Levator Muscle Function Research Articles

Transconjunctival levator muscle plication in mild to moderate congenital ptosis

Purpose The aim of this study was to evaluate the efficacy, cosmetic result, and safety of transconjunctival plication of the levator muscle in the correction of simple congenital ptosis.Patients and methods This is a prospective interventional study that was performed on 23 eyelids (17 unilateral and three bilateral) of 20 patients with simple congenital ptosis and fair to good levator muscle function. All patients were subjected to transconjunctival levator plication. Preoperative history taking and ophthalmological examination were performed. Degree of ptosis was evaluated using the marginal reflex distance 1 (MRD1). Levator muscle function was evaluated using the Berke’s method. Serial follow-up was performed for all patients.Results The mean age of the patients was 6.65±3.13 years. Anatomical success (MRD1 of 3–5 mm and intereyelid difference of <1 mm) was achieved in 20 (86.96%) eyelids, whereas undercorrection occurred in three (13.04%) eyelids. A good cosmetic outcome was obtained in 21 (91.3%) eyelids. A statistically significant improvement was found between the preoperative MRD1 values and the 1- and 6-month postoperative values (P<0.001). There was no significant difference between MRD1 at 1 and 6 months, postoperatively (P=0.07). No major postoperative complications were reported.Conclusion Levator plication using the posterior transconjunctival approach is safe and effective for correcting simple congenital blepharoptosis with a good cosmetic outcome. This technique is especially useful for mild and moderate cases of congenital ptosis associated with good to fair levator muscle function.

New algorithm for planning superior tarsal muscle resection for blepharoptosis: description of technique and results

Background. Transconjunctival techniques for blepharoptosis correction are popular because of ease of implementation and good predictability. For a long time, the phenylephrine test remained the main factor influencing the choice of blepharoptosis correction method. Recently, more and more researches indicate the possibility of the superior tarsal muscle resection in patients with negative responses to the phenylephrine test. Authors have proposed and described a new modified technique for resection of the superior tarsal muscle, which can be used to correct blepharoptosis in patients with different responses to phenylephrine test.&#x0D; Materials and methods. The study included 2 groups of patients with mild to moderate blepharoptosis with levator muscle function 8 mm or more. The main group (75 patients, 103 eyelids) underwent a modified resection of the superior tarsal muscle, and in the comparison group (26 patients, 35 eyelids) an open sky resection of the superior tarsal muscle was performed. Surgery in the main group was planned according to the following algorithm. In positive and sufficient response to the test, 2/3 of the superior tarsal muscle was resected. In case of positive but insufficient response to the phenylephrine test, subtotal superior tarsal muscle resection was performed. In case of negative or slightly positive result of phenylephrine test, an assessment of the white line motility was additionally performed intraoperatively. If the motility of the white line (in mm) was equal to the amount of ptosis, subtotal superior tarsal muscle resection was performed without resection of the superior tarsal plate. If the motility of the white line was less than desired amount of correction, then subtotal superior tarsal muscle resection was combined with tarsal plate resection to reach the desired amount of correction. The residual height of the tarsal plate was always left 5 mm or more. If superior tarsal plate was compromised or not high enough to perform desired amount of resection then white line was advanced to the tarsal plate.&#x0D; Results. The degree of ptosis, the result, the width of the palpebral fissure in the center, lateral and medial limbus, MRD 1 and MRD 2 did not significantly differ between the groups (p 0.05). However, the frequency of hypo- and hypercorrections was significantly lower in the main group (p 0.05).&#x0D; Conclusion. New algorithm of planning modified superior tarsal muscle resection gives an opportunity to use transconjuctival methods of blepharoptosis correction in cases of weak and negative phenylephrine test and to reduce the amount of hypo- and hypercorrections

The Effect of Two Different Frontalis Sling Approaches on Postoperative Eyelid Contour: A Comparative Study.

To compare two different frontalis sling approaches, tarsal fixation and orbicular muscle fixation, using silicone rod (FCI Ophthalmics, Marshfield Hills, MA, USA) in terms of postoperative upper eyelid contour in patients with poor levator muscle function. Retrospective, comparative, case series. Ten eyes of seven patients who received frontalis sling surgery with orbicularis muscle fixation (group 1), eight eyes of seven patients who received frontalis sling surgery with tarsal fixation (group 2) and 30 eyes of 15 age and sex-matched healthy controls (control group) were included. Postoperative photographs of all the participants were taken in the primary gaze, and each photograph was viewed on a computer. The distance between the upper lid margin and pupillary center (MCD), nasal limbus (MND), and temporal limbus (MTD) was measured, respectively, using the ruler in Microsoft Paint Software and compared with each other for each participant. Both nasal, central and temporal margin distance values in group 1 and group 2 were significantly lower than those of the control group (p<0.05 for all values). The ratio of MTD/MCD in the control group was significantly higher than group 1 (p = 0.04) besides the ratio of MND/MTD in the control group was significantly lower than group 1 (p = 0.01). Frontalis sling approach with tarsal fixation using silicone rod might provide improved cosmetic results including more symmetrical upper eyelid contour compared with orbicularis muscle fixation approach. Moreover, the novel measuring technique presented in the current study provides a simple and effective assessment of the upper lid contour in daily practice setting. 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.

Surgical Treatment of Severe Ptosis by Modified Brow Suspension Technique.

Blepharoptosis can occur at any age. Its surgical correction may be indicated for functional and cosmetic purposes. Blepharoptosis treatment in children <3 years old may be required on an urgent basis to prevent amblyopia. The type of surgery depends on the severity of ptosis. The purpose of the study is to assess the functional results and complications of frontalis sling operation using double-threaded prolene as a suspensory material to correct severe ptosis with minimal or no levator muscle function. In total, 72 lids of 59 patients (both male and female) having severe unilateral or bilateral ptosis were included. Frontalis sling with double-threaded prolene using cannula for introducing prolene was used to correct severe ptosis in these patients. Patients were followed up for an average of 21 (range: 12-24) months postoperatively for evaluating the functional and cosmetic results as well as possible complications. Favourable long-term functional and cosmetic results were achieved in most patients. The overall recurrence rate of ptosis was in 5 lids, most of which were in <5-year-old patients. Other complications were incomplete closure in 2 lids, overcorrection in 1 lid, and corneal exposure and exposure keratitis in 1 eye. Infection, wound problems, and supratarsal sulcus obliteration were not observed in any case during the follow-up period. Frontalis sling operation using double-threaded prolene as a suspensory material is an effective technique to correct severe ptosis.

Treatment strategy for severe blepharoptosis

ObjectiveTo establish a treatment protocol for severe blepharoptosis. This protocol helps to achieve improved accuracy and more stable correction outcome. MethodsThe levator muscle function was evaluated pre-operation. When the levator function was less than 1 mm, the frontalis suspension technique was performed; when the levator function was more than 1 mm, the techniques of levator resection, combined excision of the tarsus and levator, and tarsus–levator–CFS suspension were performed sequentially until a satisfactory correction result was achieved. ResultsA total of 389 patients with severe ptosis (561 eyes) were included; 102 eyes received levator resection, 314 eyes received combined excision of the tarsus and levator, 53 eyes received tarsus–levator–CFS suspension, and 92 eyes received frontalis suspension. In total, a satisfactory correction result was achieved in 466 eyes, while 95 cases still presented with under-correction. The symmetry findings showed that 107 (27%) cases presented good symmetry, 203 (52%) cases presented moderate symmetry, and 79 (21%) showed poor symmetry. ConclusionThis new treatment protocol overcomes the drawbacks of the traditional strategy by standardizing the correction procedure, leading to improved accuracy and more stable correction results.

Corrective Strategies for a Complex Deformity Caused by "European-Style Double Eyelid" Blepharoplasty in Asians.

"European-style double eyelid" blepharoplasty often leads to a complex deformity, which includes one or more of the following features: a high fold, upper eyelid depression, multiple folds, an obvious scar, blepharoptosis, and lower flap tumidness. However, there is still a lack of comprehensive research on evaluation and treatment strategies for this complex deformity. During a 6-year period, 65 patients (106 eyes) with a high fold and upper eyelid depression underwent corrective blepharoplasty. The authors classified this complex deformity as mild, moderate, or severe based on the extent of adhesion and tissue insufficiency, and we performed preaponeurotic fat flap transfer in 47 eyes (44.3%), free fat graft in 35 eyes (33%), and free dermis-fat graft in 24 eyes (22.6%), respectively. The outcomes in 87 eyelids were judged as excellent; and the grading was excellent in 41 eyes (87.2%) that underwent preaponeurotic fat flap transfer, 30 eyes (85.7%) that received a free fat graft, and 16 eyes (66.7%) that received a free dermis-fat graft. The outcomes in only 3 eyes (2.8%) were evaluated as unsatisfactory. The fundamental reasons behind this deformity were adhesion and tissue insufficiency above the supratarsal crease. The purpose of correction was to reconstruct the gliding system and restore the volume. The authors performed preaponeurotic fat flap transfer, free fat graft, and free dermis-fat graft and achieved satisfactory results. Great improvement in ptosis was achieved by releasing the adhesion and lowering the fold in patients with normal levator muscle function. 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 .

Tarsal switch using an anterior approach to correct severe ptosis.

BackgroundTo present the outcomes of the tarsal switch procedure using an anterior approach to correct severe ptosis with poor levator muscle function (<4 mm) with absent or poor Bell’s phenomenon.MethodsThis retrospective case series included 11 patients with severe neurogenic or acquired myogenic palpebral ptosis. All patients underwent the tarsal switch procedure through an anterior approach from 2012 to 2015. Margin reflex distance (MRD1 and MRD2) and the palpebral fissure were evaluated preoperatively and postoperatively. Data were compared using the Wilcoxon signed-rank test. P-values <0.05 were considered to indicate statistical significance.ResultsSurgery was performed on 18 eyelids (11 patients). The median age at surgery was 57 years (range, 29-86 years). Four patients had unilateral ptosis and seven had bilateral ptosis. Nine patients had myogenic ptosis and two had neurogenic ptosis. Postoperatively, the chin-up position improved in all patients. The MRD1 increased statistically significantly, from 0 mm preoperatively to 1.0 mm postoperatively (P=0.001). The MRD2 decreased statistically significantly, from 4.5 mm preoperatively to 3.0 mm postoperatively (P=0.001). The palpebral fissure did not change (4.0 mm preoperatively to 4.0 mm postoperatively) (P=0.13).ConclusionsThe tarsal switch procedure through an anterior approach is an effective alternative for correcting severe ptosis, especially neurogenic or acquired myogenic ptosis. This procedure can be performed with minimal risk of ocular surface exposure and provides stable outcomes.

Clinical and Demographic Characteristics of Blepharoptosis in Korea: A 24-year Experience including 2,328 Patients.

PurposeTo describe the demographics, relative incidence of subtypes, and clinical characteristics of blepharoptosis in Korean patients.MethodsThis is a retrospective, observational case series consisting of 2,328 patients who underwent ptosis surgery from 1991 to 2014 at a tertiary referral hospital in Korea. The patients were classified according to the type of ptosis and the evaluation of clinical characteristics including levator muscle function (LF) and degree of ptosis.ResultsOf the 2,328 patients, 1,815 (78%) had congenital ptosis and 513 (22%) had acquired ptosis. Simple congenital ptosis is the most common type overall (73.7%), and aponeurotic ptosis is the most common acquired type. More than three-quarters of eyes with congenital ptosis were affected in a moderate (34.4%) to severe degree (41.3%), and most of these eyes had fair (33.7%) to poor LF (60.1%). Among eyes with acquired ptosis, approximately three-quarters were affected in a mild (33.3%) to moderate degree (41.0%), with 63.3% of these eyes having good LF. The most widely used surgical technique was frontalis suspension (55.1%), followed by levator resection (29.0%) and aponeurosis repair (14.8%). At 3 years after the first surgery, 15.7% of patients with congenital ptosis and 10.4% of patients with acquired ptosis underwent reoperation.ConclusionsAlthough the prevalence has decreased from previous years, the proportion of cases with congenital ptosis was higher in this study than has been shown in research conducted in the West. The majority of eyes with congenital ptosis was affected to a severe degree and had poor LF, while those with acquired ptosis were affected to a moderate degree and had good LF. More cases with acquired ptosis presented with fair to poor LF, and frontalis suspension surgery was performed more commonly compared to previous studies. The reoperation rate was higher in congenital ptosis compared to acquired ptosis.

Determination of the Amount of Ptosis Correction in Levator Resection Surgery for Pediatric Congenital Ptosis

It is difficult to determine the amount of eyelid lift in levator resection surgery for congenital ptosis, especially when the surgery is performed under general anesthesia. We aim to introduce an objective and steady method with which to adjust eyelid height, and to identify other factors to be considered during surgery. This is a retrospective, observational study of 110 eyes from 78 patients who underwent levator resection surgery for congenital ptosis. Postoperative eyelid height was observed chronologically. The amount of eyelid lift during surgery was compared with the real postoperative change of palpebral fissure width (PF). The factors influencing the postoperative changes in eyelid height were investigated to predict outcome. Postoperative eyelid height stabilized 1month after surgery. The real postoperative change in PF was slightly larger than the amount of intraoperative eyelid lift in cases with levator muscle function (LF)≥7mm, whereas it tended to be smaller in cases with LF<5mm. Statistically significant factors influencing the difference between the amount of intraoperative eyelid lift and the real postoperative change of eyelid height included preoperative PF, preoperative LF, and anesthesia-induced lagophthalmos. The preoperative PF, preoperative LF, and anesthesia-induced lagophthalmos should be considered when determining the amount of ptosis correction to perform in levator resection surgery. 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 .

Effectiveness of retro-orbicularis oculi fat resection in Park double eyelid surgery to correct swollen upper eyelid

To investigate the effectiveness of retro-orbicularis oculi fat resection in Park double eyelid surgery to correct the swollen upper eyelid. Between September 2015 and July 2016, partial resection of the retro-orbicularis oculi fat was performed on 32 cases with bilateral swollen upper eyelids in Park double eyelid surgery. There were 10 males and 22 females with an average age of 25 years (range, 19-32 years). The patients had normal function of the levator muscle, and had no history of double eyelid surgery. All the incisions healed by first intention. There was no obvious congestion, swelling, levator muscle dysfunction. All patients were followed up 2-14 months, with an average of 10 months. The double eyelid fold was naturally smooth, without depressed scar; blepharochalasis was obviously improved, and the function of upper eyelid levator muscle was normal. All patients were satisfied with the aesthetic effect. Park double eyelid surgery and partial resection of retro-orbicularis oculi fat can effectively improve the aesthetic effect in patients with swollen upper eyelid, and can achieve the perfect function and appearance.

Evaluation of transconjunctival levator tucking for congenital ptosis

Purpose The purpose of this paper is to evaluate the efficacy, cosmetic results, and safety of transconjunctival tucking of the levator aponeurosis for correction of simple congenital ptosis. Patients and methods This was a prospective interventional noncomparative case-series study. This study was carried out at the Ophthalmology Department of Minia University Hospital. Thirty eyelids of 24 patients with simple congenital ptosis with fair to good levator muscle function (≥5 mm lid elevation) were subjected to transconjunctival tucking of levator aponeurosis. All patients were subjected to an assessment of history and a full ophthalmological examination. The degree of ptosis was evaluated using marginal reflex distance 1. Levator muscle function was evaluated while fixing the eyebrow. Preoperative and postoperative digital photographs were used for documentation. Results Anatomical success was achieved in 26 (86.7%) eyelids. Undercorrection was present in four (13.3%) eyelids. No case of overcorrection was encountered. Undercorrection was associated with more severe ptosis and less levator muscle function. Good cosmetic outcomes were obtained in the majority of cases. Apart from undercorrection, no significant postoperative complications occurred during the study. Conclusion Levator aponeurosis tucking using the posterior transconjunctival approach is safe and effective for correcting simple congenital blepharoptosis, with good cosmetic outcomes. This technique is especially useful for mild and moderate cases of congenital ptosis associated with fair to good levator muscle function.

Comparison of fasica lata and prolene suture in frontalis suspension surgery: frontalis muscle suspension

Objectives The aim of the study was to compare prolene suture, polytetrafluoroethylene sheet, and fascia lata for frontalis suspension surgery in the treatment of congenital ptosis with poor levator function. Background Eyelid frontalis suspension surgery is a common operative procedure used to correct severe blepharoptosis in eyes with poor levator muscle function. The main indication for frontalis suspension surgery is severe blepharoptosis secondary to myogenic, neurogenic, mechanical, and traumatic disorders. Patients and methods Eyelids were divided into three groups. In group I (20 eyelids), the upper-eyelid tarsus was suspended to the frontalis muscle using autogenous fascia lata. In group II (20 eyelids), the upper-eyelid tarsus was suspended to the frontalis muscle using a ribbon of 0.3 mm Gore-tex sheet. In group III (20 eyelids), the upper-eyelid tarsus was suspended to the frontalis muscle using prolene suture. Follow-up of eyelid level and reporting of postoperative complications and incidence of recurrence were done. Results At 12 months postoperatively (end of the follow-up period), there was no statistically significant difference between group I and group II regarding eyelid level. Fascia lata-related complications were detected in three eyelids of group I. Gore-tex-related complications were detected in five eyelids of group II. Prolene-related complications were detected in eight eyelids of group III. There was no statistically significant difference in complications between the three groups. The recurrence rate was 5% (one of 20 eyelids) in group I, 10% (two of 20 eyelids) in group II, and 40% (eight of 20 eyelids) in group III. The difference in recurrence rates was statistically nonsignificant. Conclusion Fascia lata is a good sling material, followed by Gore-tex sheet. Prolene suture has many complications and is associated with a high rate of recurrence.

Ocular Manifestations of Noonan Syndrome: A Prospective Clinical and Genetic Study of 25 Patients

To determine the full spectrum of ocular manifestations in patients with Noonan syndrome (NS). Prospective cross-sectional clinical and genetic study in a tertiary referral center. Twenty-five patients with NS (mean age, 14 years; range, 8 months-25 years) clinically diagnosed by validated criteria. All patients were examined by the same team following a detailed study protocol. Genetic analyses were performed in 23 patients. Ocular abnormalities of vision and refraction, external ocular features, ocular position and motility, anterior segment, posterior segment, and intraocular pressure. Ocular features of vision and refraction were amblyopia (32%), myopia (40%), and astigmatism (52%). External ocular features were epicanthic folds (84%), hypertelorism (68%), ptosis (56%), high upper eyelid crease (64%), lower eyelid retraction (60%), abnormal upward slanting palpebral fissures (36%), downward slanting palpebral fissures (32%), and lagophthalmos (28%). Orthoptic abnormalities included strabismus (40%), abnormal stereopsis (44%), and limited ocular motility (40%). Anterior segment abnormalities included prominent corneal nerves (72%) and posterior embryotoxon (32%). Additional ocular features were found, including nonglaucomatous optic disc excavation (20%), relatively low (<10 mmHg) intraocular pressure (22%), and optic nerve hypoplasia (4%). Mutations were established in 22 patients: 19 PTPN11 mutations (76%), 1 SOS1 mutation, 1 BRAF mutation, and 1 KRAS mutation. The patient with the highest number of prominent corneal nerves had an SOS1 mutation. The patient with the lowest visual acuity, associated with bilateral optic nerve hypoplasia, had a BRAF mutation. Patients with severe ptosis and nearly total absence of levator muscle function had PTPN11 mutations. All patients showed at least 3 ocular features (range, 3-13; mean, 7), including at least 1 external ocular feature in more than 95% of the patients. Noonan syndrome is a clinical diagnosis with multiple genetic bases associated with an extensive variety of congenital ocular abnormalities. Ocular features of NS are characterized by 1 or more developmental anomalies of the eyelids (involving the position, opening, and closure) associated with various other ocular abnormalities in childhood, including amblyopia, myopia, astigmatism, strabismus, limited ocular motility, prominent corneal nerves, and posterior embryotoxon.

Anthropometric Analysis of Levator Muscle Function: Correction

Anthropometric Analysis of Levator Muscle Function: Correction

Tarsoaponeurectomy as an alternative in difficult blepharoptosis cases.

BackgroundThe purpose of this study was to evaluate the results of tarsoaponeurectomy in patients with unsuccessful results after repetitive surgery or who developed post-traumatic blepharoptosis.MethodsThe files of 107 patients (136 eyes) on whom surgery was performed between January 2010 and December 2014 due to blepharoptosis were scanned retrospectively. Among these patients, the files and operational notes of eight patients who underwent surgery through the method of tarsoaponeurectomy were examined in detail. The epidemiological data, indication for surgery, previous ptosis and/or eyelid surgeries and trauma histories, preoperative and postoperative measurement data (palpebral space (PS), margin reflex distance (MRD1, MRD2), levator muscle function (LMF)) of the patients were recorded. The follow-up time of the patients was 7 to 34 months with an average of 16 months.ResultsA total of eight patients consisting of three females and five males were included in the study. The age range was 19 to 63 years with an average of 39 ± 16.2 years. Four patients had traumatic ptosis history whereas four patients had previous multiple levator procedure surgery history. Those patients with a history of ptosis had undergone surgery with levator procedure at least two times. Additionally, one patient had upper eyelid entropion, one had anophthalmic socket syndrome, and one had exposure keratopathy and traumatic dilated pupil. Seven patients had ptosis in the left eye whereas one patient had ptosis in the right eye. All patients were given a tarsoaponeurectomy as the basic surgical procedure while the patient with entropion was given a tarsal fracture and ear cartilage grafting as additional surgery. Two patients with vertical notching were also given a vertical blepharotomy through which a strip of tarsus was removed.ConclusionsTarsoaponeurectomy is an alternative method for oculoplastic surgeons used to deal with patients on whom sufficient and desired results have not been achieved despite repetitive surgery and in post-traumatic cases where levator muscle and aponeurosis cannot be dissociated peroperatively.

Frontalis Transfer and Closed Silicone Rod Frontalis Suspension

In severe blepharoptosis, surgical options can usually be divided depending upon the severity and extent of levator muscle function. In cases of poor levator muscle function, surgery with contraction of the frontalis is needed directly via the muscle itself or indirectly via an artificial material between the frontalis muscle and the tarsal plate. The frontalis sling technique has been considered the main procedure to treat patients with severe eyelid ptosis for decades [16]. Blepharoptosis correction under local anesthesia via frontalis transfer (local FT) can be an effective, but aggressive treatment [7]. However, if the patient is young or afraid of undergoing surgery, then surgery can be performed under general anesthesia (general FT). Silicone rod suspension surgery, a less invasive but effective treatment option, could be also performed under either general (general SS) or local anesthesia (local SS) [8,9]. The intraoperative eyelid level was adjusted until the eyelid margin covered 1.5 mm below the superior limbus of the cornea. Because the same surgeon performed all the procedures examined in this study, the effectiveness in correcting severe blepharoptosis was examined to assess whether the two operative options could be substituted for each other. In addition, the authors compare the effectiveness of the surgical options under both local and general anesthesia. Yong Jig Lee, David Dae Hwan Park

Comparison between eyelid indices of ptotic eye and normal fellow eye in patients with unilateral congenital ptosis

To evaluate the relationship between levator muscle function (LMF) and other eyelid parameters in the normal and affected eyes of patients with unilateral congenital ptosis. This study includes subjects with unilateral congenital upper lid ptosis who were referred for operation over a 2-year period. Patients with other eyelid abnormalities and previous eyelid surgery were excluded. Eyelid parameters including LMF, lid fissure height (LFH) and margin reflex distance (MRD) were measured in both eyes and analyzed. A total of 77 patients with mean age of 26.4 ± 16.4 years were enrolled in the study. Mean LMF was 8.3 ± 4.6 mm in the ptotic and 13.1 ± 3.6 mm in the normal fellow eyes. Each millimeter of difference in LMF was associated with 0.30 mm of difference in LFH (95% CI: 0.25-0.35, P < 0.001) and 0.11 mm of difference in MRD of the ptotic eyes (95% CI: 0.08-0.12, P < 0.001) in the same direction. In addition, each millimeter of difference in LMF of ptotic eyes was associated with 0.48 mm of difference (95% CI: 0.33-0.62, P < 0.001) in LMF of non-ptotic eyes in the same direction. A direct correlation was observed between LMF, and LFH and MRD in ptotic eyes which confirms the role of levator muscle dysfunction in the development of congenital ptosis and its severity. Furthermore, a direct correlation was also present between LMF of ptotic and non-ptotic eyes suggesting possible bilateral involvement in apparently unilateral congenital ptosis.

Maximal Levator Muscle Resection for Primary Congenital Blepharoptosis with Poor Levator Function

ABSTRACTPurpose: To evaluate the clinical outcomes of maximal levator muscle resection surgery in patients with poor levator function. Methods: This prospective study included 29 eyelids of 23 patients who underwent maximal levator resection surgery. Pre- and postoperatively, all patients’ routine ophthalmic examination including evaluation of upper eyelid skin crease positions; levator muscle function (LF), rima palpebrarum (RP), and margin-reflex distance (MRD) measurements were recorded. Outcome was considered successful when the difference between the two upper eyelids was ≤1 mm; if the difference between the two eyelid margins was more than 1 mm and less than 2 mm, it was considered to be satisfactory. More than 2 mm difference was considered to be poor. Results: Mean patient age was 11.3 ± 8.6 years (3 months to 24 years). Mean follow-up time was 22.8 ± 6.9 months (10 to 36 months). Preoperatively mean RP, MRD, and LF measurements were 5.5 ± 1.7 mm, −0.14 ± 1.6 mm, 2.5 ± 1.4 mm (0–4 mm), respectively. Preoperatively, eight (27,6%) patients had skin crease. Abnormal head posture was detected in eight (34.8%) of the patients. Postoperatively, RP, MRD, and LF values increased significantly (p < 0.05). Mean RP, MRD, and LF measurements were 8.3 ± 1.5 mm, 2.6 ± 1.2 mm, 5.1 ± 2.1 mm, respectively. Fourteen subjects (60.9%) had successful results, two subjects (8.7%) had satisfactory results, and seven subjects (30.4%) had poor results. Abnormal head postures of all patients were resolved. Conclusions: Maximal levator resection may be a good alternative method to frontalis suspension in congenital blepharoptosis patients with poor levator function.

Results of Frontalis Suspension Surgery in Eyes with Poor Levator Muscle Function

Amac: Otolog fasya lata veya silikon cubuk ile yapilan frontal aski cerrahisinin sonuclarini degerlendirmek. Yontemler: Goz kapaginda dusukluk yakinmasi ile basvuran, levator kas fonksiyonunun 5 mm ve daha dusuk kaydedildigi olgularda, uygulanan frontal aski cerrahisinin sonuclari ve komplikasyonlari retrospektif olarak degerlendirildi. Tek tarafli opere edilen olgularda, kapak araliginda opere edilen taraf ile diger taraf arasindaki farkin 1 mm’den az olmasi basarili, 1-2 mm arasinda olmasi tatminkar, 2 mm’den fazla olmasi basarisiz sonuc olarak degerlendirildi. Iki tarafli olgularda ust kapagin, korneayi 3 mm’den daha az ortmesi basarili, optik aksi kapatmayacak sekilde 3 mm’den fazla ortmesi tatminkar, optik aksi ortmesi ise basarisizlik olarak kabul edildi. Bulgular: Calismaya 14 hastanin 17 gozu alindi. Frontal aski cerrahisi materyeli olarak sekiz goze otojen fasya lata, dokuz goze silikon cubuk kullanildi. Cerrahi girisimler sonrasinda yapilan degerlendirmede cerrahi sonuc dokuz gozde basarili, dort gozde tatminkar, dort gozde ise yetersiz olarak kaydedildi. Postoperatif yetersiz duzeltmenin oldugu dort gozde, ilk 10 gun icinde revizyon yapildi. Bes gozde punktat keratopati, bir gozde lagoftalmi, bir gozde kapak temporalinde hafif dusukluk, bir gozde ust goz kapaginda belirgin odem komplikasyon olarak kaydedildi, otojen fasta lata uygulanan bir olguda bacaktaki yara yerinde anlamli agri ve diger bir olguda ise bacakta resuturasyona gerek duyulan yara yeri ayrismasi goruldu. Sonuc: Calismamizda revizyon ve nuks cerrahileri sonunda 17 olgumuzun 13’unde (%76,47) basarili, 4’unde (%23,53) tatminkar sonuca ulasilmistir. (Ha se ki T›p Bul te ni 2015; 53: 36-40) Anahtar Sozcukler: Otojen fasya lata, silikon cubuk, frontal askilama, ptozis cerrahisi Abs tract

Traumatic Isolated Levator Palpebrae Superioris Muscle Laceration: A Case Report

Levator muscle function and upper skin crease were absent on the left side (Figure 1). Th e sutures on the left upper eyelid were opened. At the level of the superior fornix, levator palpebra superior muscle was detached and the laceration was at the base of the brow (Figure 2). Although the anterior wall of the frontal sinus was fractured, the aeration of the sinus was good and there was no bone fragments inside it. In addition, an irregular laceration of the upper canalicular system with tissue loss was observed.