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

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.

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

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.

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.

STUDY ON MANAGEMENT OF PTOSIS BY DIFFERENT SURGICAL MODALITIES

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%).