Fasanella-Servat Procedure Research Articles

Efficacy and Complications of External and Internal Pediatric Blepharoptosis Repair Techniques: A Systematic Review.

To review and evaluate the efficacy and complication rates of external and internal blepharoptosis repair techniques in pediatric patients. The systematic review protocol was published on PROSPERO (CRD42020197343). Embase, MEDLINE, CENTRAL, and ClinicalTrials.gov were searched without date limitations. Two independent reviewers evaluated the articles for inclusion. Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS-I tool, respectively. Of 2,228 articles screened, 23 studies involving 730 patients were included. There were 20 case series and 3 retrospective cohort studies, but no randomized controlled studies. Overall study quality was low with serious risk of bias according to the GRADE and ROBINS-I criteria, respectively. External levator resection was the most studied procedure, evaluated in 18 studies. Seven studies investigated internal approaches including the Fasanella-Servat procedure. There was no standardized evaluation of surgical efficacy. Reoperation rates were 16.6% (range 3.6-50.9%) for external levator resection compared with 22.2% (range 0.0-25.8%) for internal approaches. The commonest postoperative complications were not sight-threatening. The most consistently reported complication was undercorrection, occurring at rates of 8.4% (range 2.4-16.7%) and 15.3% (range 2.7-75.0%) for external levator resection and internal approaches, respectively. There were no consistently applied, validated patient-reported outcomes or cosmetic outcomes. External and internal approaches have been successfully employed in pediatric blepharoptosis repair. However, noncomparative designs and risk-of-bias limit existing studies. Thus, prospectively designed studies with standardized outcome measures are required to minimize reporting bias, facilitate evidence synthesis, and support clinical decision making.

The Role of Postoperative Bandage Contact Lens in Patients Undergoing Fasanella-Servat Ptosis Repair.

To determine whether a bandage contact lens (BCL) improves patient comfort in the postoperative period in patients undergoing ptosis repair using the Fasanella-Servat technique, compared with no BCL. In this prospective, randomized, double-masked, comparison study, all patients had bilateral Fasanella-Servat surgery. A total of 30 patients were randomized to receive a BCL in one eye and no BCL in the other eye. Patient discomfort was measured as the primary outcome using the Eye Sensation Scale. Blurred vision was measured as a secondary outcome using selected questions from the Ocular Surface Disease Index. The surgeries were performed by 2 surgeons (J.T.H and R.S.A). Outcomes were measured one week following the procedure. Patients reported significantly less discomfort in the eye receiving a BCL, with only 13.3% ranking discomfort as "moderate" or "severe," compared with the eye not receiving BCL, where 63.3% of patients rated discomfort as "moderate" or "severe" (p < 0.001). There was no significant difference in patient-reported blurred vision between the 2 groups (p = 0.520). The use of a bandage contact lens after Fasanella-Servat procedure for ptosis repair is recommended as it improves patient comfort. In addition, it has no detrimental effect on patient-reported blurring of vision.

Enhanced Fasanella-Servat Procedure for the Graded Repair of Blepharoptosis.

To describe in detail a technique for a modified Fasanella-Servat procedure that provides a simplified method for graded Mueller muscle excision with minimal and controlled tarsal excision. A retrospective study of 71 patients (102 eyelids) who underwent the modified Fasanella-Servat procedure is reported. Measurements include the preoperative, post-phenylephrine, and postoperative margin-to-reflex distance-1, and postoperative upper eyelid height symmetry as determined by the absolute difference between right- and left-sided margin-to-reflex distance-1. Postoperative complications are reported. The average increase in margin-to-reflex distance-1 was 2.4 mm with an average postoperative upper eyelid height symmetry of 0.4 mm. Postoperative asymmetry was 1.5 mm or less in 68 patients, a success rate of 96%. Four patients (6%) exhibited overcorrection, 2 of which required additional surgery. No lagophthalmos or notable eyelid contour abnormalities were seen. The modified Fasanella-Servat technique offers a simple method to isolate and resect Mueller muscle and a minimal segment of tarsus in a quantitative fashion, allowing for a graded repair of blepharoptosis and thereby decreasing the risk of postoperative overcorrection, lagophthalmos, and eyelid contour asymmetry whilst preserving the bulk of tarsus.

Frontalis Sling Procedure Using Prolene Material in Severe Ptosis

Abnormally low position (drooping) of the upper eye lid is called ptosis. Common practices in correction of ptosis are different types of surgical procedures like, Fasanella-Servat procedure, Levator resection, Frontalis brow suspension (sling), Aponeurosis strengthening etc. In sling operation different types of materials are used, like, autogenus fascialata, cadaver fascilata, skin, sclera, collagen and artificial eg. Prolene, ethibond, silicone, supramid, mersilene mesh, goretex etc. The aim of study is to establish that use of prolene in sling operation gives better result. The study was carried out at BSMMU. A total thirty cases were selected for study. Technique of operation was Frontalis brow suspension (sling) procedure using prolene. The follow-up period was three months to six months. Final outcome of ptosis correction was good outcome in 24 (80%) patients out of 30. So prolene use in sling operation has excellent tensile strength, good handling properties, permanent result and better tolerance.Faridpur Med. Coll. J. Jan 2017;12(1): 31-33

Pediatric Blepharoptosis

Congenital blepharoptosis, caused by levator muscle dysgenesis, presents at birth and may lead to disturbed visual development and function. Other causes of ptosis in pediatric patients can be myogenic, neurogenic, mechanical, or traumatic. Timely correction is, therefore, critical, and careful preoperative planning and intraoperative considerations are crucial to achieve optimal outcomes and minimize potential complications. The various surgical techniques, including the frontalis suspension or sling, levator resection and advancement, Müller's muscle conjunctival resection (the Putterman procedure), and modified Fasanella-Servat procedure are each associated with distinct indications, benefits, and drawbacks, necessitating a unique tailored approach to each surgical candidate.

The Modified Fasanella-Servat Procedure

To describe a modified Fasanella-Servat procedure and nomogram for the correction of minimal amounts of ptosis. Retrospective review of this modified Fasanella-Servat procedure was performed on 118 eyelids in 86 consecutive patients over 2, 4-year periods by 1 surgeon (S.C.D.). The amount of tarsectomy was based on the amount of ptosis. Mean pre- and postoperative margin-to-reflex distance 1 were +0.7 mm and +2.4mm, respectively. One hundred and twelve eyelids (95%) had satisfactory results with postoperative margin-to-reflex distance 1 ≥ 1.5 mm. Eyelid symmetry was achieved in 92% of eyelids to within 0.5 mm. There was no incidence of overcorrection, tarsal buckling, or corneal abrasion. One eyelid had a contour deficit. Tarsectomy amount ranged from 2 mm to 5 mm. Average amount of tarsectomy to eyelid elevation was 2.4:1. The modified Fasanella-Servat procedure is technically easy, time-efficient, and has a low complication rate for the treatment of minimal blepharoptosis (< 2.5 mm) with good levator function and negative phenylephrine test. In the authors' hands, the ratio of tarsectomy to eyelid elevation is approximately 2:1. In addition to other techniques such as levator advancement and Müller's muscle conjunctival resection, the modified Fasanella-Servat technique is a useful adjunct to the modern ptosis surgeon's armamentarium.

Das Fasanella-Servat-Verfahren zur Therapie der erworbenen Ptosis

The oculoplastic surgeon may choose between several surgical procedures to treat ptosis of the eyelid. One such potential therapeutic option is the Fasanella-Servat procedure. The purpose of our study was to evaluate the postoperative outcome of the Fasanella-Servat procedure in patients with ptosis of the eyelid with regard to objective and subjective criteria. The postoperative success of 20 patients (23 eyelids), 11 female and 9 male, with acquired ptosis of the upper eyelid who underwent the Fasanella-Servat procedure between 1995 and 2004 in an eye tertiary care centre, was evaluated. With regard to the type of ptosis, the pre- and postoperative opening of the eyelid, the levator function, and the symmetry between both eyes were analysed statistically. The patients' subjective satisfaction with the functional and cosmetic postoperative outcome was evaluated by means of a nominal questionnaire (scale 1 - 5). The intraoperatively removed tissue was analysed histopathologically for accessory lacrimal glands or levator muscle. The mean preoperative opening of the eyelid was 7.1 mm (min. 4 mm, max. 10 mm) with a mean levator function of 12.6 mm. Postoperatively, the opening of the eyelid improved significantly to 9.3 mm (min. 7 mm; max. 14 mm), while the levator function remained stable. The preoperative asymmetry between both eyes was significantly decreased. 90 % of the patients were satisfied with the cosmetic and functional results. There were no early and late postoperative complications. No side effects were recorded following treatment. The intraoperatively removed tissue showed no evidence of tissue of accessory lacrimal gland or levator muscle. The Fasanella-Servat procedure remains an effective procedure in treating mild ptosis with few complications and good cosmetic and functional results.

Early Postoperative Adjustment of the Fasanella-Servat Procedure: Review of 102 Consecutive Cases

To describe and evaluate an office-based technique to adjust the Fasanella-Servat procedure in the first postoperative week. This retrospective case series reviewed all consecutive eyelids undergoing the Fasanella-Servat procedure between July 1, 2006, and July 1, 2007, by a single surgeon (R.D.L.). Charts were reviewed to determine the frequency, timing, safety, and efficacy of postoperative adjustment. Postadjustment photographs were reviewed by a blinded ophthalmic plastic surgeon for eyelid contour, height, symmetry, overall cosmesis, and picture quality as excellent, satisfactory, or poor. The Fasanella-Servat procedure was performed on a total of 102 eyelids in 54 patients over the 12-month interval. Postoperative adjustments at the time of suture removal were performed to improve mild eyelid asymmetries for 22 eyelids (22%) in 19 patients. Postadjustment photographs, available for 17 patients, showed excellent eyelid contour (53%), height (88%), symmetry (82%), and cosmesis (65%). Satisfactory results were obtained in all remaining photographed eyelids. The Fasanella-Servat procedure should be viewed as an adjustable ptosis correction with the adjustment as a standard component of postoperative suture removal. This manipulation takes only a few moments with minimal to no patient discomfort. It allows for improvements in eyelid height and contour. This series demonstrates a procedure that is simple, highly successful, and safe.

Modified fasanella-servat for acquired ptosis: Case report and review of the literature

A 28-year-old man who had acquired ptosis of his left upper eyelid after a traffic accident did not benefit from standard levator advancement surgery. Patient had significant ptosis with moderate levator function. A modified Fasanella-Servat procedure under local anesthesia resulted in the desired correction of his left upper eyelid ptosis. A review of the Fasanella-Servat procedure for ptosis surgery is presented, as well as its modifications, along with its limitations.

Paediatric blepharoptosis: a 10-year review

To examine the characteristics of blepharoptosis and the success of surgical intervention in a large group of children presenting to a specialist at paediatric ophthalmology center. Ten-year retrospective case notes review of patients presenting to the Birmingham Children's Hospital for blepharoptosis surgery. Resultant database was interrogated for aetiology of ptosis; severity; surgical correction; outcome; complications and need for reoperation. One hundred and fifty five children (186 eyes) underwent blepharoptosis surgery. Hundred and ten patients (71%) were treated with a levator resection procedure, 28 (18%) underwent a brow suspension using Mersilene mesh, 15 (10%) with Fasanella Servat procedure and 2 (1%) with La Mange procedure. The mean post-operative follow-up was 30.82 months with 84 children completing a minimum of 12 months follow-up. Overall, 70.97% lids were successfully corrected with a single operation. In 9.14% lids, the results were fair but no further surgery was carried out. Reoperation was required in 19.89% of lids with the mean time to second surgery being 32.69 months. Amblyopia was found in 26.45% (41 children); in 3 patients, their amblyopia became manifest after the ptosis surgery. A concomitant squint was present in 14.19%, and 18.70% had a significant refractive error requiring spectacles prescription, with anisometropia present in more than 72% of these patients. Early referral to an ophthalmologist is necessary even though surgical correction may be delayed. Children with congenital ptosis need to be monitored for amblyopia both pre- and post-operatively, as the incidence of strabismus and refractive errors is much higher than the general population and these may develop even after ptosis surgery.

Fasanella—Servat procedure: indications, efficacy, and complications

Background: The Fasanella-Servat procedure is used for the repair of mild to moderate ptosis. The purpose of this study was to determine the efficacy of the Fasanella-Servat procedure for the repair of several forms of ptosis. Methods: The authors retrospectively reviewed 169 charts of 2 surgeons from 1988 to 1996. All patients had undergone a Fasanella-Servat procedure for ptosis. Patients with less than a 1-month follow-up were excluded, leaving 153 eyelids of 144 patients. Surgical success was defined as lid symmetry within 0.5 mm or correction of eyelid contour abnormality from previous surgery or trauma. Results: Ptosis was classified as involutional, occurring after intraocular surgery, congenital, due to Horner's syndrome present after levator surgery, and myogenic/other.With a mean follow-up of 7 months, success was achieved in 89.5% of cases (137/153). Among subgroups, success was highest at 100% in Horner's syndrome (8/8) and post-levator surgery (11/11), and lowest in congenital ptosis at 76.4% (13/18). Postoperative problems included dry eye symptoms (6/144 patients), contour abnormalities in 12 lids, and dermatochalasis in 10 lids. Interpretation: The Fasanella-Servat operation is effective for mild to moderate ptosis from a variety of causes and for contour abnormality correction in patients with little or no ptosis. Despite the long-held belief that excision of the accessory lacrimal glands of Wolfring leads to dry eye symptoms, our study found this to be the exception. This procedure has the advantage of high reliability when reasonable preoperative criteria are applied and is minimally invasive.

Ptosis: causes, presentation, and management.

Drooping of the upper eyelid (upper eyelid ptosis) may be minimal (1-2 mm), moderate (3-4 mm), or severe (>4 mm), covering the pupil entirely. Ptosis can affect one or both eyes. Ptosis can be present at birth (congenital) or develop later in life (acquired). Ptosis may be due to a myogenic, neurogenic, aponeurotic, mechanical or traumatic cause. Usually, ptosis occurs isolated, but may be associated with various other conditions, like immunological, degenerative, or hereditary disorders, tumors, or infections. Besides drooping, patients with ptosis complain about tired appearance, blurred vision, and increased tearing. Patients with significant ptosis may need to tilt their head back into a chin-up position, lift their eyelid with a finger, or raise their eyebrows. Continuous activation of the forehead and scalp muscles may additionally cause tension headache and eyestrain. If congenital ptosis is not corrected, amblyopia, leading to permanently poor vision, may develop. Patients with ptosis should be investigated clinically by an ophthalmologist and neurologist, for blood tests, X-rays, and CT/MRI scans of the brain, orbita, and thorax. Treatment of ptosis depends on age, etiology, whether one or both eyelids are involved, the severity of ptosis, the levator function, and presence of additional ophthalmologic or neurologic abnormalities. Generally, treatment of ptosis comprises a watch-and-wait policy, prosthesis, medication, or surgery. For minimal ptosis, Müller's muscle conjunctival resection or the Fasanella Servat procedure are proposed. For moderate ptosis with a levator function of 5-10 mm, shortening of the levator palpebrae or levator muscle advancement are proposed. For severe ptosis with a levator function <5 mm, a brow/frontalis suspension is indicated. Risks of ptosis surgery infrequently include infection, bleeding, over- or undercorrection, and reduced vision. Immediately after surgery, there may be temporary difficulties in completely closing the eye. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return. In some cases, more than one operation is required.

The Fasanella-Servat procedure: A retrospective study

A retrospective study was carried out to assess the success of the Fasanella-Servat procedure for the management of the aponeurotic defect type of adult ptosis. Eighteen procedures were carried out on 16 patients. The mean follow-up was 3 years. The success rate of the operation was 28% with a mean residual tarsal plate height of 5 mm with a very variable tarsal plate contour.

Modification of the Fasanella-Servat procedure: An adjustable ptosis procedure

The Fasanella-Servat procedure was initially used as a shortened, simplified operation for 2 to 3 mm of ptosis correction. Both then and now, this procedure is indicated in involutional ptosis and in patients with a good tear film function. Its main advantage over traditional ptosis surgery is that it is a truly adjustable procedure, allowing eyelid recontouring or lowering at 5 to 7 days after operating at the time of suture removal. In addition, no patient cooperation is required and surgery can be performed under general anesthesia or can be combined with more extensive surgical procedures that require deep sedation. The Fasanella-Servat procedure has been shown to use both a tarsectomy and advancement and reattachment of the levator aponeurosis. The ptosis correction achieved is independent of the amount of smooth muscle removed in the surgical specimen. During the postoperative interval, the surgeon has the advantage of waiting for edema to clear before readjustment and final contouring of the eyelid height is achieved at the first postoperative visit. This allows the surgeon to lower an eyelid if Hering's Law has created a contralateral ptosis or if the operated eyelid has less than a pleasing contour.

Botulinum Toxin Injections in the Treatment of Seventh Nerve Misdirection

Inquiries to Allen M. Putterman, M.D., 111 N. Wabash Ave., Ste. 1714, Chicago, LL 60602. Misdirection of the seventh nerve occasionally occurs after regeneration of the nerve after paresis, which may be caused by such conditions as Bell's palsy. Many patients find that when they smile their eyelids narrow on the side of the seventh nerve misdirection and create a cosmetic deformity. Some of these patients can be adequately treated through a blepharoptosis procedure, such as the Fasanella-Servat procedure.' The Muller's muscle-conjunctival resection blepharoptosis procedure is effective in patients who preoperatively demonstrate a good response of their eyelid level and palpebral fissure both in the primary position of gaze and on smiling after instillation of 10% phenylephrine to the superior conjunctival fornix. There are patients, however, whose upper eyelids elevate to a cosmetically unacceptable high level in the primary position of gaze on instillation of phenylephrine even though they may have an acceptable appearance when they smile. In this group of patients, there has not been a procedure to correct the eyelid deformity fully on smiling without causing a retracted eyelid without smiling. I treated a patient who had seventh nerve misdirection whose upper eyelid elevated too high with 10% phenylephrine by injection of botulinum toxin. A 28-year-old woman had Bell's palsy, which had affected her right side ten years previously. The patient continued to be bothered by the narrowing of her right eye when she smiled. In the primary position of gaze, her palpebral fissure width measured 9.0 mm on each side. When she smiled, the right palpebral fissure narrowed to 5.5 mm (Fig. 1). On instillation of 10% phenylephrine to the right upper fornix, the right upper eyelid retracted to a level 2.0 mm higher than the left upper eyelid. When the patient smiled after phenylephrine instillation, her upper eyelid levels were symmetric. A blepharoptosis procedure in the right upper eyelid was contraindicated because of the probability that the upper eyelid would have cosmetically unacceptable retraction when the patient was not smiling. Botulinum A toxin (0.1 ml of 2.5 units per 0.1 mm of solution) was injected into the right cheek and five sites of the right upper and lower eyelids. The sites injected were the temporal and nasal ends of the right upper eyelid, the temporal and central positions of the right lower eyelid, and the temporal right inferior orbital rim. Postoperatively, the palpebral fissure width measured 9.0 mm on the right side and 9.5 mm on the left. There was no change on smiling (Fig. 2). For three months postoperatively the

Surgical management of oculomotor nerve palsy with lateral rectus transplantation to the medial side of globe.

An operation for complete third nerve paralysis involving lateral rectus muscle transplantation to the medial side of the globe as a basic procedure is described. An inferior rectus muscle recession plus resection of an apparent completely paralysed medial rectus was subsequently performed at a second stage operation. The results appeared to be an improvement on previous surgery, particularly in terms of ocular motility, with almost full adduction of the operated eye being achieved. This adduction movement occurred as part of a normal conjugate movement of the two eyes, and the question arises as to the responsible muscles, with some evidence to suggest that relearned action of the transplanted lateral rectus muscle may be implicated. Finally, a Fasanella-Servat procedure as a third stage operation appeared to be adequate to correct the ptosis.

Tarsal Buckling after Sutureless Fasanella-Servat Procedures

A patient who underwent bilateral, sutureless Fasanella-Servat procedures experienced wound dehiscence that resulted in a distorted eyelid contour which rquired substantial wound and eyelid revision. Other methods of handling the problem of suture abrasion exist that may prevent tarsal buckling after a Fasanella-Servat procedure.

Terminal Course of Nerve Supply to MüLler's Muscle in the Rhesus Monkey and Its Clinical Significance

Electron microscopic, histochemical fluorescence, and pharmacologic evidence suggested that, in the rhesus monkey, Müller's muscle was not totally denervated either by cutting the levator palpebrae superioris muscle or by a Fasanella-Servat procedure. We examined the terminal course of the sympathetic nerve supply and the potential for preserving Müller's muscle in blepharoptosis surgery.

Jaw-Winking Blepharoptosis Treated by the Fasanella-Servat Procedure

Jaw-Winking Blepharoptosis Treated by the Fasanella-Servat Procedure