INCIDENCE OF OCULAR AND SYSTEMIC ASSOCIATIONS WITH CONGENITAL PTOSIS, ITS MANAGEMENT AND COMPLICATIONS FOLLOWING PTOSIS SURGERY

Purpose: To investigate the surgical outcomes of maximum Levator resection in cases of severe upper eyelid ptosis at a tertiary oculoplastic service. Study Design: Interventional case series. Place and Duration of Study: Department of Ophthalmology, Lady Reading Hospital, Medical Teaching Hospital, Peshawar January 2013 to December 2017. Methods: One hundred and twenty three eyes of 107 patients, who underwent maximum levator resection for severe congenital ptosis were included. Patients with missing or incomplete notes, patients with previous ptosis surgery and ptosis other than congenital were excluded. Maximum levator resection of the muscle above the Whitnall ligament was performed under local/general anesthesia. All patients had a minimum of 6 months and maximum of 5 years followup. The postoperative complications were recorded and followed. Post operative followup was done at day one, week one and at four weekly intervals till the end of the study. Results: Out of 123 eyes, satisfactory results (excellent or good) were obtained in 111 (90.1%) eyes. Majority of the patients (56.09%) were females. Mean Preoperative Levator function was 2.3 ± 1.1mm. Mean Preoperative MRD1 was ?0.1 ± 1.5 mm and mean postoperative MRD1 was 3.9 ± 01.0 mm. The commonest complication was over correction which occurred in 5 (4.06%) cases, under correction in 4 (3.25%), crease abnormality in 2 (1.62%) cases and entropion was seen in only one (0.81%) case. Success rate was 90.1% at 6 months to 5-years followup. Key Words: Blepharoptosis; Levator resection; Levator function.

Download Full-text

Etiopathogenetic patterns of blepharoptosis in Western Nepal : an Overview

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v8i1.16154 ◽

2016 ◽

Vol 8 (1) ◽

pp. 36-40 ◽

Cited By ~ 3

Author(s):

Pragati Gautam ◽

Risihant Adhikari ◽

Basanta Raj Sharma

Keyword(s):

Visual Acuity ◽

Refractive Error ◽

Clinical Picture ◽

Demographic Variables ◽

Congenital Ptosis ◽

Patient Gender ◽

Type Pattern ◽

The Mean ◽

Ptosis Surgery ◽

Cosmetic Problem

Background: The clinical picture of blepharoptosis varies from a cosmetic problem to severe visual dysfunction depending on the pathogenesis and the degree of ptosis. Objective: To study the type, pattern and causes of ptosis in patients seeking oculopastic care in western Terai of Nepal Patients and methods: A retrospective descriptive hospital based was carried out over a period of 2 years in oculoplastic clinic in Lumbini Eye Institute, Bhairahawa. Demographic variables including the age of the patient, gender, laterality of the eye(s), visual acuity, presence of refractive error and or amblyopia, type of ptosis and previous ptosis surgery were recorded. Results: There were altogether 326 patients of ptosis during the 2 year-period. Congenital ptosis presented early the mean age being 23(SD ±9.91) years. Acquired ptosis presented late with the mean age of 35(SD± 14.98) years. Congenital ptosis was more common (52%) compared to acquired ptosis (48%). 4.7% of congenital ptosis had amblyopia. Among all ptosis patients, myogenic cause of ptosis was the commonest followed by mechanical, aponeurotic, traumatic and neurogenic. Simple congenital ptosis was the commonest, and among acquired ptosis, mechanical ptosis was the commonest. Most of the ptosis was unilateral (87.7%) regardless of its onset either congenital or acquired. Regarding the severity of ptosis, mild ptosis was the commonest. Conclusion: Ptosis was the 3rd most common lid condition in oculoplastic clinic presentation after entropion and chalazion. Simple congenital ptosis was the commonest form of ptosis. Nepal J Ophthalmol 2016; 8(15): 36-40

Download Full-text

Malignant hyperthermia in a 4-year-old girl during anesthesia induction with sevoflurane and succinylcholine for congenital ptosis surgery

Saudi Journal of Ophthalmology ◽

10.1016/j.sjopt.2018.10.002 ◽

2019 ◽

Vol 33 (2) ◽

pp. 183-187 ◽

Cited By ~ 2

Author(s):

Fehmi Ferhi ◽

Leïla Dardour ◽

Amel Tej ◽

Raoudha Kebaili ◽

Sarra M'aaref ◽

...

Keyword(s):

Malignant Hyperthermia ◽

Anesthesia Induction ◽

Congenital Ptosis ◽

Ptosis Surgery

Download Full-text

Strategies of upper blepharoplasty in aging patients with involutional ptosis

Archives of Plastic Surgery ◽

10.5999/aps.2020.01361 ◽

2020 ◽

Vol 47 (4) ◽

pp. 290-296

Author(s):

Tae-Yul Lee ◽

Yong Ho Shin ◽

Jin Gyu Lee

Keyword(s):

Dry Eye ◽

Excessive Amount ◽

Forehead Lift ◽

Congenital Ptosis ◽

Skin Excision ◽

Eye Symptoms ◽

Upper Blepharoplasty ◽

Ptosis Surgery ◽

Double Eyelid ◽

Dry Eye Symptoms

In many aging individuals, dermatochalasis and involutional ptosis appear together. Therefore, for functional and aesthetic purposes, ptosis correction and upper blepharoplasty are performed together. The aim of this article is to investigate factors that should be considered in order to achieve good results when simultaneously performing involutional ptosis correction and upper blepharoplasty in aging patients. Involutional ptosis is usually corrected through aponeurosis advancement in mild cases. In moderate or severe ptosis, the Muller muscle and aponeurosis are used together to correct ptosis. Using the two muscles together has the advantages of reducing lagophthalmos and increasing the predictability of outcomes after surgery. Broadly speaking, the surgical method used for involutional ptosis varies depending on the specific case, but unlike congenital ptosis, it is often not necessary to perform overcorrection. In particular, if there are problems such as severe dry-eye symptoms or risk of lagophthalmos, undercorrection should be considered. When performing ptosis correction, the surgeon should be careful not to overdo skin excision; instead, limited excision should be performed. After ptosis surgery, the brow may descend and the double fold may look too small. However, in order to make the double eyelids look larger, the surgeon should consider making the double eyelid design high rather than excising an excessive amount of skin. In some cases, to obtain more natural double eyelids and favorable results, it may be necessary to perform a sub-brow lift or forehead lift before or after involutional ptosis surgery.

Download Full-text

Safety and Long-term Outcomes of Congenital Ptosis Surgery: A Population-Based Study

Journal of Pediatric Ophthalmology & Strabismus ◽

10.3928/01913913-20160511-02 ◽

2016 ◽

Vol 53 (4) ◽

pp. 212-217 ◽

Cited By ~ 3

Author(s):

Ali Mokhtarzadeh ◽

Elizabeth A. Bradley

Keyword(s):

Population Based ◽

Long Term Outcomes ◽

Population Based Study ◽

Congenital Ptosis ◽

Ptosis Surgery

Download Full-text

Surgical Outcomes in Cases of Marcus-Gunn Jaw-Winking Phenomenon

Kathmandu University Medical Journal ◽

10.3126/kumj.v13i1.13750 ◽

2015 ◽

Vol 13 (1) ◽

pp. 34-37 ◽

Cited By ~ 2

Author(s):

RP Sthapit ◽

R Saiju

Keyword(s):

Surgical Outcomes ◽

Refractive Errors ◽

Repeat Surgery ◽

Congenital Ptosis ◽

Frontalis Suspension ◽

Upper Lid ◽

One Year ◽

Age Range ◽

Ptosis Surgery

Background Markus-Gunn Jaw-winking Phenomenon (MGJW) is a congenital ptosis associated with synkinetic movement of upper lid on masticating movements of jaw. It results from aberrant connection between motor division of trigeminal nerve and oculomotor nerve.Objective To investigate the clinical characteristics of MGJW phenomenon and evaluate its surgical outcomes of unilateral levator excision and frontalis suspension.Method It is a retrospective analysis of nine cases of MGJW phenomenon seen from 2007 to 2013 AD. The clinical features were recorded and analysed. Unilateral levator excision and frontalis suspension for the correction of synkinesis and ptosis was done for all the patients. The result of surgery was analysed.Result MGJW phenomenon was seen more in males. All the cases had unilateral ptosis with jaw winking phenomenon. Ipsilateral hypotropia and refractive errors were seen in 44%. One week post operative margin reflex distance was good in 67% of cases. Persistent jaw-winking was seen in 3 cases, two underwent repeat surgery to abolish the synkinesis. At one year follow up, 33% had good margin reflex distance of more than 4mm and 22% had fairly good margin reflex distance of 3mm.Conclusion Patients with Marcus Gunn jaw winking synkinesis can present at a wide age range. There may be an associated vertical muscle imbalance, which should be managed before ptosis surgery to avoid ptosis under correction. Unilateral frontalis flap suspension combined levator excision can correct ptosis very well for patients with Marcus-Gunn syndrome.Kathmandu University Medical Journal Vol.13(1) 2015; 34-37

Download Full-text

Mean Change in Refractive Status After Levator Muscle Resection in Patients of Simple Congenital Ptosis

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i1.996 ◽

2020 ◽

Vol 36 (1) ◽

Author(s):

Rana Muhammad Mohsin Javaid ◽

Nasir Chaudhary ◽

Rehab Habib ◽

Asad Aslam Khan ◽

Kashif Siddique

Keyword(s):

Surgical Intervention ◽

Levator Muscle ◽

P Value ◽

Congenital Ptosis ◽

Refractive Status ◽

Quasi Experimental ◽

The Mean ◽

Medical University ◽

Ptosis Surgery

Purpose: To determine the mean change in refractive status after Levator muscle resection in patients of simple congenital ptosis. Study Design: Quasi Experimental study. Place and Duration of Study: This study was carried out at Institute of Ophthalmology, King Edward Medical University, Mayo Hospital Lahore, from 2014 to 2015. Material & Methods: Fifty patients were selected under the age of 12 years with no sex predilection presenting with simple congenital ptosis of pupil sparing type. Patients with neurogenic, aponeurotic ptosis, mechanical ptosis, Blepharophimosis syndrome, patients with previous failed ptosis surgery and patients with corneal anomalies were excluded. After history and examination, Cycloplegic retinoscopy was done, which was repeated after surgical intervention. All interventions were done by a single ophthalmic surgeon. The patients were examined and discharged on the second post operative day. All data including preoperative and postoperative recordings of spherical and cylindrical values were collected on a self-designed proforma. Follow up period was extended to 3 months. At 3rd month cycloplegic retinoscopy was done and change in character of refractive status was analyzed. Mean change in refractive status was calculated by difference of preoperative and postoperative sphere and cylinder values. Results: Mean age of patients was 4.26 ± 3.78 years. Mean change in spherical value after treatment was 0.447 ± 0.339. This difference was statistically significant with p-value = 0.000. While mean change in cylindrical value after treatment was 0.640 ± 0.580. This difference in cylinder value after treatment was also statistically significant with p-value = 0.000. Conclusion: Levator muscle resection has a significant effect on refractive status of the patients with congenital ptosis.

Download Full-text