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Chen L, Li J, Zhang C, Li Y, Hou L, Ma J. Surgical Interventions for Congenital Ptosis: a Systematic Review and Meta-analysis of 14 Randomized Controlled Trials. Aesthetic Plast Surg 2023; 47:1859-1869. [PMID: 37145320 DOI: 10.1007/s00266-023-03360-9] [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: 02/22/2023] [Accepted: 04/08/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Several types of surgeries have been used in the treatment of congenital ptosis, but the optimal methods and materials for this treatment are unknown. PURPOSE The study aims to evaluate the comparative effectiveness and safety of various surgical methods and materials for treatment of congenital ptosis. METHODS We performed comprehensive searches of five databases, two clinical trial registries and one gray literature database from inception to January 2022 for related trials to include in this study. Meta-analysis was performed to evaluate the effect of surgical methods and materials on the primary outcomes: margin reflex distance 1 (MRD1), palpebral fissure height (PFH), and degree of lagophthalmos; and secondary outcomes: undercorrection, entropion, corneal epithelial defects, wound dehiscence, recurrence, infection, and cosmetic outcomes. RESULTS A total of 14 trials evaluating 909 eyes of 657 patients were included in our study. Compared with the levator plication, the frontalis sling significantly increased the MRD1 (MD = - 1.21; 95% CI [- 1.69, - 0.73]), and the levator resection significantly increased the PFH (MD = 1.30; 95% CI [0.27, 2.33]). For the frontalis sling surgical patterns, the fox pentagon was significantly better than the double triangle at improving the degree of lagophthalmos (MD = 0.70; 95% CI [0.32, 1.08]), while the opened pattern provided statistically better cosmetic outcome than the closed frontalis sling. Analysis of surgical material showed that absorbable sutures significantly increased the MRD1 (MD = 1.16; 95% CI [0.60, 1.72]) compared to non-absorbable sutures when used in levator plication; frontalis sling surgeries performed with silicon rods significantly increased the PFH (MD = 0.88; 95% CI [0.29, 1.47]) compared to those performed with Gore-Tex strips, while autogenous fascia lata provided statistically better aesthetic outcome for lid height symmetry and contour. CONCLUSION Different surgical methods and materials appear to affect different aspects of the congenital ptosis treatment outcome. LEVEL OF EVIDENCE III 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)
- Liying Chen
- Department of Ophthalmology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Jingrong Li
- Department of Ophthalmology, Chinese Medicine Hospital, Pingliang City, 744000, China
| | - Chenjia Zhang
- Department of Ophthalmology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Yanfei Li
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Liangying Hou
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Jianjun Ma
- Department of Ophthalmology, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Hung JY, Chen KW, Perera C, Chiu HK, Hsu CR, Myung D, Luo AC, Fuh CS, Liao SL, Kossler AL. An Outperforming Artificial Intelligence Model to Identify Referable Blepharoptosis for General Practitioners. J Pers Med 2022; 12:jpm12020283. [PMID: 35207771 PMCID: PMC8877622 DOI: 10.3390/jpm12020283] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 02/05/2023] Open
Abstract
The aim of this study is to develop an AI model that accurately identifies referable blepharoptosis automatically and to compare the AI model’s performance to a group of non-ophthalmic physicians. In total, 1000 retrospective single-eye images from tertiary oculoplastic clinics were labeled by three oculoplastic surgeons as having either ptosis, including true and pseudoptosis, or a healthy eyelid. A convolutional neural network (CNN) was trained for binary classification. The same dataset was used in testing three non-ophthalmic physicians. The CNN model achieved a sensitivity of 92% and a specificity of 88%, compared with the non-ophthalmic physician group, which achieved a mean sensitivity of 72% and a mean specificity of 82.67%. The AI model showed better performance than the non-ophthalmic physician group in identifying referable blepharoptosis, including true and pseudoptosis, correctly. Therefore, artificial intelligence-aided tools have the potential to assist in the diagnosis and referral of blepharoptosis for general practitioners.
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Affiliation(s)
- Ju-Yi Hung
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan;
| | - Ke-Wei Chen
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City 70101, Taiwan
| | - Chandrashan Perera
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
| | - Hsu-Kuang Chiu
- Computer Science, Stanford University, Stanford, CA 94305, USA;
| | - Cherng-Ru Hsu
- Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - David Myung
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
| | - An-Chun Luo
- Department of Electronic and Optoelectronic System Research Laboratories, Industrial Technology Research Institute, Hsinchu 31040, Taiwan;
| | - Chiou-Shann Fuh
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan;
| | - Shu-Lang Liao
- Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan
- College of Medicine, National Taiwan University, Taipei 10617, Taiwan
- Correspondence: (S.-L.L.); (A.L.K.)
| | - Andrea Lora Kossler
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
- Correspondence: (S.-L.L.); (A.L.K.)
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Shamim N, Hayat N, Cheema A. Postoperative Visual Outcome: Sling procedure with prolene sutures in children with simple congenital ptosis. Pak J Med Sci 2022; 38:232-236. [PMID: 35035431 PMCID: PMC8713194 DOI: 10.12669/pjms.38.1.4359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/20/2021] [Accepted: 08/08/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To assess the visual outcome after sling procedure using prolene sutures in children with simple congenital ptosis. Methods: A descriptive case series study was performed in the Department of Ophthalmology of Jinnah Post Graduate Medical Centre, for a duration of six months in which 20 patients aged 3-10 years were selected with either unilateral or bilateral congenital ptosis. They were thoroughly examined and visual acuity and degree of ptosis were measured pre-operatively. Frontalis sling surgery was performed using prolene sutures on all patients after which their visual acuity and degree of ptosis were measured once again after three months post-operatively. Data were analyzed using SPSS version 20.0. For qualitative variables, frequency and percentages were calculated. Mean and Standard deviation was commutated for the quantitative variable. Results: The mean age of the patients was 8.15±1.75. 11 (55%) male and 9 (45%) female participants were included in the study. Visual acuity improved in all the patients with all the patients attaining a visual acuity of 6/6 (n=12, 60%), 6/9 (n=7, 35%), and 6/12 (n=1, 5%). The degree of ptosis post-operatively was not found in any patient either. Conclusion: Sling procedure helped in eliminating ptosis and improved visual acuity in patients with simple congenital ptosis.
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Affiliation(s)
- Nida Shamim
- Dr. Nida Shamim, FCPS. Department of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Nausheen Hayat
- Dr. Nausheen Hayat, FCPS. MRCSEd Opth. Department of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Alyscia Cheema
- Dr. Alyscia Cheema, FCPS, FRCS. Department of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
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Wu P, Ma J, Zhang T, Ma D. Advances in the genetics of congenital ptosis. Ophthalmic Res 2021; 65:131-139. [PMID: 34969027 DOI: 10.1159/000521575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/09/2021] [Indexed: 11/19/2022]
Abstract
Congenital ptosis, a birth defects presents at birth or by 1 year of age, is characterized by the drooping of the upper eyelid. either in isolation (non-syndromic) or with many different systemic disorders (syndromic). The estimated prevalence of ptosis (congenital & acquired) ranges from 0.79 to 1.99 per 10,000 people in different populations, and it is more prevalent in males. The underlying pathogenesis of congenital ptosis are myogenic and neurogenic, related to the development of muscles and nerves. Although most cases are sporadic, there are familial transmission characteristics, including autosomal dominant, recessive mode and X-linkage inheritance patterns. Moreover, some forms are due to chromosomal aberrations and mutations and deletions in mitochondrial DNA. Genes involved in simple congenital ptosis are ZFHX4 and COL25A1. The clinical aspects of various syndromes involving congenital ptosis are partly caused by single gene mutations. However, the pathogenesis of congenital ptosis is not fully understood. We review the reported epidemiology, genetics and clinical features of congenital ptosis and associated syndromes here.
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Affiliation(s)
- Peixuan Wu
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China,
| | - Jing Ma
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Tianyu Zhang
- ENT Institute, Eye & ENT Hospital, Fudan University, Shanghai, China
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Duan Ma
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
- Research Center for Birth Defects, Children's Hospital, Fudan University, Shanghai, China
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Owji N, Khalili MR, Bazrafkan H, Heydari M. Long-term outcome of refractive errors in patients with congenital blepharoptosis who have undergone ptosis surgery. Clin Exp Optom 2021; 105:715-720. [PMID: 34538220 DOI: 10.1080/08164622.2021.1973344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Ptosis surgery induces some changes in pre-existing refractive errors and astigmatism. Monitoring refractive outcomes, planning of vision rehabilitation, and amblyopia treatment may be required following ptosis surgery. BACKGROUND The few studies published on the outcomes of refractive error after ptosis surgery have been controversial. The aim of this study was to evaluate long-term outcomes of refractive error in patients with congenital blepharoptosis who had undergone ptosis surgery. METHODS Patients with congenital blepharoptosis who had undergone ptosis surgery were enrolled in the study. Data on pre- and post-operative refractive errors, marginal reflex distance 1 (MRD1), and levator function were obtained. The data from fellow eyes were used as the control. RESULTS The mean patient age of patients undergoing ptosis surgery was 19.8 ± 8 years. The mean follow-up time (time between the operation and post-up measurements) was 4.7 ± 2.1 years with a range of 2-10 years. There were no significant differences in mean refractive changes, being 0.53 ± 0.40D vs. 0.36 ± 0.45D in sphere (p = 0.19) and 0.48 ± 0.56 vs. 0.30 ± 0.23 in cylinder (p = 0.17) in operated and control eyes, respectively. Astigmatism change was, however, significantly higher in the operated eyes with an MRD1 change of ≥2.5 mm (0.84 ± 0.66 vs. 0.27 ± 0.39, p = 0.024). The changes in astigmatism in the operated eyes had a significantly positive correlation with the changes of MRD1 (r = 0.497, p = 0.019). Vectorial analysis showed no significant difference between the changes in astigmatism of the operated and control eyes (0.58 *48º vs. 0.45*53º, respectively). CONCLUSION Spherical power of the eyes of patients with congenital ptosis who undergo ptosis surgery does not change. A significant change in astigmatism can be anticipated in eyes with more than 2.5 mm change in MRD1. There is an association between change in astigmatism and MRD1 following ptosis surgery.
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Affiliation(s)
- Naser Owji
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Khalili
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Bazrafkan
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Heydari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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López JP, Barriga MM, Lecea D, Parada C, Stephens G. Ophthalmology examination during well-child visits in primary care health centres: Knowledge and difficulties experienced by health workers. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:26-31. [PMID: 33067032 DOI: 10.1016/j.oftal.2020.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The red reflex examination (RRE) and visual acuity testing (VA) is a mandatory part of the examination during the well-child visits (WCV) in primary health care centres of the public system of health in Chile. The eye examination is aimed at the early detection of severe eye diseases in children, such as retinoblastoma, congenital cataracts, and amblyopia. The knowledge and difficulties experienced by health workers in primary care health centres for evaluating the red reflex during WCV in Chile is unknown. MATERIAL AND METHODS A survey was performed in primary community health centres of XXX Santiago de Chile. RESULTS The WCV were mainly performed by physicians (45.2%) and nurses (35.8%). Only 34% of health workers performed the red reflex test, and 42.3% checked VA during the WCV. The main reasons for not doing it include the lack of direct ophthalmoscopes and VA charts (55.2% and 43.9%, respectively) at their centres, and not having the knowledge or skills (29.3% and 22%, respectively) to properly perform these clinical tests. CONCLUSION In this series, the eye examination of children attending WCV was unfrequently performed. A better implementation of the health centres and training of the health workers are needed in order to improve the access and quality of the paediatric eye examination in primary health care institutions in Chile.
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Affiliation(s)
- J P López
- Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile.
| | - M M Barriga
- Facultad de Medicina, Universidad del Desarrollo-Clínica Alemana, Santiago, Chile
| | - D Lecea
- Facultad de Medicina, Universidad del Desarrollo-Clínica Alemana, Santiago, Chile
| | - C Parada
- Facultad de Medicina, Universidad del Desarrollo-Clínica Alemana, Santiago, Chile
| | - G Stephens
- Departamento de Gestión de Redes, SSMS, Santiago, Chile
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Yucel O, Taha A, Rodop O, Yesim O, Seyhan K. Results of surgical techniques applied in blepharoptosis. SANAMED 2019. [DOI: 10.24125/sanamed.v14i3.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: Our aim was to analyze the success rates of patients who underwent levator aponeurosis or frontal suspension with silicone tube surgery due to blepharoptosis according to the elevator function (LF) and to compare our results with the literature. Material and Methods: We included twenty-five eyes of 47 patients who had levator aponeurosis or frontal suspension with silicone tube surgery in this study. The patients were grouped as good, moderate, and poor according to their LF. Good and moderate patients had levator aponeurosis while poor patients had frontal suspension with silicon tube surgery. The follow-up period after surgery was 2 to 36 months. The results were evaluated with margin reflex distance (MRD) which greater than 2 mm was considered as successful, between 1 and 2 mm was satisfactory, and less than 1 mm was unsuccessful. Also, patients required revision surgery was considered as unsuccessful. Results: Twenty-nine (61.7%) men and 18 (38.3%) women with a mean age of 35.16 years (range = 0-84 years) were included in this retrospective study. Thirteen cases (27.7%) had bilateral, and 34 cases had unilateral ptosis(72.4%). Eight of the 13 patients with bilateral ptosis had bilateral and 5 of them had unilateral surgery. Blepharoptosis was due to congenital (60.0%), aponeurotic (19%), traumatic (1.8%), Horner's syndrome (1.8%) and myotonic dystrophy (1.8%). The preoperative mean MRD value was 0.56 ± 0.85 mm (0-3 mm). The levator function (LF) was poor in 18 eyes (32.7%), moderate in 9 eyes (16.4%) and good in 28 eyes (50.9%). Thirty-seven patients (67.3%) underwent levator aponeurosis, and 18 patients had frontal suspension with silicon tube surgery. In our postoperative controls, 33 patients were considered as successful. Three patients were considered as satisfactory, and one patient was considered unsuccessful. Discussion: Levator aponeurosis and frontal suspension with silicone tube surgeries are both effective surgical methods to treat ptosis. Postoperative success is positively affected by determining the surgery method, according to LF. Our results showed that elevator aponeurosis surgery is more satisfying in good and moderate cases, and frontal suspension with silicone tube is best in poor cases.
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