Correction Of Ptosis Research Articles

Combined Surgery for Simultaneous Treatment of Congenital Ptosis and Coexisting Strabismus.

To evaluate the clinical outcomes of single-stage surgery for treatment of patients with congenital ptosis and coexisting strabismus. A retrospective analysis was performed on 10 patients (17 eyes) with congenital ptosis and coexisting strabismus. Patients were treated with levator resection or frontalis suspension for ptosis and ocular muscle surgery for strabismus, performed as a single-stage procedure. Levator resection was performed in 9 patients (15 eyes) and frontalis muscle flap suspension was performed in 1 patient (2 eyes) with blepharophimosis. Seven patients (11 eyes) simultaneously underwent exotropia correction, and inferior oblique myectomy was performed in 3 patients (3 eyes) with congenital superior oblique palsy. Satisfactory efficacy of single-stage surgery for correction of congenital ptosis and coexisting strabismus was achieved without complications. Comprehensive preoperative examination is vital to determine the appropriate diagnosis and guide surgical decision-making. Single-stage surgery for congenital ptosis and coexisting strabismus is effective and a shortened treatment period is beneficial to patients. [J Pediatr Ophthalmol Strabismus. 2017;54(5):288-294.].

Plication and reinsertion of the aponeurosis of the lifting muscle of the upper eyelid with continuous suture in the surgical correction of light and moderate eyelid ptosis – personal experience

Plication and reinsertion of the aponeurosis of the lifting muscle of the upper eyelid with continuous suture in the surgical correction of light and moderate eyelid ptosis – personal experience

Clinical effects of combined fascia sheath suspension and frontal muscle flap suspension in correction of severe congenital ptosis

Objective To compare the therapeutic effect of combined fascia sheath suspension and frontal muscle flap suspension in the treatment of congenital severe congenital ptosis. Methods 46 cases (58 eyes) with congenital severe upper eyelid prolapse who were treated from March 2015 to March 2016 in Eye Hospital of Hebei Province were selected. The patients were divided into two groups: combined fascial sheath suspension group and frontalis muscle flap suspension. Comparisons of postoperative patients with eyelid height, eyelid radian, corneal exposure with eyes closed, eyelid activity, complication of the situation were carried out. And patient satisfaction survey was conducted. Results The effective rate of combined fascial sheath suspension group was 93.10%, the complication rate was 6.9%, and the patient satisfaction rate was 91.22±0.37, significantly better than the frontal muscle flap suspension group of patients (75.86%, 24.14% and 75.05±0.28, respectively). The time of closure of the eyelid was shortened, the complications were less, and the eyelid had better activity. The difference between the two groups was statistically significant (P<0.05). Conclusions Combined fascia sheath for congenital severe upper eyelid droop is significant, with fewer complications and a higher rate of satisfaction, which is worth clinical promotion. Key words: Severe congenital ptosis; Combined fascia sheath suspension; Frontal muscle flap suspension; Effective rate; Satisfaction

A modular and adjustable ptosis crutch as a non-surgical, low cost solution for elevating the upper eyelid in Myasthenia Gravis

Myasthenia Gravis (MG) is an autoimmune disorder that affects the neuromuscular junction. MG is characterised by the fatigable weakness of skeletal muscles, commonly affecting the eye and facial muscles. Africans with MG, particularly juveniles, are more likely to develop treatment-resistance of their ocular muscles, including severe blepharoptosis. Blepharoptosis, or ptosis, describes the condition of a drooping upper eyelid(s). Surgical correction of ptosis is often contraindicated in MG patients. In these cases, a non-surgical solution to elevate the ptotic eyelid above the visual axis is required. Objective: To design a ptosis crutch to elevate the ptotic eyelid(s) of MG patients. The crutch should be low cost, modular and adjustable in nature. Method: A bottom-up approach was followed for the design of the ptosis crutch. The requirements were defined according to patient, clinician and designer specifications. It underwent numerous iterations before the final design was manufactured, using 3D printing. 87 design failures were observed before the final design was realised. It was the design, test, fail, redesign cycle that lead to the discovery of a device that satisfied the requirements. Results: The ptosis crutch attaches to the superior border of the spectacle frame and is adjustable along the x, y and z-axes to cater for the inter-individual variability of horizontal eye position, globe projection and the eyelid elevation required. Conclusion: MG patient feedback on the ptosis crutch has shown a promising outcome for the device. Future work will include obtaining long term user feedback on the ptosis crutch.

Analysis of Levator Function and Ptosis Severity in Involutional Blepharoptosis.

Involutional blepharoptosis is the most common type of acquired blepharoptosis. The etiology is believed to be the degeneration of the levator aponeurosis, and levator superioris muscle function was believed to be normal. However, there are a few studies analyzing levator function (LF) in involutional blepharoptosis. Our study aimed to access the LF abnormality in involutional blepharoptosis and analyze the correlation between LF and ptosis severity in involutional blepharoptosis in Taiwan. We reviewed the medical records of patients who underwent ptosis correction surgery between October 2011 and December 2015 after receiving a diagnosis of involutional blepharoptosis. This study examined patient sex and age, preoperative LF, margin reflex distance of the upper eyelid (MRD1), and ptosis severity. Linear regression was performed for statistical analysis. Levator muscle specimen was sent for pathologic examination. We analyzed 231 eyelids of 126 patients. Average MRD1 was 0.43 ± 2.15 mm. Average LF was 14.30 ± 2.51 mm. Overall, 77.1% (178/231) of involutional blepharoptotic eyelids had normal LF (more than 12 mm). Forty-three (18.6%) of 231 were good (10-12 mm), and 10 (4.3%) of 231 were fair (6-9 mm). No patients with poor levator function (≤5 mm) were observed in our case series. A positive correlation between LF and MRD1 was observed after statistical analysis. On average, a 0.6-mm reduction in LF was observed for each 1.0-mm decrease in MRD1. Fat infiltration in levator muscle is observed both grossly and microscopically in most cases with varied degrees. Levator function and MRD1 were positively correlated in patients with involutional blepharoptosis. In our study, 77.1% (178/231) of eyelids had normal levator function, which meant there was 23.0% (53/231) of eyelids had abnormal LF, in contrast to current literature. Fat infiltration was common in our series. In Asian involutional blepharoptosis, LF was not always excellent and it had positive correlation with ptosis severity.

The Relationship of Amount of Resection and Time for Recovery of Bell's Phenomenon after Levator Resection in Congenital Ptosis.

Background: Recovery of Bell`s phenomenon after levator resection is unpredicatable. Delayed recovery can result in vision threatening corneal complications.Aim:To study the variability of Bell’s phenomenon and time taken for its recovery following levator resection for blepharoptosis and to correlate it with the amount of resection.Methods:A prospective observational study was conducted on 32 eyes of 32 patients diagnosed as unilateral simple congenital blepharoptosis who underwent levator resection at a tertiary care center between July 2013 and May 2015. Patients were followed up for 5 months and correction of ptosis, type of Bell`s, duration of Bell`s recovery and complications were noted.Results:The study group ranged from 16-25 years with 15:17 male: female ratio. There were 9 mild, 16 moderate and 7 severe ptosis. Satisfactory correction was achieved in all cases. Good Bell`s recovery occurred in 13 eyes on first post-op day, in 2-14 days in 19 eyes and 28 days in 1 eye. Inverse Bell`s was noted along with lid oedema and ecchymosis in 2 patients. Large resections (23-26mm) were associated with poor Bell`s on the first postoperative day (p=0.027, Fisher`s exact test). However, the duration required for recovery of Bell`s phenomenon did not show any significant difference with the amount of resection. (p=0.248, Mann Whitney test). Larger resections resulted in greater lagophthalmos (correlation=0.830, p<0.0001). Patients with recovery of Bell`s delayed for more than 7 days were associated with greater number of complications (p=0.001 Fisher`s Exact Test).Conclusion:Close monitoring for Bell`s recovery is required following levator resection.

Transpalpebral Corrugator Resection: 25-Year Experience, Refinements and Additional Indications.

The senior author introduced the transpalpebral approach for the first time during the ASPS meeting in 1993. He has made some refinements in the technique and has developed newer indications for this procedure. These refinements, indications and the related new video are the subject of this report. The modifications in the technique are as follows: After elevation of the skin and the orbicularis muscle and dissection under the muscle, a thin layer of the depressor supercilii muscle overlying the darker and more friable corrugator supercilii muscle is removed. A fairly constant branch of the supraorbital nerve piercing this muscle medially is first identified on the surface and followed deep in the muscle using a mosquito hemostat. The muscle is then lifted, and then, the same nerve branch is identified above the periosteum. The segment of the muscle lateral to this nerve is then isolated and removed by first transecting it medially and then lateral to the nerve. A cephalic segment is isolated and removed using the coagulation power of the cautery to minimize the postoperative bleeding. The rest of the muscle is then removed in a piecemeal fashion as thoroughly as possible, including a lateral segment of the procerus muscle, the end point being visualization of the subcutaneous fat. If the intention of the surgery is to treat frontal migraine headaches, the supratrochlear and supraorbital arteries are also removed. If the nerve and vessel pass through a foramen, a foraminotomy is carried out on patients with migraine headaches. Two to three cc of fat is injected in the glabellar and corrugator sites in most patients to avoid any depression and to restore the lost glabellar volume. Beyond patients with male pattern baldness, those with a long forehead and those with overactive frown muscles but optimal eyebrow positions, this technique is now being used for those with proptosis, exophthalmos and those with eyelid ptosis who would not undergo ptosis correction to prevent elevation of the eyebrows, which exaggerates the proptosis or makes the eyelid ptosis more discernible. Additionally, a common indication for this surgery is in patients with frontal migraine headaches. This report highlights the refinements in the transpalpebral corrugator resection that have been implemented over the last 25years and offers additional indications for its utilization. Level of Evidence V 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 .

Two different techniques for frontalis suspension using Gore-Tex to treat severe congenital ptosis

Severe congenital ptosis is commonly associated with poor levator function. This study compares the functional and cosmetic outcomes of open versus closed frontalis sling using Gore-Tex in the treatment of such conditions. Randomized interventional comparative case series of 20 eyes of 13 patients with severe congenital ptosis with levator excursion < 4mm. Patients were treated by frontalis suspension using Gore-Tex string sutures either through a skin crease incision (group 1) or supraciliary incisions (group II). Mean age was 5.10 ± 3.10years in group I and 7.30 ± 4.47years in group II. Ptosis was unilateral in six patients and bilateral in seven patients. Following surgery, there was a statistically significant improvement in the palpebral fissure width (PFW) and marginal reflex distance (MRD) in both groups (p value 0.001) with better functional outcome in group II (closed approach). The cosmetic results were better in group I (open approach). The mean operative time in group II was 18.1 ± 2.4min, which was significantly shorter than group I (30.2 ± 3.1min). No recurrence or grave complications were encountered during follow-up. Gore-Tex is a useful sling material for correction of severe congenital ptosis due to poor frontalis action. Open transcrease approach is recommended in absence of lid crease whereas closed approach is better used in cases with preserved crease due to its superior functional outcome.

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.

Levator recession with adjustable sutures in management of upper eyelid retraction

Purpose To assess the efficacy of levator recession with adjustable sutures in treatment of upper eyelid retraction. Patients and Methods Patients with upper eyelid retraction were included in this prospective, non-randomized, interventional case series study. All patients underwent correction of upper eyelid retraction with levator recession using adjustable sutures ,and were followed up every week for a month, then monthly for three months. In each visit, the margin reflex distance (MRD1) and palpebral fissure (PF) were measured. Results The included patients of the present work were classified into 3 groups: Group A: lid retraction secondary to over correction of ptosis, group B: thyroid related lid retraction, and group C congenital lid retraction. Among the 17 patients that participated in the follow-up examination, mean age ± SD was 21.12 ± 13.73 years (range 7–52 years). Eight were males and nine were females. Mean ± SD (range) of central height of the palpebral fissure was 13.79 ± 1.37 mm (10–16 mm) preoperatively, and 11.04 mm (9–12 mm) at follow up. Mean ± SD (range) of MRD1 was 6.77 ± 0.86 mm (5–8 mm) preoperatively, and 4.78 mm (4.5–5 mm) at follow-up. Conclusion Levator recession with adjustable sutures is effective technique in treatment of upper eyelid retraction of all degrees with different causes. However,increase the number of cases with long term follow up are recommended.

Therapeutic Mammoplasty in Management of Breast Cancer: A Prospective Clinical Study

Background: The introduction of oncoplasticbreast surgery, with a concomitant contralateral symmetrization procedure, allows the surgical oncologist the freedom to perform wider excisions, with more favorable cosmetic outcomes. Objective: To assess the feasibility of bilateral breast reduction for the management of breast cancer, and to determine the most suitable surgical technique of therapeutic mammoplasty for each patient. And to evaluate the cosmetic outcome during the postoperative period. Methods: This study was from June 2014 until June 2016, and included 86 female patients with breast cancer; divided in 3 groups; group A; had bilateral superior pedicle reduction mammoplasty, group B; had bilateral inferior pedicle reduction mammoplasty, group C; had bilateral batwing mastopexy. 1 month postoperative, patients were asked to answer a 5-scale questionnaire evaluating their own cosmetic outcome. Criteria they were asked to evaluate were: symmetry, shape and volume, projection, correction of ptosis, visibility of the scars and overall satisfaction. A similar questionnaire was answered by a panel made up of a surgeon and breast-care nurse after seeing the pre- and post-operative photos of the patients in question. Results: Group A had a mean tumor size of 2.7 ± 0.69 cm, least resected margins 1.2 - 4.3 cm, Group B had a mean tumor size of 3.2 ± 1.19 cm, least resected margins 0.7 - 3.8 cm, Group C had a mean tumor size of 3.4 ± 1.12 cm, least resected margins 1.7 - 5.2 cm. Cosmetic results fared high above average. Group C fared better in overall satisfaction but Group B fared better in ptosis correction, projection and symmetry. The panel answers showed difference regarding shape and volume; the only two criteria to be almost of the same result among the three groups. Conclusion: Bilateral TM has some advantages when compared to standard conventional BCS techniques without having any unfavorable effects on surgical margin confidence, local recurrence, and survival rates. So, it is a valuable addition to consider the use of such surgical techniques whenever indicated in the surgical management of patients with breast cancer. Batwing mastopexy showed superiority in operating time, hospital stay and overall satisfaction of patients, surgeons and nurses.

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.

Efficacy of brow suspension with autogenous fascia lata in simple congenital ptosis.

Objective:To assess the mean change in interpalpebral fissure height and marginal reflex distance after brow suspension with autogenous fascia lata sling in patients of ptosis.Methods:This was a Quasi experimental study conducted at Department of Ophthalmology, Mayo Hospital, King Edwards Medical University Lahore, from Jan 2013 to June 2016. Included were the patients who had unilateral or bilateral ptosis with poor levator function (< 5 mm). Informed consent was obtained from all patients after explaining about the research project. Patients were admitted in ward and all of them underwent surgery by a single surgical team. The surgical procedure was performed in supine position under general anesthesia in children and uncooperative patients. Patients were followed at week 4, 8, 12 and 24 to observe vertical interpalpebral fissure height and marginal reflex distance.Results:The mean age of the patients was 9.03 ± 5.26 years. The mean Inter palpebral fissure height (IPFH) was 4.40±0.91 mm and mean MRD was 0.50 ± 1.00 mm before surgery while after surgery it was 7.41±0.76 mm and 3.10 ± 1.50 mm respectively at 04 weeks. The mean IPFH and MRD at 24 weeks postoperatively were 8.43±0.98 mm and 3.60 + 1.50 mm respectively. The mean change in IPFH and MRD at 24th week, were 3.90 ± 0.34 mm and 3.50 ± 1.00 mm.Conclusion:Brow suspension with fascia lata sling is safe and effective technique for correction of ptosis with poor levator function.

Efficacy of frontalis suspension with silicone rods in ptosis patients with poor Bell's phenomenon.

PURPOSE:The purpose of the study was to evaluate the efficacy of silicone rods as frontalis sling for correction of ptosis associated with poor Bell's phenomenon in specific situations.MATERIALS AND METHODS:A retrospective interventional case series of 25 eyes of 19 patients who underwent frontalis suspension surgery with silicone rods for ptosis correction from May 2006 to April 2011, was performed. Inclusion criteria included severe ptosis with poor Bell's phenomenon. Patient evaluation included clinical history and other relevant parameters of ptosis measurement. Final outcome measurements included postoperative lid height, lagophthalmos, complications, need for reoperation, and patient satisfaction.RESULTS:Mean age at presentation was 25.72 ± 2.2 years. The sex ratio of male: female was 1.11. The causes of ptosis included chronic progressive external ophthalmoplegia (CPEO) in 11 eyes (44%), oculopharyngeal dystrophy in 2 (8%), third cranial nerve palsy in 7 (28%), traumatic in three eyes (12%), and iatrogenic postoperative ptosis (after orbital tumor excision) in two eyes (8%). The postoperative palpebral fissure height and margin reflex distance improved significantly (P = 0.0001). Extrusion of the sling and granuloma formation occurred in two eyes each, and these patients had to undergo sling removal. One patient developed mild exposure keratopathy and was managed conservatively.CONCLUSION:Silicone is an effective material for use in frontalis suspension in the management of severe ptosis with poor Bell's phenomenon. The elastic nature of silicone rod makes it an ideal suspensory material for patients with CPEO or third nerve palsy.

A modified implant for upper eyelid ptosis correction in frontalis suspension surgery

to develop a modified implant to correct ptosis through brow suspension and to evaluate its effectiveness. The clinical group consisted of 20 patients (29 eyes) aged 23 to 69 years (45±5.3 years on the average) and the comparison group - of 20 patients (33 eyes) aged 19 to 77 years (47±9.5 years on the average). All patients were operated on for severe ptosis of the upper eyelid, which implied stitching their eyelids to the eyebrows. In the main group, an original implant was introduced as suspensory material - a 200 µm thick porous polytetrafluoroethylene tape, length 13 cm, width 6 mm, round staggered perforation pattern, 1.5 mm holes, 3.5 mm pitch. In the comparison group, Mersilene mesh strips were used. The article contains a detailed description of the surgical technique. Checkups were performed at 1, 6, and 12 months. Follow-up periods were up to 4 years (1.7 years on the average) in the main group and up to 7 years (5.1 years on the average) - in the controls. Were evaluated by the width of the palpebral fissure at raised eyebrows, marginal reflex distance (MRD, which is the distance between the center of the pupil and the upper eyelid margin), presence and depth of the upper eyelid crease, and residual lagophthalmos. Examinations held at months 1, 6, and 12 after surgery showed that the results were positive and stable in all cases. Neither signs of recurrence, nor statistically significant differences between the groups were found. The use of the original modified implant during frontalis suspension surgery provides high and stable cosmetic result and expands the possibilities of ophthalmic plastic surgery.

All Seasons Vertical Augmentation Mastopexy: A Simple Algorithm, Clinical Experience, and Patient-reported Outcomes.

The safety of augmentation mastopexy has been questioned. Staging has been recommended for women deemed to be at higher risk, such as women with greater degrees of ptosis. Most existing studies evaluate women treated with multiple methods, including the traditional Wise pattern. This retrospective study specifically evaluates vertical augmentation mastopexy. A simple algorithm is introduced. From 2002 to 2016, 252 women underwent consecutive vertical augmentation mastopexies performed by the author, with no staged surgery. All patients underwent a vertical mastopexy using a medially based pedicle and intraoperative nipple siting. A subset of women treated from 2012 to 2016 were surveyed to obtain outcome data; 90 patients (inclusion rate, 90%) participated. The complication rate was 32.9%, including persistent ptosis, delayed wound healing, scar deformities, and asymmetry. There were no cases of nipple loss. An increased risk of complications was detected for smokers (P < 0.01), but not for combined procedures, secondary breast augmentations, or secondary mastopexies. The revision rate was 15.5%. Persistent nipple numbness was reported by 13.3% of respondents. Eighty percent of women were self-conscious about their breast appearance before surgery; 22% of respondents were self-conscious about their breasts after surgery. Seventy percent of respondents reported an improved quality of life, 94.4% would repeat the surgery, and 95.6% would recommend it. A simple algorithm may be used to guide treatment in women who desire correction of ptosis and upper pole fullness. An "all seasons" vertical augmentation mastopexy is safe and widely applicable. Staging is unnecessary.

Effectiveness and safety of expanded polytetrafluoroethylene-assisted frontalis suspension for pediatric congenital ptosis

Background Congenital ptosis is a common eye disease of children that easy cause amblyopia.Searching for an ideal frontalis suspension material is very important for the timely treatment of ptosis.Expanded polytetrafluoroethylene (e-PTFE), a new frontalis suspension material, has been widely applicated abroad to correct the congenital ptosis, but the clinical data of e-PTFE use in congenital ptosis is lack. Objective This study was to evaluate the efficacy and safety of e-PTFE patch as sling material in frontalis suspension surgery for congenital ptosis of children. Methods A prospective serial cases-observational study was conducted.Forty-five eyes of 36 children with congenital ptosis enrolled in Beijing Children's Hospital from July to August 2012 with the age of 2.8-6.0 years.All the children received e-PTFE-frontalis sling surgery after their custodians signed the informed consent.The margin-reflex distance (MRD) upper eyelids, width of palpebral fissure, linkage between the frontalis muscle and the upper eyelid, catamysis, upper eyelid late drop, appearance score, recurrence rate and postoperative complications were evaluated 1 day, 1 week, 1 month, 3 months, 6 months and 1 year, 1.5 years after surgery. Results The mean MRD was (1.8±1.2)mm and (2.8±0.8)mm before surgery and 1.5 years after surgery, respectively, showing a significant difference between them (t=4.651, P=0.000). The catamysis was (1.3±0.5)mm and (1.1±0.5)mm before surgery and 1.5 years after surgery, respectively, and there was not significant difference between them (t=1.897, P=0.061). The linkage between the frontalis muscle and the upper eyelid after surgery was 75%±20%, and e-PTFE achieved a satisfied stable ptosis correction and approving appearance.Ptosis recurrence was noticed in 1 case; The complications included low-correction in 1 eye of 1 patient, slight ceratitis in 1 eye of 1 patient, entropion in 1 eye of 1 patient, granuloma in 1 eye of 1 patient and subcutaneous nodule in 20 eyes of 16 patients, and these complications were cured by medication.Recurrence of ptosis was seen in 1 patient and was cured by reoperation. Conclusions E-PTFE is an effective and safe frontalis sling material in frontalis sling surgery for congenital ptosis of younger children.This surgery is ideal for the improvement of both upper eyelid function and appearance. Key words: Blepharoptosis/congenital; Blepharoptosis/surgery; Blepharoplasty/methods; Prosthesis implantation; Polytetrafluoroethylene, expand; Child; Treatment outcome; Frontalis suspension

Refinement in Asian blepharoplasty for the aging

&lt;p&gt;Signs of an aging face beginning at the periorbital region are easily noticeable and may require surgical correction. The hanging of upper eyelids, tired look, and sunken upper eyelids are common symptoms and signs. Most of the described techniques of blepharoplasty for the aging emphasize on the excision of the hanging eyelid skin which will leave patients with long scar. However, eyebrow and eyelid ptosis are common among aging people. Therefore, undertaking only an upper blepharoplasty does not necessarily yield good aesthetic results. This paper describes a modified blepharoplasty technique with limited incision. The operation also includes eyebrow reposition and/or correction of eyelid ptosis that further improve results. An asymmetry of the frontalis muscle could cause asymmetry in the eyelid folds post-operatively. However, botulinum toxin injection may correct this problem.&lt;/p&gt;

Clinical and pathological features and surgical treatment of eyelid/conjunctival amyloidosis

Objective: To study the clinical and pathological features and surgical outcome of eyelid/conjunctival amyloidosis. Methods: It was a retrospective case series study. The clinical and pathological records of 11 patients who were diagnosed as eyelid/conjunctival amyloidosis and had surgical treatment between February 2007 and October 2015 at Beijing Tongren Hospital were analyzed. Routine pathological examinations and Congo red staining were performed. All of the 11 patients received surgical treatment. Seven patients with ptosis underwent surgical excision and ptosis repair. One patient with lower eyelid mass underwent surgical excision and reconstruction of the lower eyelid. One patient with upper eyelid mass underwent surgical excision. Two patients with conjunctival mass underwent surgical excision. Results: In the 11 patients, 6 were male and 5 were female. The mean age was 31 years old, median age was 21 years old, and the range of age was13-59 years old. Eight cases presented as eyelid thickening and nodular growth of the conjunctiva, and 7 of them had ptosis. One case presented as tumor of the upper lid. Two cases presented as conjunctival masses at the semilunar fold. None of the patients were found to have systemic involvement. All of the 11 cases received surgical treatment including excision of the lesions and correction of ptosis when necessary. Pathological examinations confirmed the diagnosis of amyloidosis. Follow up time was 1-9 years. Nine cases were stable, 1 case had progression in the conjunctival lesion and 1 case was lost to follow up. Conclusions: Eyelid/conjunctival amyloidosis usually present as mass or diffuse thickening of the eyelid/conjunctiva. The outcome of surgical treatment was satisfying.(Chin J Ophthalmol, 2016, 52: 775-779).

Maximal levator resection in unilateral congenital ptosis with poor levator function

Background/aimsSurgical treatments for the correction of congenital ptosis with poor levator function, including frontalis suspension or maximal levator resection, remain controversial. We evaluated the postoperative surgical and cosmetic outcomes after...