10.1097/prs.0000000000010309] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND One of the main causes of unsatisfactory outcomes after unilateral blepharoptosis surgery is asymmetry of the upper eyelid height, which occurs as a result of a contralateral eyelid droop. Therefore, the authors evaluated the efficacy of Müller muscle-conjunctival resection (MMCR) for the treatment of contralateral ptosis following unilateral external levator advancement (ELA). METHODS This study analyzed 26 eyelids of 26 patients with upper eyelid height asymmetry following unilateral ELA who underwent contralateral MMCR retrospectively. The phenylephrine test was performed before ELA and before MMCR. The main outcome measures were symmetry outcomes and clinical outcomes. RESULTS The mean patient age was 55.81 ± 7.98 years (range, 44 to 70 years); 15 were female (57.7%). The Hering dependency was observed in 13 of the patients (50%) before ELA. An adequate response to phenylephrine was observed before MMCR but not before ELA. Symmetry outcomes after MMCR were perfect (<0.5 mm), good (≥0.5 mm and <1 mm), and fair (≥1 mm) in seven, 17, and two patients, respectively. An optimal upper eyelid height was noted in 47 of the 52 eyelids after the MMCR, whereas three of the 52 eyelids had minimal overcorrection, and two eyelids had undercorrection. The mean change in marginal reflex distance 1 of the contralateral eyelid droop was greater for patients with than without the Hering dependency ( P < 0.0001) after ELA but not after MMCR. Two patients (7.6%) underwent revision ELA surgery. CONCLUSION MMCR and use of the phenylephrine test to predict the eyelid position may represent an alternative approach in patients who require management of contralateral ptosis following unilateral ELA. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Mehmet Serhat Mangan
- From the Division of Oculoplastic and Reconstructive Surgery, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Clinic
| | - Hatice Tekcan
- From the Division of Oculoplastic and Reconstructive Surgery, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Clinic
| | - Serap Yurttaser Ocak
- Department of Ophthalmology, University of Health Sciences, Okmeydani Education and Research Hospital
| | - Alev Ozcelik Kose
- From the Division of Oculoplastic and Reconstructive Surgery, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Clinic
| | - Sevcan Balci
- From the Division of Oculoplastic and Reconstructive Surgery, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Clinic
| | - Nimet Yesim Ercalik
- From the Division of Oculoplastic and Reconstructive Surgery, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Clinic
| | - Serhat Imamoglu
- From the Division of Oculoplastic and Reconstructive Surgery, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Clinic
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Cang ZQ, He YX, Liu CH, Fan X, Sun LM, Ma N, Song BQ, Hao DY, Peng P, Cao J. Modified Levator Resection Technique for Moderate Congenital Blepharoptosis. Aesthetic Plast Surg 2023; 47:1430-1438. [PMID: 37193888 DOI: 10.1007/s00266-023-03382-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/23/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND For moderate ptosis associated with fair levator function (LF), the levator resection is the most commonly used procedure. However, the levator resection technique still has some disadvantages, such as residual lagophthalmos (RL), undercorrection, conjunctival prolapse, and eyelid contour abnormality. To solve the above problems, our team have made modifications to the levator resection technique in three aspects: releasing the levator muscle sufficiently, preserving the supporting structure of the conjunctiva, and placing multiple suture sites. METHODS Fifty-seven patients (81 eyes) underwent the modified levator resection technique and were enrolled in the study. Preoperative data collected included age, sex, margin reflex distance 1 (MRD1), and LF. Postoperative data collected included MRD1, RL, patient satisfaction, complications, and length of follow-up. RESULTS Mean MRD1 significantly increased from 1.45 ± 0.65 mm preoperatively to 3.57 ± 0.51 mm postoperatively. Mean LF significantly increased from 6.49 ± 1.12 mm preoperatively to 9.48 ± 1.39 mm postoperatively. Successful correction was obtained in 77 eyes (95.1%). Mean RL was 1.09 ± 0.57 and 72 eyes (88.9%) showed excellent or good eyelid closure function. Fifty-four patients (94.7%) were completely satisfied with the final result. Complications such as hematoma, infection, conjunctival prolapse, suture exposure, corneal abrasion, and keratitis were not found in any cases during follow-up. CONCLUSION This modified levator resection technique introduced in this study is effective in correcting moderate congenital blepharoptosis, while minimizing RL, undercorrection, conjunctival prolapse, eyelid contour abnormality by releasing the levator muscle sufficiently, preserving the supporting structure of the conjunctiva, and placing multiple suture sites. LEVEL OF EVIDENCE IV This journal requires that authors 42 assign a level of evidence to each article. For a full 43 description of these Evidence-Based Medicine ratings, 44 please refer to the Table of Contents or the online 45 Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Zheng-Qiang Cang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Yun-Xia He
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Chao-Hua Liu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Xiao Fan
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Li-Ming Sun
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Na Ma
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Bao-Qiang Song
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Dong-Yue Hao
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
| | - Pai Peng
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
| | - Jiao Cao
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
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Manta AI, Jackson NJ, Dan J, Tran A, Rootman DB. Effect of external eyelid weighting on eyelid and eyebrow position in normal and ptosis patients. Graefes Arch Clin Exp Ophthalmol 2023; 261:849-855. [PMID: 36112219 DOI: 10.1007/s00417-022-05825-0] [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: 11/13/2021] [Revised: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study aims to characterize the physiologic response of both eyelid and eyebrow position to increasing downward forces simulated by external weights. METHODS In this prospective observational study, both normal individuals and patients affected by ptosis were tested. External eyelid weights were placed on one upper eyelid with incrementally increasing weight from 0.2 to 2.4 g. The eyelid carrying the weight was randomly selected for normal subjects and patients with bilateral ptosis, whereas for unilateral ptosis, the ptotic eyelid was utilized. Photographs were obtained at baseline and with increasing weight until MRD1 reached 0 on the weighted side or, until 2.4 g was reached. Eyelid and brow position on the weighted and unweighted sides were digitally measured in millimeter. Primary outcome measures were change in the margin to reflex distance (MRD1) and pupil to brow distance (PTB) with weight on the weighted and unweighted sides for normal and ptosis subjects. RESULTS The weighted eyelid MRD1 decreased linearly with increasing weight. This was true for normal and ptosis subjects. The unweighted eyelid MRD1 increased linearly with increasing weight. This was also the case for both normal and ptosis subjects. With increasing weight, PTB increased linearly on the weighted side. No significant intergroup differences were noted. CONCLUSIONS In normal and ptosis subjects, when external weight on the eyelid is incrementally increased, the weighted eyelid MRD1 decreases, the unweighted eyelid MRD1 increases, and both brows elevate in a linear fashion.
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Affiliation(s)
- Alexandra I Manta
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA.
| | - Nicholas J Jackson
- David Geffen School of Medicine, Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, USA
| | - Joshua Dan
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA
| | - Annie Tran
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA.,Division of Orbital and Ophthalmic Plastic Surgery, Doheny Eye Center, University of California, Los Angeles, CA, USA
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Chen HJ, Wang CY, Huang YF, Wu YC, Wei LC. Effect of Muller's muscle-conjunctival resection on the upper eyelid crease position in Asian eyelids: a retrospective cohort study. BMC Ophthalmol 2022; 22:377. [PMID: 36131334 PMCID: PMC9490903 DOI: 10.1186/s12886-022-02605-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/14/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Investigating the effect of Muller’s muscle-conjunctival resection (MMCR) on the eyelid crease position. Methods This retrospective study included patients with unilateral acquired blepharoptosis who underwent MMCR during October 2018–December 2021. The following factors were recorded: preoperative, after phenylephrine, postoperative marginal reflex distance1 (MRD1) and tarsal platform show (TPS) of bilateral eyelids. The primary outcome was to measure the change in TPS and evaluate the factors associated with post-operative TPS. The secondary outcomes included exploring the rate of MRD1 and TPS symmetry after the operation. Results Forty patients were included in the final analysis. The mean MRD1 of the ptotic eye was 1.28 ± 0.78 mm, 2.79 ± 0.66 mm and 3.20 ± 0.67 mm before, after phenylephrine and after the operation, respectively. The mean TPS of the ptotic eye was 5.90 ± 1.86 mm, 3.96 ± 1.49 mm and 2.79 ± 1.63 mm before, after phenylephrine and after the operation, respectively. Changes in mean TPS after the phenylephrine test and post-operation were statistically significant (p < 0.001). The linear regression model revealed that the absolute change in TPS after phenylephrine drop and absolute change in MRD1 post-operation were significantly correlated with the absolute change in TPS post-operation. Besides, the ratio of symmetry in MRD1 and TPS was greatly improved post-operation (82.5% and 70.0% respectively). Conclusion MMCR is an effective surgical method for ptosis correction as it can not only correct the eyelid crease position but also narrow the wide TPS. This method is particularly beneficial to patients with both mild to moderate ptosis and an asymmetric crease height. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02605-6.
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Affiliation(s)
- Hung-Ju Chen
- Department of Ophthalmology, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist, Taichung, 407, Taiwan (R.O.C.)
| | - Chun-Yuan Wang
- Department of Ophthalmology, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist, Taichung, 407, Taiwan (R.O.C.)
| | - Yu-Fang Huang
- Department of Ophthalmology, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist, Taichung, 407, Taiwan (R.O.C.)
| | - Yu-Chieh Wu
- Department of Ophthalmology, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist, Taichung, 407, Taiwan (R.O.C.)
| | - Li-Chen Wei
- Department of Ophthalmology, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist, Taichung, 407, Taiwan (R.O.C.).
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American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline: Eyelid Surgery for Upper Visual Field Improvement. Plast Reconstr Surg 2022; 150:419e-434e. [PMID: 35895522 DOI: 10.1097/prs.0000000000009329] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A group of experts from different disciplines was convened to develop guidelines for the management of upper visual field impairments related to eyelid ptosis and dermatochalasis. The goal was to provide evidence-based recommendations to improve patient care. METHODS A multidisciplinary group of experts representing their specialty organizations was selected. A systematic literature review was performed including topics regarding documentation of the underlying cause for visual field impairment, selection of an appropriate surgical repair, assessment of the type of anesthesia, the use of adjunctive brow procedures, and follow-up assessments. The Grading of Recommendations, Assessment, Development, and Evaluation methodology process was used to evaluate the relevant studies. Clinical practice recommendations were developed using BRIDGE-Wiz (Building Recommendations In a Developers' Guideline Editor) software. RESULTS Each topic area was assessed. A clinical recommendation was made, and the relevant literature was discussed. CONCLUSIONS The review of the literature revealed varied complication rates and diverse treatment modalities for the correction of upper visual field deficit. Strong recommendations could not be made in most topic areas because of a paucity of methodologically sound studies in the literature. More rigorously designed studies are needed to measure outcomes of interest, with fewer sources of potential error or bias. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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"Predicting Facial Changes After Blepharoplasty". J Plast Reconstr Aesthet Surg 2022; 75:3499-3505. [PMID: 35752591 DOI: 10.1016/j.bjps.2022.04.066] [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: 03/26/2021] [Revised: 03/14/2022] [Accepted: 04/26/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The primary goal of blepharoplasty for blepharoptosis and blepharochalasis is to elevate the upper eyelid to restore a full field of vision, although many surgeons also aim to provide a better aesthetic outcome. Several facial configuration changes may occur following blepharoplasty. This study examined the effectiveness of vessel clips to preoperatively predict facial configuration alterations. METHODS We retrospectively enrolled 93 consecutive patients who underwent blepharoplasty correction for blepharoptosis and blepharochalasis with eyebrow elevation. Frontal portrait images were taken at the initial examination without load, preoperatively with vessel clips, and without load at 6 months postoperatively for evaluations of eyebrow height, forehead wrinkle length, and procerus area wrinkle length. Subjective outcomes were also surveyed by questionnaires and interviews at 6 months post-surgically. RESULTS No significant differences were detected between preoperative measurements with vessel clips and recordings at 6 months postoperatively. Significant correlations were identified among the addition/reduction values for preoperative and postoperative measurements (eyebrow height and forehead wrinkle length: r=0.402, p<0.001; eyebrow height and procerus area wrinkle length: r=-0.327, p<0.01; forehead wrinkle length and procerus area wrinkle length: r=-0.488, p<0.001). Women more frequently described notable changes in wrinkles than men. CONCLUSIONS Postoperative facial change outcomes for blepharoplasty may be predicted using the simple but effective vessel clip test. A better understanding of surgical results can relieve patient anxiety and contribute to increased satisfaction.
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Nichols KK, Malloy KA, Karpecki PM, Bacharach J, Douglas RS, Foster S, Gromacki SJ, Whitley WO. Topical Review: An Update of Diagnostic and Management Algorithms for Acquired Blepharoptosis. Optom Vis Sci 2022; 99:230-240. [PMID: 35058403 DOI: 10.1097/opx.0000000000001868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE Acquired ptosis is a condition of the upper eyelid that has negative cosmetic and functional effects but is likely underdiagnosed and undertreated. Given the evolving understanding of the condition and expanding therapeutic options, this review reappraised published evidence and clinical experience regarding diagnosis and treatment of acquired ptosis.The authors met over two structured virtual working sessions to review current evidence and develop timely recommendations for acquired ptosis identification, differential diagnosis, characterization, and treatment selection. Diagnostic algorithms, plus management and referral guidelines, are presented. Eyelid evaluation and, when needed, ptosis diagnostic workup are essential in the comprehensive eye examination. Acquired ptosis can be efficiently identified via patient questionnaire, history, and photograph review combined with assessment of eyelid position and symmetry using established methods. When ptosis is present, it is essential to evaluate onset, symptoms, pupil diameter, and extraocular muscle function to identify or rule out serious underlying conditions. If signs of serious underlying etiology are present, immediate referral/follow-up testing is required. After ruling out serious underlying causes, masquerade conditions, and pseudoptosis, pharmacologic or surgical treatment should be selected based on the clinical evidence. Effectively managing acquired ptosis requires practice-wide commitment to thorough eyelid evaluation, accurate diagnosis, and adoption of new treatment modalities. Aided by evolving pharmacologic therapeutic options, shifting from a "detect and refer" to a "diagnose and manage" approach can support identification and treatment of more patients with acquired ptosis, particularly mild-to-moderate cases.
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Affiliation(s)
| | - Kelly A Malloy
- The Eye Institute of the Pennsylvania College of Optometry, Salus University, Philadelphia, Pennsylvania
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Nilforoushzadeh MA, Heidari‐Kharaji M, Behrangi E, Lotfi E, Roohaninasab M, Nouri M, Nobari NN. Effect of Endolift Laser on Upper Eyelid and Eyebrow Ptosis Treatment. J Cosmet Dermatol 2022; 21:3380-3385. [DOI: 10.1111/jocd.14798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Mohammad Ali Nilforoushzadeh
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran Iran
- Jordan Dermatology and Hair Transplantation Center Tehran Iran
| | - Maryam Heidari‐Kharaji
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran Iran
- Jordan Dermatology and Hair Transplantation Center Tehran Iran
- Institut National de la Recherche Scientifique (INRS) Centre Armand‐Frappier Santé Biotechnologie (CAFSB) Laval Quebec Canada
| | - Elham Behrangi
- Department of Dermatology Rasool Akram Medical Complex Iran University of Medical Sciences Tehran Iran
| | - Elaheh Lotfi
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran Iran
| | - Masoumeh Roohaninasab
- Department of Dermatology Rasool Akram Medical Complex Iran University of Medical Sciences Tehran Iran
| | - Maryam Nouri
- Skin and Stem Cell Research Center Tehran University of Medical Sciences Tehran Iran
- Jordan Dermatology and Hair Transplantation Center Tehran Iran
| | - Niloufar Najar Nobari
- Department of Dermatology Rasool Akram Medical Complex Iran University of Medical Sciences Tehran Iran
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Objective quantification of the impact of blepharoplasty on the superior visual field. Arch Plast Surg 2022; 49:19-24. [PMID: 35086303 PMCID: PMC8795654 DOI: 10.5999/aps.2021.01109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/06/2021] [Indexed: 11/14/2022] Open
Abstract
Background Blepharoplasty has both aesthetic and functional benefits in patients with pseudoptosis; however, previous studies could not demonstrate its beneficial effects quantitatively and objectively. The authors objectively analyzed the visual field before and after surgery and investigated whether measurements of the visual field can be applied as a suitable predictor of surgical outcomes. Methods In total, 18 eyelids in nine patients with pseudoptosis who had undergone simple skin excision blepharoplasty were evaluated prospectively from February to May 2016. The visual fields were analyzed preoperatively and 3 months postoperatively using the Goldmann kinetic perimetry test. The visual field test area was assessed using Adobe Photoshop. Results Blepharoplasty had an average 4.99-fold beneficial effect on the superior visual field. In particular, more improvement was seen in the superior temporal quadrant than in the nasal quadrant. No correlation was found between the preoperative margin-to-reflex distance 1 (MRD1) and the surgical outcome (P=0.119). However, there was a strong correlation between the preoperative superior visual field and the surgical outcome (P=0.001). Conclusions Using the Goldmann kinetic perimetry test, we objectively and quantitatively proved the beneficial effect of blepharoplasty on patients with pseudoptosis. Furthermore, we demonstrated that the preoperative visual field is a better preoperative surgical outcome predictive factor than the preoperative MRD1.
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Nestor MS, Han H, Gade A, Fischer D, Saban Y, Polselli R. Botulinum toxin-induced blepharoptosis: Anatomy, etiology, prevention, and therapeutic options. J Cosmet Dermatol 2021; 20:3133-3146. [PMID: 34378298 PMCID: PMC9290925 DOI: 10.1111/jocd.14361] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
Background Botulinum toxin A (BoNT‐A) has grown tremendously in aesthetic dermatology since 2002 when the United States Food and Drug Administration (FDA) first approved its use for treating moderate‐to‐severe glabellar lines. Blepharoptosis, due to local spread of toxin, is a reported side effect of BoNT‐A which, although rare, more frequently occurs among inexperienced practitioners. Objectives The purpose of this review is to highlight the causes and management of eyelid ptosis secondary to BoNT‐A administration including new anatomic pathways for BoNT‐A spread from the brow area to the levator palpebrae superioris muscle. Methods A literature search was conducted using electronic databases (PubMed, Science Direct, MEDLINE, Embase, CINAHL, EBSCO) regarding eyelid anatomy and the underlying pathogenesis, presentation, prevention, and treatment of eyelid ptosis secondary to BoNT‐A. Anatomic dissection has been performed to assess the role of neurovascular pedicles and supraorbital foramen anatomic variations. Results Blepharoptosis occurs due to weakness of the levator palpebrae superioris muscle. Mean onset is 3–14 days after injection and eventually self‐resolves after the paralytic effect of BoNT‐A wanes. Administration of medications, such as oxymetazoline hydrochloride or apraclonidine hydrochloride eye drops, anticholinesterase agents, or transdermal BoNT‐A injections to the pre‐tarsal orbicularis, can at least partially reverse eyelid ptosis. Anatomic study shows that a supraorbital foramen may be present in some patients and constitutes a shortcut from the brow area directly into the orbital roof, following the supraorbital neurovascular pedicle. Conclusion Providers should understand the anatomy and be aware of the causes and treatment for blepharoptosis when injecting BoNT‐A for the reduction of facial wrinkles. Thorough anatomic knowledge of the supraorbital area and orbital roof is paramount to preventing incorrect injection into “danger zones,” which increase the risk of eyelid ptosis.
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Affiliation(s)
- Mark S Nestor
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Haowei Han
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA
| | - Anita Gade
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA
| | - Daniel Fischer
- Center for Clinical and Cosmetic Research, Aventura, Florida, USA
| | - Yves Saban
- Facial Plastic and Maxillofacial Surgery, Facial Anatomist, Nice, France.,European Academy of Facial Plastic Surgery (EAFPS), Lübeck, France.,Rhinoplasty Focus Group, Chennai, India
| | - Roberto Polselli
- Ear Nose Throat, Facial Plastic Surgery, Private Practice in Marina di Carrara, Marina di Carrara, Italy
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Bacharach J, Lee WW, Harrison AR, Freddo TF. A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options. Eye (Lond) 2021; 35:2468-2481. [PMID: 33927356 PMCID: PMC8376882 DOI: 10.1038/s41433-021-01547-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/15/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
Blepharoptosis (ptosis) is among the most common disorders of the upper eyelid encountered in both optometric and ophthalmic practice. The unilateral or bilateral drooping of the upper eyelid that characterises ptosis can affect appearance and impair visual function, both of which can negatively impact quality of life. While there are several known forms of congenital ptosis, acquired ptosis (appearing later in life, due to a variety of causes) is the predominant form of the condition. This review summarises the prevalence, causes, identification, differential diagnosis, and treatment of acquired ptosis. Particular attention is paid to the differential diagnosis of acquired ptosis and emerging treatment options, including surgical and pharmacologic approaches.
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Affiliation(s)
| | - Wendy W Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew R Harrison
- Department of Ophthalmology and Visual Neurosciences, Department of Otolaryngology, University of Minnesota, Minneapolis, MN, USA
| | - Thomas F Freddo
- Massachusetts College of Pharmacy and Health Sciences, Worcester, MA, USA
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Sithole HL. Understanding vernal keratoconjunctivitis in children. AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Vernal keratoconjunctivitis (VKC) is a public health problem that mostly affects children in warm subtropical climates. Unfortunately, the causative factors of the disease are not clearly defined, thus posing a serious management challenge to healthcare providers. It is therefore argued that understanding the pathogenesis of the disease and how various inflammatory cells affect the conjunctiva and the cornea may assist in the management of the disease.Aim: As visual impairment and avoidable blindness are indicated, it is advisable for optometrists to understand the clinical presentation of this chronic condition in order to initiate appropriate interventions and/or immediate referrals where necessary.Methods: A thorough literature search was conducted on peer-reviewed publications on VKC and children. All material obtained were then studied and the information extracted was used to document relevant information required for understanding VKC amongst children.Results: The results in the studied material revealed that VKC was prevalent amongst children aged 2 to 18 years, affecting mostly male children of African and Indian origins. Different strategies of management of the disease have been proposed, including but not limited to explaining to parents the nature of the disease, environmental strategies and preventive measures as well as possible surgical intervention.Conclusion: In view of the nature of this disease, healthcare providers should therefore seek to understand the history of the patient better when such patients present for their first consultation in order to develop a comprehensive management approach.
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Abstract
INTRODUCTION Several factors may influence aesthetic outcomes of ptosis surgery, especially in patients with asymmetrical ptosis. We retrospectively assessed the effect of Hering's law on surgical outcomes of patients with asymmetrical ptosis. METHODS Patients with mild to moderate asymmetrical ptosis (N = 300) who underwent advancement or plication of upper eyelid aponeurosis between January 2014 and July 2016 were enrolled. Fifty patients (group A) underwent surgery without taking into consideration the impact of Hering's law. Of these, 35 patients with unilateral ptosis (subgroup A1) underwent standard surgery on the contralateral side, whereas 15 patients with bilateral ptosis (subgroup A2) were first operated on the milder side followed by the more severely affected side.In 250 patients (group B), surgery was performed taking cognizance of the implications of Hering's law. These included 100 patients with unilateral ptosis (B1) and 150 with bilateral ptosis (B2). Difference in bilateral palpebral fissure symmetry by less than 0.5 mm was considered as satisfactory outcome. RESULTS Duration of postoperative follow-up ranged from 3 to 24 months. Satisfactory outcomes were achieved over 60% of patients in group A (A1, 60.6%; A2, 66.67%) and in 96% of patients in group B (B1, 95%; B2, 96.67%). Patients with unsatisfactory outcomes underwent repair according to Hering's law after 3 months and obtained good results. CONCLUSIONS Application of Hering's law may improve outcomes of corrective surgery in patients with asymmetric ptosis.
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Oh JK, Winn BJ, Dagi Glass LR. Young Woman Referred for a Drooping Eyelid. JAMA FACIAL PLAST SU 2018; 20:515-516. [PMID: 30128542 DOI: 10.1001/jamafacial.2018.0740] [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]
Affiliation(s)
- Jin Kyun Oh
- SUNY Downstate College of Medicine, Brooklyn, New York
| | - Bryan J Winn
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York
| | - Lora R Dagi Glass
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York
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Ali F, Khan MS, Sharjeel M, Din ZU, Murtaza B, Khan A. Efficacy of brow suspension with autogenous fascia lata in simple congenital ptosis. Pak J Med Sci 2017; 33:439-442. [PMID: 28523052 PMCID: PMC5432719 DOI: 10.12669/pjms.332.11521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: To assess the mean change in interpalpebral fissure height and marginal reflex distance after brow suspension with autogenous fascia lata sling in patients of ptosis. Methods: This was a Quasi experimental study conducted at Department of Ophthalmology, Mayo Hospital, King Edwards Medical University Lahore, from Jan 2013 to June 2016. Included were the patients who had unilateral or bilateral ptosis with poor levator function (< 5 mm). Informed consent was obtained from all patients after explaining about the research project. Patients were admitted in ward and all of them underwent surgery by a single surgical team. The surgical procedure was performed in supine position under general anesthesia in children and uncooperative patients. Patients were followed at week 4, 8, 12 and 24 to observe vertical interpalpebral fissure height and marginal reflex distance. Results: The mean age of the patients was 9.03 ± 5.26 years. The mean Inter palpebral fissure height (IPFH) was 4.40±0.91 mm and mean MRD was 0.50 ± 1.00 mm before surgery while after surgery it was 7.41±0.76 mm and 3.10 ± 1.50 mm respectively at 04 weeks. The mean IPFH and MRD at 24 weeks postoperatively were 8.43±0.98 mm and 3.60 + 1.50 mm respectively. The mean change in IPFH and MRD at 24th week, were 3.90 ± 0.34 mm and 3.50 ± 1.00 mm. Conclusion: Brow suspension with fascia lata sling is safe and effective technique for correction of ptosis with poor levator function.
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Affiliation(s)
- Farhan Ali
- Dr. Farhan Ali, MBBS, FCPS. Mayo Hospital, King Edwards Medical University, Lahore, Pakistan
| | - Muhammad Saim Khan
- Dr. Muhammad Saim Khan, MBBS, FCPS, FICO, MRCSEd. Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan
| | - Muhammad Sharjeel
- Dr. Muhammad Sharjeel, MBBS, FCPS. Mayo Hospital, King Edwards Medical University, Lahore, Pakistan
| | - Zaheer Ud Din
- Dr. Zaheer Ud Din, MBBS, FCPS. Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan
| | - Bilal Murtaza
- Dr. Bilal Murtaza, MBBS. Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan
| | - Asfandyar Khan
- Dr. Asfandyar Khan, MBBS, FCPS. Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan
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Abstract
BACKGROUND Traditional descriptions of blepharoplasty and ptosis surgery focus on the incision and eyelid crease. However, it may be more useful to consider the tarsal platform show as the important construct in analyzing and planning aesthetic eyelid surgery. METHODS In order to measure and characterize the key contours of the eyelid, the authors find it helpful to consider the brow fat span, tarsal platform show, and margin reflex distance. RESULTS Subtle eyelid ptosis can result in asymmetry by lengthening the tarsal platform show, and it is exacerbated by the tendency for the eyebrow to compensate. When ptosis is asymmetric, the plan should usually include asymmetric ptosis surgery. There are two general patterns that can be recognized and used for planning to address preoperative tarsal platform show asymmetry. If the tarsal platform show is longer on the side with worse blepharoptosis, then asymmetric or unilateral ptosis surgery will improve symmetry. In the cases of symmetric show despite asymmetric blepharoptosis, there may be bony and soft-tissue asymmetry, which leads to crowding of the orbit on the more ptotic side. Surgical planning should include consideration to increase the tarsal platform show on the more crowded side. It is not necessary to cut the eyelid skin in order to alter the tarsal show and brow fat span; ptosis surgery alone, by altering the eyelid position and eyebrow compensation, can reset the tarsal platform show/brow fat span relationship. CONCLUSIONS It is important to recognize preoperative asymmetry, to predict the resetting of compensatory mechanisms, and to design asymmetric surgery, in order to maximize postoperative symmetry.
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Affiliation(s)
- Colin W McInnes
- Section of Plastic Surgery (McInnes); Department of Ophthalmology (Lee-Wing), University of Manitoba, Winnipeg, Man.
| | - Matthew Lee-Wing
- Section of Plastic Surgery (McInnes); Department of Ophthalmology (Lee-Wing), University of Manitoba, Winnipeg, Man
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Eye Dominance and Hering’s Law Effect on Bilateral Blepharotosis Repair. Ophthalmic Plast Reconstr Surg 2013; 29:437-9. [DOI: 10.1097/iop.0b013e31829d02e8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effect of brow lifting using botulinum a toxin on upper eyelid height in patients with ptosis undergoing the frontal sling technique. Ann Plast Surg 2012; 70:175-9. [PMID: 22791060 DOI: 10.1097/sap.0b013e31823b680a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In this study, brow lifting with botulinum A toxin was performed on patients whose ptosis was corrected using the frontal sling technique, and the effects of this application on ptosis were investigated. Seven patients (with 12 eyelids) on whom the frontal sling procedure was performed using a tensor fascia lata graft were enrolled in the study. The patients underwent brow lifting using botulinum A toxin. Digital photographs of the patients were obtained before and 21 days after botulinum A injection. In digital imaging analysis, although a statistically significant elevation was detected in the eyelids and brows of the patients following botulinum A injection, it did not to lead to a significant difference in the degree of lagophthalmos. In the current study, this procedure was found to reduce the degree of ptosis without increasing the degree of lagophthalmos in patients who had previously undergone ptosis correction using the frontal sling.
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Zoumalan CI, Lisman RD. Commentary on: Anthropometry of the eyelid and palpebral fissure in an Indian population. Aesthet Surg J 2011; 31:295-6. [PMID: 21385739 DOI: 10.1177/1090820x11398477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Christopher I Zoumalan
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, New York University School of Medicine, New York, USA
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