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Kotb AN, Soliman NM, Raza A, Nour NA, Mattout HK. Sling for the sling: a new technique for long-term correction of severe congenital ptosis. BMC Ophthalmol 2024; 24:112. [PMID: 38454351 PMCID: PMC10921586 DOI: 10.1186/s12886-024-03371-3] [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: 08/15/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Severe congenital ptosis poses a complex challenge for oculoplastic surgeons, requiring meticulous surgical intervention to restore eyelid function and improve aesthetic outcomes mainly by using frontalis sling approach. A crucial issue in frontalis sling surgeries is the sustainability of effect. PURPOSE This retrospective study reports the outcomes of two surgical techniques for treating severe congenital ptosis in the paediatric age group: Silicon rods ptosis sling and a novel technique involving the use of Silicon rods with green braided polyester (Ethibond) sutures to secure the rods in place "sling for the sling". METHODS The medical records of children who underwent frontalis suspension were reviewed in a retrospective fashion. We identified two groups; the first group (20 patients: 35 eyelids) had the traditional frontalis suspension surgery using silicone suspension set, the second group (14 patients: 25 eyelids) was operated using the new "sling for sling" technique. We used the postoperative marginal reflex distance-1 (MRD-1) as the primary outcome measure while the frequency of both wound related complications and recurrence were considered as secondary outcome measures. Post operative data were collected and compared after 1 month, 6 months, 12 months, and 18 months. RESULTS Preliminary results indicate promising outcomes for both techniques, with significant improvement in eyelid elevation observed in both groups. However, the novel technique using Silicon rods with Ethibond sutures demonstrated enhanced sustainability, leading to a more durable outcome with significantly less recurrence. CONCLUSION This study highlights the potential benefits of the novel technique in treating severe congenital ptosis and introduces an innovative approach to Silicone rods fixation to achieve a long-term corrective effect.
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Affiliation(s)
- Ahmed N Kotb
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Noha M Soliman
- Institute of Ophthalmology, University College London, London, UK.
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
| | - Ahmer Raza
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Noran A Nour
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala K Mattout
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Tan Y, Wang X, Fu J, Tang J, Xiang J, Tao L, Luo Y. Amblyopic astigmatism characteristics and surgical outcomes in younger children with severe congenital ptosis after frontalis suspension surgery. BMC Ophthalmol 2023; 23:54. [PMID: 36750792 PMCID: PMC9903475 DOI: 10.1186/s12886-023-02804-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND To examine the astigmatism characteristics and surgical outcomes in patients with unilateral severe congenital ptosis following frontalis suspension surgery. METHODS We included 53 congenital ptosis patients who underwent frontalis suspension surgery in Hunan Children's Hospital. Each patient underwent a refractive examination before and after surgery to assess astigmatism. We also evaluated the effects and complications associated with the procedure. RESULTS Degree of astigmatism in ptotic and fellow eyes was - 1.45 ± 0.59 D and - 0.66 ± 0.51 D before surgery. Ratio of severe astigmatism in ptotic and fellow eyes was 51.3 and 12.8%. The fellow eyes presented with with-the-rule astigmatism (WR; 71.8%) and against-the-rule astigmatism (AR; 20.5%) types, with no cases of oblique astigmatism (OA). Ptotic eyes demonstrated higher frequencies of AR (59.0%) and OA (10.2%) than did fellow eyes. Furthermore, the former showed increased astigmatism, followed by a gradual decrease at the 6-month, before significantly decreasing at the 1-year postoperatively. The ratio of postoperative AR and OA astigmatism cases in ptotic eyes decreased to 35.9 and 7.7% 1 month postoperatively. However, there was a postoperative increase in the WR ratio from 30.8 to 56.4% after 1 month. Kaplan-Meier survival analysis showed a success rate of 81.4% at 6 months and 62.9% at 12 months which was influenced by the following complications: suture reaction, epithelial keratopathy, infection and granuloma, lid lag, and recurrence. CONCLUSION Monocular congenital ptosis could develop severe astigmatism and higher frequency of AR or OA, early surgery may ameliorate astigmatic amblyopia.
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Affiliation(s)
- Yilan Tan
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Xilang Wang
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Jing Fu
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Jing Tang
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Jianbo Xiang
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Lijuan Tao
- grid.440223.30000 0004 1772 5147Department of Ophthalmology, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province China
| | - Yulin Luo
- Department of Ophthalmology, Hunan Children's Hospital, No. 86 Ziyuan Road, Changsha City, Hunan Province, China.
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Bai JS, Song MJ, Li BT, Tian R. Timing of Surgery and Treatment Options for Congenital Ptosis in Children: A Narrative Review of the Literature. Aesthetic Plast Surg 2023; 47:226-234. [PMID: 36114384 DOI: 10.1007/s00266-022-03039-7] [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: 05/15/2022] [Accepted: 07/21/2022] [Indexed: 11/01/2022]
Abstract
Congenital ptosis has varying degrees of impact on the visual development or psychological health of a child depending on its severity. Some controversies and misconceptions remain regarding the management of congenital ptosis in children. Particularly, the accurate diagnosis of the severity of congenital ptosis in younger children, assessment of the visual developmental status of the child, optimal timing of surgery, and treatment choice are still issues in clinical practice that need to be explored. This report presents a comprehensive review of these aspects of the correction of congenital ptosis to provide a valuable reference for clinical practice. Our review shows that currently used surgical procedures for ptosis may result in over- or under-correction to varying degrees. The differences may be due to the physical condition and age of the child and the degree of cooperation during preoperative examination and assessment, resulting in inaccurate results. Alternatively, intraoperative swelling and bleeding may lead to errors in the values recorded by the surgeon. 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)
- Jian-Shu Bai
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China
| | - Mei-Jiao Song
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China
| | - Bing-Tao Li
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China
| | - Rui Tian
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China.
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Qiu Y, Jin R, Dong X, Shen Y, Ding F, Deng Z, Zhou X, Ning Y, Yang J, Liu F. Conjoint fascial sheath suspension with levator muscle advancement for severe blepharoptosis. J Plast Surg Hand Surg 2023; 57:533-538. [PMID: 36661892 DOI: 10.1080/2000656x.2023.2168275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In patients with severe blepharoptosis, the function of the levator muscle is usually weak. Even if a large amount of levator is resected, under-correction and recurrence often occur postoperatively. Frontalis suspension is the first choice for severe ptosis; however, the external orbital lifting force of the frontalis causes non-physiological eyelid movement. Conjoint fascial sheath (CFS) is a fibrous tissue which can provide dynamic movement of upper eyelids and has been applied for the treatment of mild and moderate blepharoptosis in recent years. This study aims to assess the efficacy and safety of CFS suspension combined with levator muscle advancement for treating severe blepharoptosis. A retrospective study included 44 patients (60 eyelids) with severe ptosis who underwent the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 (MRD1) were measured. Surgical outcomes, symmetry results and complications were evaluated postoperatively. At the 12-18 months follow-up, adequate or normal correction was achieved in 56 eyelids (93.3%), and 37 patients (84.1%) presented good or fair symmetry results. The most common complication was conjunctival prolapse, which was observed in six eyelids (10.0%), followed by lid fold deformity and under-correction. No exposure keratitis was recorded. In conclusion, the modified technique can physically elevate the eyelid with limited tissue injury and is effective for the correction of severe ptosis. Both satisfactory functional and esthetic results were achieved, and severe complications (such as exposure keratitis) were not observed.
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Affiliation(s)
- Yucheng Qiu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Rui Jin
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xue Dong
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yirui Shen
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Feixue Ding
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhizhong Deng
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xianyu Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Youcong Ning
- The First People's Hospital of the Lancang Lahu Autonomous County, Yunnan, China
| | - Jun Yang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fei Liu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Hendricks TM, Griepentrog GJ, Hodge DO, Mohney BG. Psychosocial and mental health disorders among a population-based, case-control cohort of patients with congenital upper eyelid ptosis. Br J Ophthalmol 2023; 107:12-16. [PMID: 34281901 PMCID: PMC9311484 DOI: 10.1136/bjophthalmol-2021-319276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIM Recent studies have demonstrated adverse psychosocial and mental health disorders among children with ocular disorders. The mental health burden of children with simple congenital ptosis, however, is unknown. The purpose of this study was to compare the psychosocial and mental health findings of children with simple congenital ptosis with controls. METHODS The medical records of all children (<19 years) diagnosed with simple congenital ptosis from 1 January 1965 through 31 December 2004 while residing in Olmsted County, Minnesota were retrospectively reviewed for psychosocial and mental health morbidity. One-to-one randomly selected age-matched and gender-matched controls from the same population were similarly reviewed. RESULTS 81 children with ptosis were diagnosed at a mean age of 3.2 years (range, 1 month-16 years), 35 (43.2%) of whom were girls. An adverse psychosocial development was diagnosed in 41 (50.6%) patients with simple congenital ptosis monitored to a mean age of 21.4 years, compared with 26 (32.5%) controls (p=0.02). A mental illness was diagnosed in 31 (38.3%) patients with ptosis compared with 16 (20%) controls (p=0.01). Children with ptosis were 2.5 times more likely than controls to develop a mental illness and 2.1 times more likely to develop a psychosocial maladjustment. Patients with ptosis were also significantly more likely to have more mental health disorders (p=0.02) and a longer duration of psychotropic medication use (p=0.005). CONCLUSIONS Children diagnosed with simple congenital ptosis in this population had significantly greater psychosocial and mental health morbidity compared with controls. Children with ptosis may benefit from early psychosocial intervention.
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Affiliation(s)
- Tina M Hendricks
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Gregory J Griepentrog
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David O Hodge
- Division of Biostatistics, Mayo Clinic, Jacksonville, Florida, USA
| | - Brian G Mohney
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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Wang NW, Georgara N, Khan HS. Shwachman-Diamond Syndrome With Congenital Myogenic Ptosis: Case Report of a Rare Association? J Pediatr Hematol Oncol 2022; 44:345-346. [PMID: 35482443 DOI: 10.1097/mph.0000000000002469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Shwachman-Diamond syndrome (SDS) is a multisystem disorder characterized by exocrine pancreatic insufficiency and bone marrow failure. There is considerable variation in the phenotypes of SDS. We present a case of an infant presenting with SDS and left-sided ptosis. OBSERVATION We report a case of an infant who presented with 2 episodes of severe sepsis and cytopenia, without overt symptoms of exocrine pancreatic deficiency or skeletal abnormalities. Persistent left-sided ptosis was noted in both presentations. Genetic testing confirmed the diagnosis of SDS. The left-sided ptosis was diagnosed as congenital myogenic ptosis. CONCLUSION The association of ptosis and other congenital bone marrow failure syndromes is well established, but this is the first description of SDS with ptosis. This association may expand our understanding of SDS phenotypes if similar cases are reported in the future.
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Affiliation(s)
| | - Natalia Georgara
- Department of Pediatrics, Hull University Teaching Hospitals, NHS Trust, Hull, UK
| | - Haji S Khan
- Department of Pediatrics, Hull University Teaching Hospitals, NHS Trust, Hull, UK
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7
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Conjoint Fascial Sheath Suspension for Severe Blepharoptosis through Palpebral Margin Incision. Aesthetic Plast Surg 2022; 46:2301-2309. [PMID: 35166873 DOI: 10.1007/s00266-022-02771-4] [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: 11/03/2021] [Accepted: 01/02/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Conjoint fascial sheath suspension can achieve pleasing surgical efficacy and dynamic eyelid movement in the treatment of severe ptosis. In recent years, the palpebral margin incision technique has been applied for double-eyelid blepharoplasty, which is characterized by inconspicuous scarring, short convalescence, and natural-looking outcome. However, studies of the application of this technique in the treatment of ptosis are scarce. This article aims to evaluate the efficacy and safety of conjoint fascial sheath suspension for treating severe blepharoptosis through palpebral margin incision. METHODS From March 2019 to January 2021, 32 patients (37 eyelids) underwent treatment with the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 were documented. Correction effects, symmetry results, and complications were also evaluated postoperatively. RESULTS Adequate or normal correction was achieved in 33 eyelids (89.2%), and 31 patients (96.9%) obtained good or fair symmetry results. Common complications were undercorrection and conjunctival prolapse, which were both observed in four eyelids (10.8%), followed by overcorrection and hematoma. CONCLUSIONS The modified technique provides physical eyelid elevation and inconspicuous scarring and is effective for treating severe ptosis. Satisfactory functional and esthetic results could be obtained simultaneously without severe 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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Mattout HK, Fouda SM, Hemeda S. The Combined Use of Silicone and Green Braided Polyester Suture (Ethibond) versus Silicone or Ethibond Alone for Frontalis Suspension Surgery in Children. Clin Ophthalmol 2022; 16:339-347. [PMID: 35173412 PMCID: PMC8841597 DOI: 10.2147/opth.s353369] [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: 12/17/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Hala K Mattout
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Correspondence: Hala K Mattout, Email ;
| | - Sameh M Fouda
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sahar Hemeda
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Lim HK, Lau AZ, Charles WN, Khajuria A. Efficacy and Complications of External and Internal Pediatric Blepharoptosis Repair Techniques: A Systematic Review. Ophthalmic Plast Reconstr Surg 2022; 38:1-7. [PMID: 33782331 DOI: 10.1097/iop.0000000000001974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review and evaluate the efficacy and complication rates of external and internal blepharoptosis repair techniques in pediatric patients. METHODS The systematic review protocol was published on PROSPERO (CRD42020197343). Embase, MEDLINE, CENTRAL, and ClinicalTrials.gov were searched without date limitations. Two independent reviewers evaluated the articles for inclusion. Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS-I tool, respectively. RESULTS Of 2,228 articles screened, 23 studies involving 730 patients were included. There were 20 case series and 3 retrospective cohort studies, but no randomized controlled studies. Overall study quality was low with serious risk of bias according to the GRADE and ROBINS-I criteria, respectively. External levator resection was the most studied procedure, evaluated in 18 studies. Seven studies investigated internal approaches including the Fasanella-Servat procedure. There was no standardized evaluation of surgical efficacy. Reoperation rates were 16.6% (range 3.6-50.9%) for external levator resection compared with 22.2% (range 0.0-25.8%) for internal approaches. The commonest postoperative complications were not sight-threatening. The most consistently reported complication was undercorrection, occurring at rates of 8.4% (range 2.4-16.7%) and 15.3% (range 2.7-75.0%) for external levator resection and internal approaches, respectively. There were no consistently applied, validated patient-reported outcomes or cosmetic outcomes. CONCLUSIONS External and internal approaches have been successfully employed in pediatric blepharoptosis repair. However, noncomparative designs and risk-of-bias limit existing studies. Thus, prospectively designed studies with standardized outcome measures are required to minimize reporting bias, facilitate evidence synthesis, and support clinical decision making.
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Affiliation(s)
- Hong Kai Lim
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, United Kingdom
| | - Ashton Z Lau
- The Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Walton N Charles
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ankur Khajuria
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Nuffield Department of Surgical Sciences, Kellogg College, University of Oxford, Oxford, United Kingdom
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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: 28] [Impact Index Per Article: 9.3] [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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Ueno K, Shirakawa Y, Wada Y, Uemura K, Kumegawa S, Iwanishi H, Saika S, Asamura S. Frontalis suspension procedure with an upper retroauricular fascia graft: a preliminary case report. Int J Ophthalmol 2020; 13:2012-2014. [PMID: 33344204 DOI: 10.18240/ijo.2020.12.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/12/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kazuki Ueno
- Department of Plastic and Reconstructive Surgery, Graduate School of Wakayama Medical University, Wakayama City, Wakayama 6410012, Japan
| | - Yuji Shirakawa
- Department of Plastic and Reconstructive Surgery, Graduate School of Wakayama Medical University, Wakayama City, Wakayama 6410012, Japan
| | - Yoshitaka Wada
- Department of Plastic and Reconstructive Surgery, Graduate School of Wakayama Medical University, Wakayama City, Wakayama 6410012, Japan
| | - Kazuhisa Uemura
- Department of Plastic and Reconstructive Surgery, Graduate School of Wakayama Medical University, Wakayama City, Wakayama 6410012, Japan
| | - Shinji Kumegawa
- Department of Plastic and Reconstructive Surgery, Graduate School of Wakayama Medical University, Wakayama City, Wakayama 6410012, Japan
| | - Hiroki Iwanishi
- Department of Ophthalmology, Graduate School of Wakayama Medical University, Wakayama City, Wakayama 6410012, Japan
| | - Shizuya Saika
- Department of Ophthalmology, Graduate School of Wakayama Medical University, Wakayama City, Wakayama 6410012, Japan
| | - Shinichi Asamura
- Department of Plastic and Reconstructive Surgery, Graduate School of Wakayama Medical University, Wakayama City, Wakayama 6410012, Japan
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12
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Quaranta‐Leoni FM, Secondi R, Quaranta‐Leoni F, Nardoni S. Histological findings of levator muscle in unilateral congenital ptosis in different age groups. Acta Ophthalmol 2020; 98:e363-e367. [PMID: 31654462 DOI: 10.1111/aos.14284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/28/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the different degree of muscle atrophy in specimens of levator muscle of patients operated on for unilateral congenital ptosis, as related to the age of the patient. METHODS Histological analysis of the specimen of the levator muscle of 29 patients who underwent a unilateral levator muscle resection under the care of one surgeon was performed. The study population was divided into two different groups according to the timing of surgery: group 1 included 15 children operated on at 2 to 4 years, and group 2 included 14 children operated on at 4.1 to 11 years. RESULTS Levator muscle of 12 patients of group 1 showed mild degree of muscle atrophy, with striated muscle fibres separated by thin fibrous septa incorporating groups of cells with peripheral nuclei and non-hyalinized cytoplasm (Masson's trichrome stain). In eight cases of group 2, levator muscle showed instead severe atrophy, with discontinuous striated muscle fibres separated by thick fibrous septa including cells with centralization of nuclei, hyalinization of cytoplasm (Masson's trichrome stain) and fatty infiltration. CONCLUSION Myofibres found in specimens of levator muscle following levator resection for congenital ptosis show characteristics of a degenerative process. This study seems to demonstrate that atrophy in the levator muscle appears to be related to the age of the patient at surgery, as atrophy tends to be more evident in older children with congenital ptosis.
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Affiliation(s)
- Francesco M. Quaranta‐Leoni
- Oftalmoplastica Roma Rome Italy
- Orbital and Adnexal Service Department of Ophthalmology Villa Tiberia Hospital – GVM Care & Research Rome Italy
| | | | | | - Stefano Nardoni
- Department of Pathology San Filippo Neri Hospital Rome Italy
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Rosenberg JB, Andersen J, Barmettler A. Types of materials for frontalis sling surgery for congenital ptosis. Cochrane Database Syst Rev 2019; 4:CD012725. [PMID: 31013353 PMCID: PMC6478334 DOI: 10.1002/14651858.cd012725.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Congenital ptosis is a drooping of one or both eyelids at birth, often due to poor development of the levator palpebrae superioris muscle. This can result in amblyopia, astigmatism, and ocular torticollis and therefore may necessitate surgical intervention in early childhood if visual development is compromised. Patients may have varied levels of levator function. Those with moderate to good function may elect to first attempt ptosis repair with external levator advancement or mullerectomy/Fasanella-Servat procedures. For those with poor function, those procedures are less likely to be effective, so they may undergo frontalis sling surgery, in which the tarsal plate is coupled to the frontalis muscle, so that movement of the brow and forehead result in movement of the eyelid. The optimal material to use in this surgery is unknown. OBJECTIVES To evaluate the comparative effectiveness and safety of various materials used in frontalis sling surgery for congenital ptosis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (June 2018), Ovid MEDLINE, Ovid MEDLINE E-pub Ahead of Print, Ovid Medline In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to 20 June 2018), Embase (January 1947 to 20 June 2018), PubMed (1948 to 20 June 2018), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to 20 June 2018), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 20 June 2018. SELECTION CRITERIA We included randomized trials that compared one material to another for the treatment of congenital ptosis. DATA COLLECTION AND ANALYSIS Two review authors independently completed eligibility screening, data abstraction, 'Risk of bias' assessment, and grading of the evidence. MAIN RESULTS We identified three randomized trials that had compared four different materials, two materials in each trial. The studies included a total of 160 participants. The surgical procedures compared were polytetrafluoroethylene (Gore-Tex), Ethibond suture, Mersilene mesh, and autogenous fascia lata.We judged all studies to be at unclear risk of bias due to incomplete reporting of methods and other methodological deficiencies.Because the three included studies compared different types of implants, we were unable to combine data in a meta-analysis. The limited data preclude any conclusion regarding the optimal implant for frontalis sling surgery.In terms of the primary outcome of functional success, this was defined as widening of the opening between eyelids, assessed either by grade or by millimeter measurement. Bajaj 2004 showed that 93% of the Gore-Tex group and 83% of the Ethibond group had a good or satisfactory outcome (as defined by investigators). Elsamkary 2016 reported that 78.1% of the autogenous fascia group and 61.8% of the Gore-Tex group had a very good or good outcome. Salour 2008 did not include this type of grading system; they showed that the lid fissure increased 4.0 mm ± 1.46 mm in the Mersilene group and 3.13 mm ± 1.72 mm in the fascia lata group.In terms of adverse events, Bajaj 2004, which included 15 patients per group, showed no recurrence in the Gore-Tex group and 1 in the Ethibond group; no need for removal in the Gore-Tex group and 1 in the Ethibond group; and no infections in the Gore-Tex group and 1 in the Ethibond group. Elsamkary 2016, which included 55 patients per group, had 3 recurrences in the fascia group and 6 in the Gore-Tex group; no need for removal in either group; and 1 infection in the fascia group and 2 in the Gore-Tex group. Salour 2008, which included 10 patients per group, had no recurrence, removals, or infections in either the Mersilene or the fascia group. AUTHORS' CONCLUSIONS The three trials included in this review evaluated four materials for frontalis sling surgery. Assessment of these three studies does not allow us to identify the optimal material. Future randomized trials should be rigorously designed so as to identify the best treatment for this condition.
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Affiliation(s)
- Jamie B Rosenberg
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Ophthalmology3332 Rochambeau Avenue, 3rd FloorBronxNYUSA10467
| | - James Andersen
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Ophthalmology3332 Rochambeau Avenue, 3rd FloorBronxNYUSA10467
| | - Anne Barmettler
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Ophthalmology3332 Rochambeau Avenue, 3rd FloorBronxNYUSA10467
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Son KY, Kim YD, Woo KI, Park KA. Clinical Outcomes and Refractive Error Characteristics in Patients with Congenital Blepharoptosis after Ptosis Repair Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.12.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ki Young Son
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Frontalis Muscle Flap Versus Maximal Anterior Levator Resection as First Option for Patients With Severe Congenital Ptosis. Ophthalmic Plast Reconstr Surg 2018; 34:565-569. [DOI: 10.1097/iop.0000000000001105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jamison A, Kemp EG, Drummond SR. Surgical intervention for paediatric blepharoptosis: a 6-year case series. Int Ophthalmol 2018; 39:1931-1938. [PMID: 30244388 DOI: 10.1007/s10792-018-1020-1] [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: 05/03/2018] [Accepted: 09/11/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To present our experience of paediatric blepharoptosis in a tertiary referral centre and evaluate the effectiveness of surgical intervention. METHODS A retrospective cohort study of all children receiving surgical blepharoptosis correction between 1/1/10 and 29/2/16. Children with pre-operative levator function (LF) ≥ 7 mm received levator resection, those with LF ≤ 4 mm received brow suspension, and in those children with LF of 5-6 mm, either levator resection or brow suspension was chosen depending on the degree of frontalis recruitment. RESULTS Ninety-five children (109 eyes, 64 boys) underwent blepharoptosis surgery within the study period. Mean (range) age at surgery was 5.9 (1.2-12.5) years. Seventy-nine (83.2%) had simple levator maldevelopment. Fifteen children were excluded due to inadequate follow-up. Of the remaining 80 children, 41 (51.2%) underwent levator resection, 27 (33.8%) underwent fascia lata brow suspension, and twelve (15.0%) underwent mersilene mesh brow suspension. Margin reflex distance-1 was greatest at 6-week follow-up with a small "lid drop" by 6-month follow-up in both the levator resection (0.9 mm pre-operatively, 3.1 mm at 6-week follow-up, 2.6 mm at 6-month follow-up) and fascia lata brow suspension (0.3 mm, 2.5 mm, 2.2 mm) groups. No immediate complications, and only two serious post-operative complications, were noted. One case of residual blepharoptosis was re-operated (fascia lata brow suspension). CONCLUSIONS Surgical correction of paediatric blepharoptosis is safe and, after an observed lid drop between 6-week and 6-month follow-up (not seen in the mersilene mesh brow suspension group), effect appears to be maintained to 6 months and beyond. Readily accessible orthoptic assessment would help identify children at risk of amblyopia, both pre-operatively and post-operatively.
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Affiliation(s)
- Aaron Jamison
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, Scotland, UK.
| | - Ewan G Kemp
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, Scotland, UK
- Ophthalmology Department, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Suzannah R Drummond
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, Scotland, UK
- Ophthalmology Department, Royal Hospital for Children, Glasgow, Scotland, UK
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Andersen J, Barmettler A, Rosenberg JB. Types of materials for frontalis sling surgery for congenital ptosis. Hippokratia 2017. [DOI: 10.1002/14651858.cd012725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- James Andersen
- Montefiore Medical Center, Albert Einstein College of Medicine; Department of Ophthalmology; 3332 Rochambeau Avenue, 3rd Floor Bronx NY USA 10467
| | - Anne Barmettler
- Montefiore Medical Center, Albert Einstein College of Medicine; Department of Ophthalmology; 3332 Rochambeau Avenue, 3rd Floor Bronx NY USA 10467
| | - Jamie B Rosenberg
- Montefiore Medical Center, Albert Einstein College of Medicine; Department of Ophthalmology; 3332 Rochambeau Avenue, 3rd Floor Bronx NY USA 10467
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Gazzola R, Piozzi E, Vaienti L, Wilhelm Baruffaldi Preis F. Therapeutic Algorithm for Congenital Ptosis Repair with Levator Resection and Frontalis Suspension: Results and Literature Review. Semin Ophthalmol 2017; 33:454-460. [PMID: 28296517 DOI: 10.1080/08820538.2017.1297840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Several treatments have been described for the treatment of congenital ptosis, but there are few studies that analyze the effectiveness of a therapeutic approach rather than a single technique. AIMS In this study, we aim to evaluate the effectiveness of our therapeutic algorithm, which relies on levator muscle resection and frontalis suspension with silicone rods, polytetrafluoroethylene (PTFE), or autologous fascia lata. METHODS We retrospectively analyzed all patients affected by congenital ptosis who underwent corrective surgery at a single department between January 1998 and January 2016. RESULTS A total of 116 procedures were performed in 86 patients, accounting for 35 levator resections, 67 frontalis suspensions, and 14 revisions. A satisfactory result was observed in 65 cases after one procedure (75.6%). Complications occurred in 13 cases after primary surgery (15.1%). Ptosis relapse was observed in 25 cases after primary procedure (21.5%). Frontalis suspension displayed a higher number of complications than levator resection (22.2% vs 3.1%, p=0.02). CONCLUSION Our therapeutic algorithm was effective in 75.6% after one procedure. Frontalis suspension procedures encountered a higher rate of complication than levator resection. Fascia lata should be preferred to silicon rods whenever possible due to the lower recurrence rate. These issues confirm the therapeutic algorithm, although larger prospective studies are necessary to validate our approach.
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Affiliation(s)
- Riccardo Gazzola
- a Plastic Surgery Department, Policlinico di Monza , Monza , Italy
| | - Elena Piozzi
- b Pediatric Ophtalmology Department , Ospedale Niguarda Cà Granda , Milan , Italy
| | - Luca Vaienti
- c Plastic Surgery Department , IRCCS Policlinico San Donato , San Donato Milanese , Italy
| | - Franz Wilhelm Baruffaldi Preis
- d Plastic and Reconstructive Surgery Service , Ospedale San Raffaele , Milan , Italy.,e Plastic and Reconstructive Surgery Department , IRCCS Istituto Ortopedico Galeazzi , Milan , Italy
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Ho YF, Wu SY, Tsai YJ. Factors Associated With Surgical Outcomes in Congenital Ptosis: A 10-Year Study of 319 Cases. Am J Ophthalmol 2017; 175:173-182. [PMID: 28040525 DOI: 10.1016/j.ajo.2016.12.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the 10-year results of surgery for congenital ptosis and identify factors associated with excellent outcomes and recurrence. DESIGN Retrospective, interventional case series. METHODS A retrospective analysis was conducted of 319 patients who underwent surgical correction at a tertiary medical center for congenital ptosis. The main outcome measures were postoperative surgical outcomes and recurrence rates. Excellent lid height was assessed as a marginal reflex distance (MRD) greater than 3 mm. Recurrence was defined as a lid height less than 50% of the initial postoperative lid height. RESULTS The overall surgical success rate was 97.2%. On multivariate analysis, 3 factors were significantly associated with a greater probability of achieving excellent lid height: treatment using levator muscle resection (LMR) (adjusted odds ratio [OR], 1.76; P = .04), better preoperative MRD (adjusted OR, 2.21; P < .001), and absence of Marcus Gunn (jaw-winking) syndrome (adjusted OR, 0.12; P = .01). For recurrence, 7 significant risk factors were identified: children less than 1 year old (adjusted OR, 4.92; P = .02), poorer preoperative MRD (adjusted OR, 0.64; P = .04), poorer postoperative MRD (adjusted OR, 0.32; P < .001), treatment with frontalis suspension (FS) (adjusted OR, 5.86; P < .001), wound infection (adjusted OR, 9.45; P = .02), postoperative entropion (adjusted OR, 11.25; P = .003), and conjunctival prolapse (adjusted OR, 7.10; P = .03). Kaplan-Meier analysis showed that the 1-, 5-, and 10-year recurrence-free rates were 97.3% ± 1.2%, 80.5% ± 4.4%, and 76.7% ± 5.6%, respectively, for the LMR group and 90.9% ± 3.1%, 42.9% ± 8.1%, and 20.8% ± 10.1%, respectively, for the FS group (P < .001, log-rank test). CONCLUSIONS Surgical treatment of congenital ptosis had a high success rate. Identifying the risk factors and taking appropriate measures may result in better surgical outcomes and less recurrence. Our retrospective study showed that the likelihood of achieving excellent outcomes with lower recurrence rates was higher with LMR than with FS. However, a prospective randomized study is necessary to clarify their efficacy.
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