Predicting the Success Rate of Levator Resection Surgery Using Whitnall Ligament Position

Ptosis is defined as lower positioning of the upper eyelid margin which normally is placed 1.5 mm below the superior corneal limbus [1]. Ptosis can be accounted as the 3rd most common eyelid disorders following chalazion and entropion [2]. It may result in amblyopia, visual field defect, cosmetic and psychological problems. Generally, ptosis is subdivided to congenital and acquired cases [3]. Abnormal development of levator muscle or innervation abnormalities is responsible for congenital cases of ptosis. On the other side, trauma, several neurologic disease, and defective levator aponeurosis can lead to acquired ptosis [4]. Levator function, clinical feature, and concomitant eyelid or face abnormalities are the determining factors for choosing appropriate surgical plan [5]. Common surgical approaches include frontalis suspension technique and levator muscle procedures (levator advancement and levator resection) in which frontalis suspension is performed in cases with poor levator function and the latter one is suitable for patients with preserved levator function [4]. Levator resection outcomes are not absolutely predictable. Multiple factors such as ptosis severity, levator function, and age of patient have been discussed as predictive factors for surgical success rate.

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The analysis of complications due to the erroneous strategy of the surgical treatment of the upper lid ptosis

Russian Pediatric Ophthalmology ◽

10.18821/1993-1859-2016-11-2-89-92 ◽

2016 ◽

Vol 11 (2) ◽

pp. 89-92 ◽

Cited By ~ 2

Author(s):

I. A Filatova ◽

S. A Shemetov

Keyword(s):

Surgical Treatment ◽

Surgical Intervention ◽

Levator Muscle ◽

Clinical Group ◽

Upper Eyelid ◽

Incorrect Choice ◽

Tarsal Plate ◽

Short Period ◽

Frontalis Suspension ◽

Upper Lid

Objective. The purpose of the present study was to analyze the complications developing as a result of the application of the incorrect strategy of the surgical treatment of the upper lid ptosis. Material and methods. The analysis of the clinical material covers the period of 10 years. A total of 275 patients presenting with the upper lid ptosis underwent the surgical intervention. A separate clinical group consisting of 89 patients (32.4%) was distinguished, each having been previously operated from 1 to 4 times (m = 1.8) either without effect, with a poor effect, or suffering various complications. The age of the patients varied from 3 to 63 (mean 14.7 ± 5.3) years. The children (n = 61) accounted for 68.5% of the total number of the patients. All the patients underwent the surgical treatment consisting of the revision and cutting of the scar, the excision of inadequate “frontalis suspensions”, resection of the levator muscle, and frontalis sling suspension of the upper eyelid to a brow with the use of the mersilen mesh. Results. The analysis of the available clinical materials has demonstrated the following mistakes in the choice of the strategy of the surgical treatment of the upper lid ptosis: (1) Inadequate frontalis sling suspensions in 72.5% of the cases were performed. Nevertheless, the surgery of the suspension type was carried out in 38.3% of the cases of the mild and moderately severe ptosis when the levator function remained intact and sufficient. (2) In the majority of the patients, the technical errors resulting in inadequate “frontalis suspensions” took place, with the suspensions being either mistakenly fixed to the soft tissues of the upper eyelid or rigidly attached to the periosteum of the upper edge of the orbit rather than to the upper tarsal plate. Moreover, 21.4% of the patients presented with the cicatrices at the internal surface of the upper eyelids following frontalis suspension even though the surgical intervention envisaged neither the opening of the conjunctiva nor the resection of the tarsal plate. (3) The inadequate choice of a material for frontalis suspension (strings, rigid tapes, fishing line, and elastics). (4) The large number of repeated surgical interventions during a short period of time. In all the cases, the surgical treatment caused the improvement of the patients’ conditions as appeared from the reduction of the degree of ptosis, the better expression of the crease of the upper eye lid, and lagophthalmia of 1-3 mm. In addition, the mobility of the upper eyelids increased upon the resection of the levator muscle (m = 3.9 mm). In the presence of complications of the previous operations for the resection of the levator, its function also increased (m = 2.3 mm). Conclusion. The majority of the complications have been caused by the incorrect choice of the method for the surgical treatment of the upper lid ptosis which suggests the necessity of the differential approach to the diagnostics and surgical treatment of this pathological condition taking into consideration its cause and severity. Of primary importance is the choice of the treatment by the pathogenetically substantiated method.

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A Newly Modified Technique for Levator Muscle Tucking in Blepharoptosis Surgery: An Egyptian Tertiary Center Study

10.21203/rs.3.rs-554984/v1 ◽

2021 ◽

Author(s):

Mahmoud Ahmed ELSamkary ◽

Maged Maher Roshdy ◽

Marwa Ahmed Abdel Karim

Keyword(s):

Patient Satisfaction ◽

Functional Outcome ◽

Operating Time ◽

Levator Muscle ◽

Ocular Motility ◽

University Hospitals ◽

Modified Technique ◽

Eyelid Margin ◽

Upper Eyelid ◽

Tertiary Center

Abstract Background: To highlight a newly modified technique for levator muscle tucking for the management of mild to moderate blepharoptosis.Methods: A prospective single-centre study enrolling 180 patients with blepharoptosis at Ain Shams University Hospitals from March 2017 to February 2019. Patients of unilateral or bilateral mild to moderate ptosis with good levator function (more than 8 mm) were included. Those with severe, traumatic, recurrent, mechanical ptosis, Marcus–Gunn jaw winking syndrome, third nerve palsy, absent Bell’s phenomenon, or abnormal ocular motility were excluded. The follow-up was at one week, one month, three months, six months, and one year visits. Functional outcome was assessed by analysis of the upper eyelid margin position in relation to the superior limbus and classified as very good (2 mm), good (2–4 mm), poor (5 mm) and preoperative to postoperative difference in marginal reflex distance (MRD). The aesthetic outcome was assessed in the form of symmetry of eyelid height, lid contour, lid crease presence, and degree of patient`s postoperative satisfaction.Results: The newly modified technique of levator tucking had a success rate of 92.1% in the form of a very good (77.7%) and good (14.4%) functional outcome, with highly acceptable aesthetic outcomes: symmetry of eyelid height in unilateral cases (86.1%) and bilateral cases eye (84%), lid contour regularity (91.6%) and lid crease symmetry (88.8%). Postoperative patient satisfaction was 83%, with a short operating time of 27.4 ± 4.6 minutes per eye.Conclusion: The newly modified technique of levator tucking is a rapid, simple, highly effective technique, with less recurrence and high patient satisfaction.Trial Registration:· Trial registry: ClinicalTrials.gov· Unique identifying number: NCT04883853· Date of registration: 11/5/2021 (retrospectively registered).

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A quantitative approach to shortening the levator palpebrae superioris to correct congenital ptosis in children

International Eye Research ◽

10.18240/ier.2020.03.01 ◽

2020 ◽

Vol 1 (3) ◽

pp. 133-139

Author(s):

Xin-Yu Huang ◽

◽

Hui-Zhen Huang ◽

Yuan-Yuan Du ◽

◽

...

Keyword(s):

Postoperative Outcome ◽

Early Postoperative Period ◽

Eyelid Margin ◽

Upper Eyelid ◽

Primary Position ◽

Congenital Ptosis ◽

Feasible Method ◽

Levator Resection ◽

Severe Group ◽

Levator Palpebrae

AIM: To develop a feasible method to correct congenital ptosis in children. METHODS: Sixty-four patients (102 eyelids) were divided into three groups based on the degree of ptosis: mild (<2 mm); moderate (3-4 mm); and severe (>4 mm). All patients underwent the same levator resection surgery in which the suspensory system of the LPS is retained. After capturing a standard photograph of primary position, the height of the superior palpebral margin was measured preoperatively by using Image J software to calculate its ideal height required during surgery. Postoperative outcome measures included upper eyelid margin height, degree of scleral exposure and exposure keratitis. The patients were followed-up at 1wk, 1mo and 6mo postoperatively. RESULTS: In the early postoperative period, except two cases with overcorrection, the positions of the eyelid upper margins were normal in all cases in the mild and moderate groups. Six months postoperatively, the eye with overcorrection in the moderate group showed improvement, while the eye in the mild group did not. Seven eyes in the severe group exhibited residual ptosis to varying degrees. The eyelids exhibited appropriate closing functionality; exposure keratitis was absent. CONCLUSION: Using this preoperative quantification technique to guide surgery not only provide a gauge for LPS shortening under general anesthesia, but also increase the success rate of surgery.

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Effect of the Simultaneous Operation of Levator Resection and Frontalis Suspension for Congenital Ptosis

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2012.53.12.1737 ◽

2012 ◽

Vol 53 (12) ◽

pp. 1737

Author(s):

Ah Ron Kim ◽

Chang Wook Choi ◽

Sang Duck Kim

Keyword(s):

Simultaneous Operation ◽

Congenital Ptosis ◽

Levator Resection ◽

Frontalis Suspension

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RESULTS OF INTRALESIONAL TRIAMCINOLONE ACETONIDE FOR CHALAZION TREATMENT

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.5.13 ◽

2011 ◽

pp. 100-104

Author(s):

Thi Thu Nguyen ◽

Viet Hien Vo ◽

Thi Em Do

Keyword(s):

Success Rate ◽

Key Words ◽

Triamcinolone Acetonide ◽

Lower Eyelid ◽

Upper Eyelid ◽

Interventional Trial ◽

The Mean ◽

First Time

The study use intralesional triamcinolone acetonide injection proceduce for chalazion treatment.1. Objectives: To evaluate results of intralesional triamcinolone acetonide injection for chalazion treatment. 2. Method: This noncomparative prospective interventional trial included 72 chalazions of 61 patients. 3. Results: 61 patients (72 chalazions) with 19 males (31.1%) và 42 females (68.9%), the mean age was 24 ± 9,78 years. 31.1% patients was the first time chalazion and 68.9% patients was more than one times chalazion including 78.6% patients was recurrent at the first position and 21.4% patients occur at new position. 72 chalazions with 16 (22.2%) chalazions was treated before and 56 (77.8%) chalazions wasn’t done that. 72 chalazions with 49 chalazions (68.1%) are local in upper eyelid and 23 chalazions (31.9%) are local in lower eyelid. The mean of chalazion diameter is 6.99 ± 3.03mm. Intralesional triamcinolone acetonide is injected to treat 72 chalazions with 16 (22.2%) chalazions are injected through the route of skin and 56 (77.8%) chalazions are injected through the route of conjunctiva. After 2 weeks follow-up, the success rate was 93.1% and 6.9% failed. 4. Conclusion: intralesional triamcinolone acetonide injection for chalazion treatment is really effective. Key words: chalazion, intralesional triamcinolone acetonide.

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Double Rectangle Fascia Lata Frontalis Sling: A Rationale Approach for Ptosis

Indian Journal of Plastic Surgery ◽

10.1055/s-0041-1723909 ◽

2021 ◽

Vol 54 (01) ◽

pp. 058-062

Author(s):

Pawan Agarwal ◽

Dhananjaya Sharma ◽

Vikesh Agrawal ◽

Swati Tiwari ◽

Rajeev Kukrele

Keyword(s):

Retrospective Study ◽

Surgical Outcomes ◽

Functional Outcomes ◽

Fascia Lata ◽

Modified Technique ◽

Eyelid Margin ◽

Upper Eyelid ◽

Light Reflex ◽

Straight Line

AbstractBackground The purpose of this study was to evaluate the functional outcomes of a modified technique of double rectangle pattern for correction of severe ptosis.Methods This is a retrospective study over a period of 8 years including patients who underwent correction of ptosis by double rectangle using autologous fascia lata sling. Surgical outcomes were assessed postoperatively by distance from the corneal light reflex to the upper eyelid margin (MRD1) and levator function.Results Twenty-six eyelids were operated in 20 patients. There were 9 males and 11 females, with age ranging from 4 to 35 years. Preoperatively, all patients had poor MRD1 and poor levator function. Postoperative MRD1 was good in 13 patients (17 eyelids), fair in 5 (7eyelids), and poor in 2 patients (2 eyelids). Postoperative levator function was excellent in 12 patients (15 eyelids), good in 6 (9 eyelids), and fair in 2 patients (2 eyelids). At a mean follow-up of 12 months, adequate correction was achieved in 24 eyelids, and 2 eyelids had undercorrection.Conclusion Frontalis sling with a double rectangle is simple and more efficient, as it provides a straight line of pull to the eyelid for correction of severe ptosis.

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Veleszületett szemhéjcsüngés műtéti megoldása a szemhéjemelő izom kötőhártya felőli redőzésével

Orvosi Hetilap ◽

10.1556/650.2021.32091 ◽

2021 ◽

Vol 162 (18) ◽

pp. 705-711

Author(s):

Zsuzsanna Antus ◽

Olga Lukáts ◽

Irén Szalai ◽

Zoltán Zsolt Nagy ◽

Nóra Szentmáry

Keyword(s):

Success Rate ◽

Posterior Approach ◽

Treatment Method ◽

Inclusion Criteria ◽

Upper Eyelid ◽

Congenital Ptosis ◽

Surgical Success ◽

Suitable Treatment ◽

The Difference

Összefoglaló. Bevezetés: Szemhéjcsüngésnek (ptosis vagy blepharoptosis) nevezzük azt az állapotot, amikor a felső szemhéj abnormálisan alacsony pozícióban van. A szemhéjcsüngésnek lehetnek veleszületett és szerzett formái. Célkitűzés: Célunk volt bemutatni a szemhéjemelő izom (levator) – veleszületett szemhéjcsüngés korrekciója céljából végzett – kötőhártya felőli redőzésének eredményeit retrospektív módszerrel. Módszer: 20 beteg 22 szemhéján végeztük el a műtétet (átlagéletkor: 19,4 ± 9,9 év, férfi: 12 [60%], nő: 8 [40%]). Beválasztási kritérium volt a közepes (5–8 mm) vagy jó (9 mm felett) levatorfunkció. Kizártuk a korábban szemhéjkorrekciós műtéten átesett és a 3 hónapnál rövidebb követési idővel rendelkező betegeket. A műtét előtt megmértük a levatorfunkciót és a margó–reflex-távolságot. A műtét után megmértük a margó–reflex-távolságot, a szemhéjak magassága közti aszimmetria mértékét, és elemeztük a szemhéj posztoperatív kontúrját. Eredmények: A preoperatív levatorfunkció 10,6 ± 3,0 mm, a preoperatív margó–reflex-távolság 1,8 ± 0,8 mm volt. A 7,8 ± 7,2 hónap átlagos követési idő alatt a posztoperatív margó–reflex-távolság 3,2 ± 0,8 mm volt. A preoperatív és a posztoperatív margó–reflex-távolság különbsége nem tért el szignifikánsan a sikeres és a sikertelen műtétek között (p = 0,523). A szemhéjak magassága közti aszimmetria mértéke 3 betegnél haladta meg az 1 mm-t. A szemhéj posztoperatív kontúrja minden esetben megfelelő volt. A műtét összességében 86,4%-ban (19/22) volt sikeres. A helyi érzéstelenítésben és altatásban végzett műtétek közt nem találtunk szignifikáns különbséget a sikeresség tekintetében (p = 0,227). Következtetés: Tanulmányunk alapján az elvégzett műtéteink eredményessége a nemzetközi irodalomban közöltekhez hasonló volt. A veleszületett szemhéjcsüngés korrekciójára a kötőhártya felőli levatorredőzés megfelelő kezelési mód közepes vagy annál jobb levatorfunkció esetén. Orv Hetil. 2021; 162(18): 705–711. Summary. Introduction: Droopy eyelid (ptosis or blepharoptosis) is defined through abnormally low upper eyelid position. Ptosis can be classified as congenital or acquired. Objective: Our purpose was to report the results of posterior approach levator plication for congenital ptosis in a retrospective review. Method: 22 eyelids of 20 patients were included in this study (age: 19.4 ± 9.9 years, male: 12 [60%], female: 8 [40%]). The inclusion criteria were moderate (5–8 mm) or good (more than 9 mm) levator function. Patients with postoperative follow-up time shorter than 3 months and those who underwent previous eyelid surgery were excluded. The data collected included preoperative levator function and margin reflex distance, postoperative margin reflex distance, inter-eyelid height asymmetry and postoperative eyelid contour. Results: Preoperative levator function was 10.6 ± 3.0 mm, preoperative margin reflex distance was 1.8 ± 0.8 mm. During 7.8 ± 7.2 months postoperative follow-up, postoperative margin reflex distance was 3.2 ± 0.8 mm. The difference between preoperative and postoperative margin reflex distance was not significant (p = 0.523) in the group of successful operations compared with unsuccessful operations. Inter-eyelid height asymmetry was more than 1 mm in 3 cases. Satisfactory postoperative eyelid contour was achieved in all cases. Overall success rate was 86.4% (19/22). Surgical success did not differ significantly between surgeries in local or general anaesthesia (p = 0.227). Conclusion: Our study shows an overall success rate of the procedures comparable to those in international publications. Posterior approach levator plication for congenital ptosis with moderate or better levator function seems to be a suitable treatment method. Orv Hetil. 2021; 162(18): 705–711.

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