Correction Of Severe Blepharoptosis Research Articles

An Adjustable Magnetic Levator Prosthesis for Customizable Eyelid Reanimation in Severe Blepharoptosis II: Randomized Evaluation of Angular Translation.

Examine the effect of force modulation via angular translation of a static magnetic field for customizable treatment of severe blepharoptosis. Prototype adjustable-force magnetic levator prostheses (aMLP) consisted of a spectacle-mounted magnet in rotatable housing and small eyelid-attached magnets embedded in a biocompatible polymer. Interpalpebral fissure (IPF) of 17 participants with severe blepharoptosis was continuously measured for one minute at five spectacle magnet angles, with order randomized and participant and data analyst masked. The hypothesis that angular position affected opening IPF (o-IPF), minimum blink IPF (m-IPF), and comfort ratings (1-10) was tested. The aMLP improved o-IPF from 4.5 mm without the device to 6.2 mm on the lowest force setting (P < 0.001) and 7.1 mm on the highest setting (P < 0.001) and allowed for complete volitional blink regardless of setting (average m-IPF 0.4 mm and no change with aMLP; P = 0.76). Spontaneous blink without the device (2.0 mm) was affected on the highest force setting (m-IPF 3.9 mm; P < 0.001) but only marginally so on the lowest setting (3.0 mm; P = 0.06). Comfort (7.6/10) did not vary with the angle (P > 0.36). Profile analysis found substantial individual responses to angle (P < 0.001), confirming the value of customization. Angular translation provided adjustable force, which had a statistically and clinically meaningful impact on eye opening and the completeness of the spontaneous blink. This quantitative evidence supports continued use of the angular translation mechanism for force adjustment in the customizable magnetic correction of severe blepharoptosis. Evidence for the benefit of customizable magnetic force via angular translation in a larger sample of participants than reported previously.

Use of an Orbital Septum Flap for Correcting Severe Blepharoptosis.

Several surgical procedures are available for the treatment of severe blepharoptosis with poor levator function. However, the procedures have advantages and disadvantages. Particularly, complications such as lagophthalmos and lid lag are commonly observed after conventional interventions. Thus, the present study aimed to introduce a surgical technique that uses an orbital septum flap without the orbital oculi muscle for the correction of severe blepharoptosis. The technique utilizes the orbital septum flap, which is connected with the frontalis muscle via the galea aponeurosis and frontal periosteum, to suspend the tarsal plate. In this case series, the technique was used for the correction of blepharoptosis in 16 eyes from 12 patients. The margin reflex distance in all patients improved at 6 months after surgery. Two patients presented with lagophthalmos and three with mild recurrence. However, revision surgery was not required, and none of patients presented with lid lag. For the correction of blepharoptosis, the use of the orbital septum flap without the orbital oculi muscle can be easily selected compared with other conventional methods that are more likely to cause overcorrection and closure disorders. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Function-Preserving Frontalis Orbicularis Oculi Muscle Flap for the Correction of Severe Blepharoptosis With Poor Levator Function.

BackgroundSevere blepharoptosis with poor levator function (LF) has traditionally been managed with exogenous frontalis suspension but complications such as lagophthalmos, infection, and rejection are often reported.ObjectivesThe aim of this study was to design a function-preserving frontalis orbicularis oculi muscle (FOOM) flap to correct severe blepharoptosis with poor LF. The long-term surgical outcome of the technique was assessed.MethodsThis retrospective study included only adult patients with severe blepharoptosis and poor LF, all of whom had their surgery performed by the senior surgeon over a 6-year period. Clinical assessment of LF, palpebral fissure height (PFH), marginal reflex distance 1 (MRD1), duration of follow-up, and postoperative complications were recorded.ResultsA total of 34 patients and 59 eyelids were recorded during a mean follow-up period of 17.7 months. Postoperative evaluation yielded mean [standard deviation] improvements of PFH gain of 5.62 [1.61] mm (P < 0.001), and MRD1 and PFH increases of 4.03 [0.82] mm (P < 0.001) and 8.94 [0.81] mm (P < 0.001), respectively. All patients demonstrated normalization of orbicularis function: no lagophthalmos was observed at the 8-month postoperative follow-up. Recurrence of ptosis was recorded in 4 eyelids (6.78%). Revisions were performed in 2 eyelids (3.39%). No infection or granuloma was noted.ConclusionsThe function-preserving FOOM flap is a useful vector for frontalis suspension. Not only does it effectively address lagophthalmos as well as other complications, but it provides aesthetically pleasing outcomes in patients with severe blepharoptosis and poor LF.Level of Evidence: 4

Conjoint fascial sheath suspension for early correction of severe blepharoptosis after double-eyelid blepharoplasty.

We aimed to investigate the feasibility and efficacy of early correction of severe blepharoptosis after double-eyelid blepharoplasty using conjoint fascial sheath (CFS) suspension. From July 2013 to July 2016, 23 patients (25 eyes) with severe blepharoptosis were treated with CFS suspension and followed up for 12-36 months. The levator function, margin reflex distance, patients' satisfaction with the appearance of the double eyelids, and complications were retrospectively analysed. Full correction was achieved in 24 eyes and overcorrection in one eye. No undercorrection was noticed. Postoperatively the mean levator function was significantly increased (from 1.5 to 10.2mm) and the margin reflex distance was significantly increased from -1.0 to 4.8mm. All patients were satisfied with the appearance of the double eyelids. No recurrence of blepharoptosis occurred postoperatively. One patient had postoperative chemosis and was well-managed with conservative treatments. CFS suspension is a safe and effective way to treat severe blepharoptosis after double-eyelid blepharoplasty. The treatment is effective in the long term.

Evaluation of Long-term Outcomes of Correction of Severe Blepharoptosis with Advancement of External Levator Muscle Complex: Descriptive Statistical Analysis of the Results.

Evaluation of long-term results after aponeurotic blepharoptosis correction with external levator muscle complex advancement. We carried out a retrospective study with medical record review of 20 patients (40 eyes) affected by bilateral aponeurotic moderate and severe ptosis who underwent primary surgery between January 2010 and December 2013. Criteria for outcome evaluations included 3-year postoperative follow-up of upper margin reflex index (uMRD) and symmetry. 3-Year postoperative follow-up showed 17 (85%) cases of successful correction of ptosis and three cases (15%) showed partial success. Two eyes showed hypocorrection, while one eye was overcorrected. The symmetry was maintained in all patients except for the oldest. External superior levator advancement is an effective procedure for moderate and severe aponeurotic blepharoptosis correction, and establishes good long-term eyelid position and symmetry.

Frontalis muscle transfer technique for correction of severe congenital blepharoptosis in Chinese patients: An analysis of surgical outcomes related to frontalis muscle function

The aim of this study is to evaluate the surgical outcomes related to frontalis muscle function using the frontalis muscle transfer technique in Chinese patients with severe congenital blepharoptosis and poor levator function. Between December 2003 and December 2011, using the frontalis muscle transfer technique, 37 patients of Chinese origin underwent surgery on 53 eyelids. The frontalis muscle function was assessed and categorized as poor (excursion≤7mm) and good (excursion>7mm) before the surgery. The results, including complications of the treatment procedure, were followed up and evaluated. Using the Cochran-Mantel-Haenszel statistic, the preoperative ptosis severity was compared with the degree of ptosis correction, and the preoperative frontalis muscle function was compared with the degree of ptosis correction using Fisher's exact test for paired data. A two-sided value of p<0.05 was considered statistically significant. Of the total eyelids considered, sufficient postoperative correction of ptosis was achieved in 43 eyelids (81.1%), while the correction was insufficient in 10 eyelids (18.9%). Fifteen (28.3%) eyelids were either overcorrected (n=5) or undercorrected (n=10). The rate of lagophthalmos was 3.8%. Eyelids with preoperative frontalis muscle function >7mm had a higher rate of sufficient correction in comparison to those with preoperative frontalis muscle function ≤7mm (91.2% vs. 63.2%; p<0.05). However, postoperative ptosis correction had no relationship with preoperative ptosis severity. The frontalis muscle is the main motor muscle used in the correction of severe blepharoptosis via the frontalis muscle transfer technique. Although the technique is considered to be an effective surgical method for the correction of severe blepharoptosis, the outcome of the correction procedure depends on the preoperative frontalis muscle function of the patient.

Comparison of Blepharoptosis Correction Using Müller-aponeurosis Composite Flap Advancement and Frontalis Muscle Transfer.

Treatments for severe blepharoptosis are well documented and include the most common operations for restoring upper eyelid ptosis, which are levator surgery and frontal muscle transfers; however, the choice of treatment is still controversial. There are different approaches to the restoration of upper eyelid ptosis, and the choice will be based on ptosis severity and the surgeon's skill and experience. Two hundred and fourteen patients presenting with a levator function of between 2 and 4 mm received ptosis correction between 1991 and 2010 at our clinic. Of these, 71 patients underwent Müller aponeurosis composite flap advancement for correction of 89 eyelids, and frontalis muscle transfer was performed on 143 patients (217 eyelids). Postoperative results were evaluated with an average follow-up period of 23 months. The preoperative average for marginal reflex distance (MRD1) in the Müller aponeurosis composite flap advancement group was 1.25 mm, and in the frontal muscle transfer group, it was 0.59 mm. The area of corneal exposure (ACE) was 57.2% in the Müller aponeurosis composite flap advancement group and 53.6% in the frontal muscle transfer group. The postoperative average distance was not significantly different for the 2 techniques. In the Müller aponeurosis composite flap advancement group, MRD1 was 2.7 mm and ACE was improved to 73.5%. In the frontal muscle transfer group, MRD1 was 2.3 mm and ACE was 71.2%. Undercorrection and eyelid asymmetry were the most frequently observed postoperative complications for both techniques. In our study, we confirmed that Müller aponeurosis composite flap advancement and the frontalis transfer technique are both effective in the correction of severe blepharoptosis; our results showed no significant differences between the 2 techniques.

Superior Tarsectomy Augments Super-Maximum Levator Resection in Correction of Severe Blepharoptosis with Poor Levator Function

To determine if a superior tarsectomy improves the ptosis corrective ability of the super maximum levator resection in cases of severe blepharoptosis with poor levator function (less than 5 mm). Retrospective, consecutive case series. Patients who underwent super maximum levator resection with (8 eyelids) or without superior tarsectomy (10 eyelids) at one institution. Chart review of patients who underwent super maximum levator resection with or without superior tarsectomy. Data regarding eyelid position, surgical outcome, and postoperative complications were evaluated. Margin reflex distance-1 (distance [mm] between corneal light reflex and upper eyelid margin), bilateral eyelid symmetry, and postoperative complications. A statistically significant improvement in ptosis correction was demonstrated when integrating the superior tarsectomy with the super maximum levator resection (P = 0.029). In addition, the superior tarsectomy significantly decreased the incidence of undercorrection (margin reflex distance-1 values less than 2.0 mm) compared with the super-maximum levator resection alone (12.5% vs. 70%; P = 0.023). Improved postoperative eyelid symmetry within 1.0 and 1.5 mm was demonstrated in cases treated by the superior tarsectomy. Postoperative complications were similar in both treatments. The super maximum levator resection combined with superior tarsectomy can correct severely ptotic eyelids with Berke levator function ranging from 3 to 4.5 mm.

Correction of severe blepharoptosis using an orbicularis oculi muscle flap

目的 探讨眼轮匝肌瓣悬吊治疗重度上睑下垂方法的临床效果.方法做重睑成形术切口,于皮肤与眼轮匝肌间向上分离达眉上缘,再于眼轮匝肌深面、眶隔浅面向上分离达眶上缘;根据睑板宽度及弧度设计眼轮匝肌瓣,向下推进固定在睑板前方,悬吊上睑.结果15例24只眼重度上睑下垂者术后效果均较满意,睑缘外形匀称优美,眼睑闭合功能良好,无并发症.不足之处是,向下注视时有上睑停滞现象.结论眼轮匝肌瓣悬吊手术操作简单,手术野显露良好,固定牢靠,张力适当,不易复发;无需做额肌纵切口,不损伤眶上血管神经束及面神经额支,不减弱额肌的收缩力,是一种治疗重度上睑下垂可供选择的方法。

Transposition of the levator in blepharoptosis using a single superior lid crease incision

In 1999 we introduced the technique of transposition of the levator using a suture to the frontalis muscle for the correction of severe blepharoptosis [16, 17]. This operation was carried out using two skin incisions, one on the superior lid crease and the other at the superior margin of the eyebrow. It was later demonstrated that the levator muscle becomes reinnervated by the facial nerve branches to the frontalis muscle [18]. The results of this procedure have been satisfactory without infections or lagophthalmos [9, 19, 20]. The only limit of this technique is the ability of the patient to contract the frontalis muscle. This limitation, however, applies to any surgical technique which consists of suspension of the eyelid to the frontalis area. After having performed 22 levator transpositions, utilizing two skin incisions, the procedure is now performed with a single skin incision on the superior lid crease. With this modification the technique might be well accepted by those surgeons who deal with the problems of upper eyelid ptosis.