scholarly journals Outcomes of Maximum Levator Resection in Severe Upper Eyelid Ptosis at a Tertiary Oculoplastic Service

2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Mohammad Idris ◽  
Hassan Yaqoob ◽  
Hadia Sabir ◽  
Hera Faheem ◽  
Muhammad Jamshed
Keyword(s):  
Postoperative Complications ◽  
Surgical Outcomes ◽  
Case Series ◽  
Upper Eyelid ◽  
Congenital Ptosis ◽  
Study Results ◽  
Department Of Ophthalmology ◽  
Levator Resection ◽  
Upper Eyelid Ptosis ◽  
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.

Lagophthalmos after congenital ptosis surgery: comparison between maximal levator resection and frontalis sling operation

Eye ◽  
2020 ◽  
Author(s):  
Stephanie Ming Young ◽  
Yukihiro Imagawa ◽  
Yoon-Duck Kim ◽  
Ji Woong Park ◽  
Jaeho Jang ◽  
...  
Keyword(s):  
Congenital Ptosis ◽  
Levator Resection ◽  
Ptosis Surgery

scholarly journals Postoperative Visual Outcome: Sling procedure with prolene sutures in children with simple congenital ptosis

2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Nida Shamim ◽  
Nausheen Hayat ◽  
Alyscia Cheema
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Visual Outcome ◽  
Congenital Ptosis ◽  
Sling Procedure ◽  
Creative Commons ◽  
Case Series Study ◽  
Department Of Ophthalmology ◽  
Qualitative Variables ◽  
Sling Surgery

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. doi: https://doi.org/10.12669/pjms.38.1.4359 How to cite this: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(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4359 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals How to determine the amount of levator resection in congenital ptosis repair

2021 ◽  
Vol 25 (1) ◽  
pp. 415-422
Author(s):  
Muhamed Hamadamin ◽  
Jalal Fattah
Keyword(s):  
Case Series ◽  
Private Hospitals ◽  
Congenital Ptosis ◽  
Fascial Sling ◽  
Number Of Patients ◽  
Case Series Study ◽  
Levator Resection ◽  
Prospective Case Series ◽  
Series Study ◽  
Levator Aponeurosis

Background and objective: Levator aponeurosis resection is an effective technique to correct blepharoptosis when the levator function is fair to good. This study aimed to determine the amount of levator resection in congenital blepharoptosis repair. Methods: This is a prospective case series study conducted in Rizgary teaching hospital and private hospitals in Erbil city, Kurdistan Region, Iraq, from June 2011 to August 2019. The data of 53 patients (64 eyelids) affected by congenital blepharoptosis with poor to good levator function that underwent unilateral orbilateral levator resection blepharoptosis repair through the standard approach were included. The final outcome measures included postoperative eyelid height, contour, and symmetry. Results: This study includes a total of 53 patients with congenital blepharoptosis (64 eyelids); 20 males and 33 females. The age of the patients ranged from 3 years to 54 years, with a mean age ± SD of 14.11 ± 10.66 years. The ptosis was right sided in 22 patients (41.5%), left sided in 20 patients (37.7%), and bilateral in 11 patients (20.8%). The study showed good patient satisfaction in 66.03% of the cases, suboptimal satisfaction in 22.64% of the cases, and poor satisfaction in 11.32% of the cases. Conclusion: The levator resection for congenital ptosis is effective even with poor levator function and replaced in our practice the traditional fascial sling. We recommend that further studies be done on a larger number of patients to investigate the effectiveness of levator resection in patients with severe ptosis and very poor levator function. Keywords: Congenital blepharoptosis; Levator aponeurosis; Levator resection; Levator resection.

Evaluation of intraoperative lagophthalmos formula for levator resection in congenital ptosis in Egyptian patients

2020 ◽  
pp. 112067212095176
Author(s):  
Tarek M Rakha ◽  
Abd El Khalik I El Saadani ◽  
Amr M Awara ◽  
Sameh S Mandour
Keyword(s):  
Case Series ◽  
Levator Muscle ◽  
Palpebral Fissure ◽  
Congenital Ptosis ◽  
Egyptian Children ◽  
Egyptian Patients ◽  
Levator Resection ◽  
Prospective Case Series ◽  
Formula Method

Purpose: To evaluate the recent intraoperative lagophthalmos formula method for levator resection in determining postoperative lid height in congenital ptosis on Egyptian patients. Methods: This is a prospective case series which included 20 eyelids of 17 Egyptian children with congenital ptosis whose levator function is 4 mm or better. They underwent levator muscle resection guided by the recently presented intraoperative lagophthalmos formula. Preoperative Margin-to-Reflex Distance 1 (MRD1) and levator function were measured then intraoperative palpebral fissure opening was determined from formula: Intraoperative lagophthalmos = 9.08 − (0.48 × Preoperative MRD1) − (0.26 × Levator function). Success was defined as postoperative MRD1 ⩾ 3 mm and difference between both eyelid height ⩽1 mm at 6 months. Results: From 20 eyelids, there were five cases with mild (25%), 11 with moderate (55%), and four with severe (20%) ptosis. They showed success in four cases (80%), eight cases (73%), and three cases (75%) in each degree respectively with an overall success of 15 cases (75%). Conclusion: Proposed intraoperative lagophthalmos formula showed relatively good results in predicting postoperative eyelid level in Egyptian children with simple congenital ptosis with fair to good levator function.

STUDY ON MANAGEMENT OF PTOSIS BY DIFFERENT SURGICAL MODALITIES

2021 ◽  
pp. 11-14
Author(s):  
S. Suhail ◽  
J. Dwivedi ◽  
S. Mithal ◽  
R.C. Gupta ◽  
A. Gupta ◽  
...  
Keyword(s):  
Age Of Onset ◽  
Population Based ◽  
Medical Terminology ◽  
Congenital Ptosis ◽  
Medical College ◽  
Field Of Vision ◽  
Department Of Ophthalmology ◽  
Levator Resection ◽  
Sling Surgery ◽  
Abnormal Head

BACKGROUND:Ptosis is derived from the greek word for falling and is the medical terminology describing a drooping or abnormal lowering of an anatomical area. Ptosis that obstruct the pupil may interfere with the normal development of vision, resulting in amblyopia in children2 .In adult it may impair the field of vision and interfere with activities of daily living Ptosis is broadly classified into congenital and acquired,based on age of onset of the ptosis.Ptosis that is present at birth or within the first year of life is called congenital ptosis. Ptosis that presents after the age of one year is termed acquired ptosis. The treatment of ptosis depends upon the underlaying etiology. Ptosis usually does not improve over time and nearly always require corrective surgery. Depending upon the severity of congenital ptosis ,patients should be monitored every 3-12 months for sign of amblyopia due to congenital ptosis. In mild cases of congenital ptosis observation is sufficient ,if no sign of amblyopia, strabismus and abnormal head posture are present. METHODS:This study was conducted in the Upgraded Department of Ophthalmology,LLRM Medical College,Meerut during 2018–2019. Study design-A Population based Prospective interventional study was done on patients selected from OPD and camps during 2018-2019. Plan & Work: All patients with ptosis who are attending ophthalmology OPD and admitted in eye wards were included in the study provided they fulfill the inclusion criteria. RESULTS AND CONCLUSION: The subjects in our study were more males 12(66.66%) than females(33.33%). In our study there were 12(66.66%) patients of myogenic ptosis,out of them 11(61.11%) had frontalis sling surgery and 1(5.55%) had levator resection surgery. There was 2(11.11%) cases of neurogenic ptosis which was congenital in nature and in which 1(5.55%) is operated with frontalis sling &1(5.55%) with levator resection surgery. Most commonly performed surgery was frontalis sling 14(77.77%) followed by levator resection 2(11.11%) and 2(11.11%).

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

2015 ◽  
Vol 13 (1) ◽  
pp. 34-37 ◽  
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

Psychosocial and mental health disorders among a population-based, case–control cohort of patients with congenital upper eyelid ptosis

2021 ◽  
pp. bjophthalmol-2021-319276
Author(s):  
Tina M Hendricks ◽  
Gregory J Griepentrog ◽  
David O Hodge ◽  
Brian G Mohney
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Psychosocial Development ◽  
Mental Health Disorders ◽  
Population Based ◽  
Upper Eyelid ◽  
Congenital Ptosis ◽  
Health Disorders ◽  
And Gender ◽  
Upper Eyelid Ptosis

Background/AimRecent 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.MethodsThe 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.Results81 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).ConclusionsChildren 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.

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

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.

A Comprehensive Approach to Asian Upper Eyelid Ptosis Correction: The Levator Musculo-Aponeurotic Junction Formula

2021 ◽  
Author(s):  
Chin-Ho Wong ◽  
Michael Ku Hung Hsieh ◽  
Bryan Mendelson
Keyword(s):  
Revision Rate ◽  
Inclusion Criteria ◽  
Eyelid Margin ◽  
Upper Eyelid ◽  
Congenital Ptosis ◽  
Asian Patients ◽  
Eye Dominance ◽  
Post Surgery ◽  
Upper Eyelid Ptosis

Abstract Background The unique anatomy of the Asian upper eyelid requires specific adaptation to the levator advancement technique for ptosis correction to achieve predictable and reproducible outcomes. Objectives The levator musculo-aponeurotic junction was used as our key landmark. With a formula that we developed, the location of fixation relative to this landmark can be predicted preoperatively. Our clinical experience and outcomes with this technique are presented in this study. Methods Our inclusion criteria were Asian patients with mild to severe ptosis with at least fair levator function. Patients with acquired or congenital ptosis, primary and revisional cases were all included. The location for the placement of the advancement sutures was measured from the musculo-aponeurotic junction of the upper eyelid levator. This distance was determined by a formula that takes into consideration 1) the amount of elevation of the upper eyelid margin needed, 2) the degree of compensatory brow elevation that is present and 3) eye dominance. Results One hundred and fifty-six Asian patients were included in this prospective study. Of these 148 were bilateral and 8 were unilateral corrections. The technique was predictable with resolution of symptoms of eyelid ptosis post-surgery and good long-term symmetry of the palpebral aperture and crisp upper eyelid creases. The formula for estimating the fixation point on the levator was accurate to within +/- 1mm in the majority of patients. Our aperture revision rate was 2%. Conclusions This novel technique provides a predictable and reliable approach for upper eyelid ptosis correction in Asian patients.

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