1
|
Fogel Tempelhof O, Bachar Zipori A, Mezad-Koursh D, Tomashpolski E, Abumanhal M, Leibovitch I, Ben Cnaan R. Congenital ptosis repair in children: comparison of frontalis muscle suspension surgery and levator muscle surgery. Graefes Arch Clin Exp Ophthalmol 2023; 261:2979-2986. [PMID: 37195337 DOI: 10.1007/s00417-023-06105-1] [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: 01/03/2023] [Revised: 04/11/2023] [Accepted: 05/06/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Comparing the surgical and refractive outcomes of congenital ptosis repair by different surgical techniques. METHODS This longitudinal cohort study reviewed medical records of 101 patients who underwent congenital ptosis repair, from 2006 to 2022 in a single center. Analysis was performed for demographic background, co-morbidities, pre-operative and post-operative ocular examinations and refraction, complications, reoperations, and success rates. RESULTS Following exclusion criteria, we remained with 80 patients (103 eyes) who underwent either frontalis muscle suspension surgery (FMS) (55 eyes) or levator muscle surgery (LM) (48 eyes). Patients in the FMS group were younger (mean age of 3.1 vs. 6.0 years, p < 0.001) and had worse pre-operative ocular assessments including prevalence of visual axis involvement, chin-up head position, ptosis severity, and levator muscle function (LF) (p < 0.001). Both groups had a 25% rate of reoperation, however while in the LM group reoperation was required solely due to undercorrection, in the FMS group various indications prompted reoperation. Success rate was higher in the FMS group (87.3% vs. 60.4%, p = 0.002). While pre-operative astigmatism was higher in the LM group (p = 0.019), no significant differences were observed post-operatively. Spherical and spherical equivalent changes over time were significant only in the FMS group (p = 0.010 and p = 0.004, respectively). CONCLUSIONS Within our cohort, a higher success rate of congenital ptosis repair was observed among patients who underwent FMS compared to LM, despite similar reoperation rates. In cases of severe ptosis and moderate LF, LM demonstrated a lower-than-anticipated success rate. Astigmatic changes following ptosis repair were not consistent in either group.
Collapse
Affiliation(s)
- Ortal Fogel Tempelhof
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel.
| | - Anat Bachar Zipori
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Daphna Mezad-Koursh
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Elena Tomashpolski
- Department of Radiology, Shamir, Assaf Harofeh Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, Be'er Ya'akov, Israel
| | - Muhammad Abumanhal
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Igal Leibovitch
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Ran Ben Cnaan
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel
| |
Collapse
|
2
|
Ke Y, Meng J, Zhou M, Wu P, Zhang F, Hei X, Huang D. The Recurrence of Ptosis after Correction Surgery Is Associated with Refractive Error. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59030630. [PMID: 36984631 PMCID: PMC10056684 DOI: 10.3390/medicina59030630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/06/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
Background and objectives: Previous studies on ptosis recurrence after correction surgery have tended to focus on postoperative complications, surgical methods and suspension materials, few have mentioned refractive error. This research is to investigate the potential relation between refractive error and recurrence after correction surgery in pediatric patients with simple congenital ptosis. Materials and Methods: We conducted a retrospective analysis of data from patients with simple congenital ptosis who were treated at Zhongshan Ophthalmic Center (ZOC) between 2017 and 2020. In total, 111 eyelids of 85 patients without surgery-related complications who underwent frontalis muscle flap suspension (FMFS) for simple congenital ptosis were included. Postoperative changes in eyelid height were assessed. Cycloplegic refraction was assessed before surgery and during the follow-up period (every 3 months after surgery). Recurrence in the postoperative period was defined as a marginal reflex distance 1 (MRD1) of <1 mm. Results: There were 16 recurrence and 69 non-recurrence cases, with no statistically significant differences, in terms of patient age at the time of surgery, patient sex, or preoperative MRD1, between the recurrence and non-recurrence groups. The postoperative cylindrical diopter (adjusted odds ratio [OR] = 0.432, p = 0.005), laterality (adjusted OR = 0.202, p = 0.006), and preoperative MRD1 (adjusted OR = 0.617, p = 0.019) were associated with ptosis recurrence after surgery. Differences between the recurrence and non-recurrence groups in spherical diopter and spherical equivalent (SE) before and after surgery were not statistically significant. In addition, preoperative refractive error and postoperative spherical diopter were not significantly associated with ptosis recurrence after correction surgery. Conclusions: Ptosis recurrence after FMFS in pediatric cases of congenital ptosis is associated with refractive error. Timely refractive correction and amblyopia treatment may help to reduce ptosis recurrence.
Collapse
Affiliation(s)
- Yu Ke
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510080, China
| | - Jie Meng
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Min Zhou
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510080, China
| | - Pengsen Wu
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510080, China
| | - Fan Zhang
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510080, China
| | - Xiangqing Hei
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510080, China
| | - Danping Huang
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510080, China
| |
Collapse
|
3
|
Ripa M, Cuffaro G, Pafundi PC, Valente P, Battendieri R, Buzzonetti L, Mattei R, Rizzo S, Savino G. An epidemiologic analysis of the association between eyelid disorders and ocular motility disorders in pediatric age. Sci Rep 2022; 12:8840. [PMID: 35614310 PMCID: PMC9132918 DOI: 10.1038/s41598-022-12883-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/06/2022] [Indexed: 11/09/2022] Open
Abstract
Aim of the study was to assess: (a) the prevalence and type of strabismus, ptosis and eyelid dynamic disorders features, (b) the prevalence of refractive errors, amblyopia and, (c) their association with ocular/systemic syndromes in a cohort of patients. This is a retrospective observational multicenter cohort study. Patients with coexisting ocular motility disorders, comitant and incomitant strabismus, ptosis and dynamic eyelid disorders who have never undergone surgery were enrolled throughout a 3-years a study period. 137 out of 19,089 patients were enrolled, of which 97 with uniocular and 40 with binocular disease. Isolated congenital ptosis was observed in 84 patients. A polymalformative syndrome was present in almost one third of cases, whilst among strabismus type, esotropia was slightly more prevalent. Most patients were hypermetropic. In monocular disease, myopia mainly affected older patients, who were characterized by a worse ptosis margin reflex distance and levator function, and significantly higher astigmatism. Amblyopia occurred in 67.4% of the study sub-population. Of note, in monocular disease this was mild in 25.8%, moderate in 24.2% and severe in 11.3% of cases, whilst in binocular disease it was mild in 25%, moderate in 41.7% and severe in 16.7%. All patients with coexisting eyelid and ocular motility dysfunctions in pediatric age need ophthalmologic and systemic evaluation to accurately assess amblyopia, refractive errors and systemic/ocular disorders.
Collapse
Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Giovanni Cuffaro
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Pia Clara Pafundi
- Facility of Epidemiology and Biostatistics, Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paola Valente
- Ophthalmology Department, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Remo Battendieri
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Luca Buzzonetti
- Ophthalmology Department, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Roberta Mattei
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
| | - Gustavo Savino
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| |
Collapse
|
4
|
Hsia NY, Wen LY, Chou CY, Lin CL, Wan L, Lin HJ. Increased Risk of Refractive Errors and Amblyopia among Children with Ptosis: A Nationwide Population-Based Study. J Clin Med 2022; 11:jcm11092334. [PMID: 35566461 PMCID: PMC9100637 DOI: 10.3390/jcm11092334] [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: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This study aimed to investigate the risk of refractive errors (astigmatism, myopia, and hyperopia) and amblyopia in children with ptosis and association between age at diagnosis of ptosis and subsequent risks of vision problems. Methods: Retrospective claims data from the Taiwan National Health Insurance Research Database (NHIRD) were analyzed. We identified 1799 children aged 0−18 years who were newly diagnosed with ptosis between 2000 and 2012 and 7187 individuals without the disease. Both cohorts were followed up until 2013 to estimate the incidence of refractive errors and amblyopia. Results: Children with ptosis had 5.93-fold, 3.46-fold, 7.60-fold, and 13.45-fold increases in the risk of developing astigmatism, myopia, hyperopia, and amblyopia, respectively, compared with the control cohort (astigmatism: adjusted hazard ratio, aHR = 5.93, 95% confidence interval, CI = 5.16−6.82; myopia: aHR = 3.46, 95% CI = 3.13−3.83; hyperopia: aHR = 7.60, 95% CI = 5.99−9.63; amblyopia: aHR = 13.45, 95% CI = 10.60−17.05). Children diagnosed with ptosis at an age older than 3 years old had a higher risk of myopia than patients diagnosed with ptosis before age 3. There was no significant difference of the risk of astigmatism, amblyopia, and hyperopia between age groups. Conclusions: Children with ptosis may exhibit a higher risk of astigmatism, myopia, hyperopia, and amblyopia than children without ptosis. The risk of myopia is higher in children with ptosis diagnosed at >3 years than those diagnosed at ≤3 years.
Collapse
Affiliation(s)
- Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, Taichung 40402, Taiwan;
- School of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Li-Yen Wen
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
| | - Ching-Ying Chou
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 40402, Taiwan;
| | - Lei Wan
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung 41354, Taiwan
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 40402, Taiwan
- Correspondence: (L.W.); (H.-J.L.)
| | - Hui-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, Taichung 40402, Taiwan;
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
- Correspondence: (L.W.); (H.-J.L.)
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|