Severe Congenital Ptosis Research Articles

Unilateral ptosis correction with mersilene mesh frontalis sling in infants: thirteen-year follow-up report

To assess surgical, visual, refractive, and aesthetic outcomes 13 years after mersilene mesh frontalis sling (MMFS) operation for severe unilateral congenital ptosis performed in 10 infants before 1 year of age. Longitudinal follow-up of an interventional case series by structured ocular examinations, external photographs, and questionnaire-based interviews. Mean age at surgery was 6.9+/-2.7 months. After a mean follow-up of 13.0+/-0.6 years, one patient (10%) had recurrent ptosis with the upper lid 2 mm below the superior limbus at 3 months postoperatively. Best-corrected visual acuities were within two Snellen lines between the two eyes in all patients. Astigmatic errors were 1.20+/-1.00 D and 1.10+/-1.70 D between operated and unoperated eyes. Four patients had 2 mm lid lag on down-gaze and one of them had 2 mm lagophthalmos. Mean satisfaction scores (scale of 1 to 100) for lid position, cosmesis, function, and to the procedure were 83.3+/-11.8, 77.0+/-22.9, 89.4+/-5.5, and 86.8+/-6.3, respectively. No case of overcorrection, sling extrusion, stitch granuloma, or exposure keratopathy was noted. In view of the low recurrence rate (10%) and absence of serious complication or need for revision after 13 years, the use of MMFS seems effective and feasible in infants less than 1 year old. Achieving compatible long-term stability, satisfactory aesthetic, and visual outcomes, MMFS may offer an alternative to delaying operations for autogenous fascia lata harvesting in infants requiring early ptosis correction.

Stability of Silicone Band Frontalis Suspension for the Treatment of Severe Unilateral Upper Eyelid Ptosis in Infants

To address the efficacy, safety, and stability of frontalis suspension of the upper eyelid with a silicone band for the treatment of severe congenital ptosis in infants. Data from 22 pediatric patients undergoing unilateral frontalis suspension with silicone band were retrospectively reviewed with a follow-up ranging from 18 to 30 months. The margin-reflex distance (MRD) and the corneal staining had been evaluated at each pre- and postoperative visit. Data were analyzed by analysis of variance and t test for paired data. MRD was absent before surgery in all cases: it ranged from -1 mm to -4 mm (-2.4+/-0.8 mm). Immediately after surgery, it increased to 2.9+/-0.3 mm, and then progressively reduced by 0.6 mm within the first 3 months (p=0.001); a further reduction of 0.2 mm, occurring between 3 and 12 months after surgery, was not statistically significant. After the 12-month visit, no changes in MRD were found at follow-up for any patient. Corneal staining, which was present in five patients over the first 2 postoperative weeks, recovered without sequelae. Complications occurred in three eyes: overcorrection and corneal ulcer in one case requiring removal of the silicone band, one granuloma, and one extrusion of the silicone band from the upper frontal incision. During the study period, the frontalis suspension with a silicone band was an effective and safe procedure. MRD values were stable between month 3 and the end of follow-up, although this series does not preclude the possible occurrence of blepharoptosis at longer time intervals.

Improved surgery method for severe congenital ptosis

目的 探讨改进的上睑提肌缩短术治疗重度先天性上睑下垂的临床效果.方法 对38例(46眼)确诊为重度先天性上睑下垂行改进的上睑提肌缩短术,术后随访观察3月-2年.结果 46眼中一次手术成功40眼,另6眼欠矫,3～6月行二次手术成功.所有患者全部矫正满意,外观良好,无并发症发生.结论 改进的上睑提肌缩短术治疗重度先天性上睑下垂手术成功率高,疗效好。

Correction of Congenital Severe Ptosis by Suspension of a Frontal Muscle Flap Overlapped with an Inferiorly Based Orbital Septum Flap

This report introduces a new method for correction of congenital severe upper eyelid ptosis. The poor levator-function upper eyelid ptosis of 22 patients was corrected using suspension of the frontal muscle flap overlapped with an inferiorly based orbital septum flap as a motor unit, which substituted for the function of the levator muscle. The frontal muscle flap and orbital septum flap were formed in the frontal part and upper eyelid, respectively. Two flaps were overlapped and sutured to suspend the upper eyelid and to correct the congenital severe upper eyelid ptosis. This technique avoids the need for the linking structure necessary with the standard frontalis sling approach and improves the direction of pull to mimic that of a normal levator more closely than that of frontalis muscle advancement. The follow-up period ranged from 6 to 20 months (mean, 12 months). A total of 4 patients had bilateral surgery, whereas 18 patients underwent unilateral surgery (26 eyelids). In 22 cases (26 eyes), congenital severe upper eyelid ptosis was treated using suspension of the frontal muscle flap overlapped with an inferiorly based orbital septum flap. After the operation, 17 cases (19 eyes) were followed up and analyzed retrospectively. The average follow-up period was about 12 months (range, 6-20 months). The 17 corrected eyes had a symmetric redundant fold of preseptal skin according to the marginal reflex distance-1 (MRD-1) measurement used to judge efficacy. Two eyes in this series required reoperation for undercorrection. Complications such as ectropion and corneal exposure were avoided. Use of a frontalis muscle lap overlapped with an inferior based orbital septum flap to manage severe congenital upper eyelid ptosis is a useful procedure that results in substantial cosmetic and functional improvement with few complications.

Frontalis suspension using Gore-rex soft-tissue patch for severe congenital ptosis in children

目的 探讨Gore-Tex补片应用于额肌悬吊术治疗儿童先天性完全性上睑下垂的临床价值.方法 将Gore-Tex 补片作为悬吊材料,对15例(19眼)儿童先天性完全性上睑下垂行额肌悬吊术.术后随访6个月.结果 术后早期出现暴露性角膜炎1例(1眼);复发1例(1眼),上睑缘回落至瞳孔上缘;余均矫正满意,且未见血肿、感染、睑内翻、睑外翻或慢性肉芽肿等并发症.结论 Gore-Tex补片作为悬吊材料用于治疗儿童先天性完全性上睑下垂其效果令人满意。

Use of the Levator Muscle as a Frontalis Sling

To investigate the use of the distal portion of levator aponeurosis as a flap for frontalis suspension in patients with severe congenital ptosis and poor levator function. Eleven procedures were performed on 8 patients with severe congenital ptosis and poor levator muscle function. Three of the 8 patients had Marcus-Gunn jaw-winking phenomenon. Preoperative evaluation included measurements of the degree of ptosis, levator function, superior rectus action, Bell phenomenon, lagophthalmos, and (if present) synkinetic eyelid movement. Surgery involved fashioning a flap from the distal portion of the levator aponeurosis and anchoring it to the frontalis muscle. Postoperatively, patients were followed for at least 6 months to assess the level of the eyelid in the primary position at rest and when the brow is raised, the degree of eyelid margin excursion on brow elevation, persistence of synkinetic eye movement, presence of complications, lagophthalmos, corneal exposure, and symmetry. Synkinetic muscle movements were completely abolished. All cases had good primary eyelid position, no corneal complications, and effective frontalis action on eyelid elevation. The distal levator muscle flap is an effective frontalis suspension material to correct ptosis with poor levator function and to abolish synkinetic eyelid movement without compromising corneal protection.

Clinical Controversy: Congenital Unilateral and Jaw-Winking Ptosis

Paediatric ptosis is routinely more challenging than adult ptosis with considerations such as amblyopia, difficulty of examination and at what age surgery should be performed. Unilateral severe congenital ptosis and jaw-winking ptosis raise additional questions of which surgical procedure and whether unilateral or bilateral surgery should be performed. A panel of international experts answer questions relating to two clinical scenarios.

Surgical treatment of severe congenital ptosis

目的 探讨治疗重度先天性上睑下垂的有效手术方法.方法对31例(43眼)平均年龄11.25岁的重度先天性上睑下垂施行上睑提肌缩短联合上横韧带悬吊术.此改进的术式与常规术式不同之处在于将上睑提肌缩短术与上横韧带悬吊术两种手术相结合.结果术后随访6月～2.5年,平均1.5年.治愈41眼,治愈率95.35%,效果满意.结论上睑提肌缩短联合上横韧带悬吊术治疗重度上睑下垂效果肯定,在改善功能和美学方面优势明显。

Frontalis Muscle Advancement: A Dynamic Structure for the Treatment of Severe Congenital Eyelid Ptosis

Frontalis Muscle Advancement: A Dynamic Structure for the Treatment of Severe Congenital Eyelid Ptosis

Frontalis muscle advancement: a dynamic structure for the treatment of severe congenital eyelid ptosis.

Forty-two consecutive patients have had severe eyelid ptosis corrected by intraorbital frontalis flap advancement as a motor unit to substitute for the function of the levator muscle. This technique has avoided the need for the linking structure necessary in the standard frontalis sling approach and has improved the direction of pull to more closely mimic that of a normal levator. This simple technique includes elevation of the innervated frontalis muscle flap and the creation of a pulley near the insertion of the orbital septum at the superior orbital rim, which redirects the lid movement along the surface of the globe rather than lifting it from the globe's surface toward the brow. This type of displacement is produced because the muscle is directed posteriorly by the pulley, so that it conforms to the plane of the levator aponeurosis all the way down to the tarsal plate. In addition, to improve the remaining function of the levator muscle (if any) and to facilitate voluntary positioning of the eyelid, the levator aponeurosis is shortened by plication. Symmetry is created by intervention on the contralateral eyelid to provide symmetrical supratarsal creases.

Superior levator muscle resection combined superior transverse ligment advancement for the treatment of severe congenital ptosis

目的 探讨上睑提肌缩短并上横韧带徙前固定于睑板的方法治疗中重度先天性上睑下垂的效果.方法对11例(17眼)中重度先天性上睑下垂进行上睑提肌缩短合并上横韧带徙前手术治疗.结果上睑下垂矫正满意11眼(64.71%),矫正良好5眼(29.41%),矫正不足1眼(5.88%).结论借助上横韧带的力量增加上睑提肌缩短的作用达到提上睑的目的,手术成功率高,矫正效果满意。

Long-term results of frontalis suspension using autogenous fascia lata for congenital ptosis in children under 3 years of age

Purpose To evaluate the outcome of frontalis suspension surgery for congenital ptosis using autogenous fascia lata for children under 3 years of age. Design Retrospective nonrandomized interventional case series. Methods This study included nine children (14 eyelids) with severe congenital ptosis aged less than 3 years. All patients underwent frontalis suspension surgery using autogenous fascia lata. Postoperative lid level results, ptosis recurrence, and cosmetic appearance of leg scars were evaluated after the operation. Results The mean age of the patients was 15.3 months (range, 6 months to 2.5 years) with a mean follow-up period of 41.6 months (range, 18 to 96 months). All children achieved satisfactory cosmetic and functional results, with no postoperative complications such as wound infection, corneal exposure, eyelid contour abnormalities, or ptosis overcorrection. No recurrence of ptosis was encountered. Harvesting was not difficult, and a sufficient amount of material was achieved. There was one patient (11.1%) with a hypertrophied leg scar. Conclusions Frontalis suspension using autogenous fascia is proposed as a possible procedure for correcting congenital ptosis in children younger than 3 years of age. It appears to be an effective and feasible treatment for children with poor levator muscle function in this age group.

Improved technique for fascial sling reconstruction of severe congenital ptosis.

Fascial sling surgery for severe congenital ptosis yields superior results when the operative result is dynamic rather than merely suspensory. The sling itself is attached as in a tendon transfer solely to the frontalis muscle, minimizing adherence to the underlying periosteum and the overlying dermis. The sling is passed behind a pulley created by the superior transverse ligament so as to produce a more normal vector of pull. The dermis of the skin is attached to the sling to create a dynamic supratarsal crease. Postoperative retraining allows the patient to achieve more than one centimeter of levator function. These operative modifications make this procedure more closely parallel the normal eyelid dynamics and yield consistently good results for this difficult problem.

Maximal levator resection in the treatment of unilateral congenital ptosis with poor levator function

From 1994 to 1999, 1121 operations for blepharoptosis were performed in our department on 987 patients. In 44 cases we found a moderate to severe congenital ptosis with a levator function of less than 2 mm. Until today, in such cases, it is recommended to use a frontalis suspension in order to elevate the upper eyelid. Unsatisfactory cosmetic results in facial expression and lack of skin-fold are only a few of the disadvantages of this technique. In 1994, therefore, we decided to perform a maximal levator resection in the treatment of unilateral congenital ptosis with poor levator function. All children included in our study were younger than six years of age. The ptosis was moderate (2–4 mm) in 36/44 and severe (>4 mm) in 8/44 cases. The levator function was less than 2 mm. Complete transsection of the medial and lateral horn of the levator aponeurosis under preservation of the Whitnall ligament is the most important surgical step in mobilizing the levator muscle. A satisfactory eyelid elevation (generally considered to be a difference of less than 1 mm between both eyelid fissures) was achieved in 36/44 cases. Our results indicate that, in contrast to established practice, maximal levator resection is the treatment of choice for congenital ptosis with poor levator function.

Congenital ptosis: longterm results using stored fascia lata.

Frontalis brow suspension, using stored donor fascia lata, allows early correction of severe congenital ptosis. We report longterm results of 18 patients, (29 ptotic eyelids). Patient records were retrospectively reviewed. Lid position at the first and subsequent post-operative visits was recorded, as was the time when ptosis recurred. The mean follow-up period was 42.9 months (range 7 to 84 months). All patients achieved a Good initial result. Partial ptosis recurrence was noted in 7 patients (10 eyelids), within 18 months of surgery. One of these patients required reoperation. Lid position did not change after the first 18 months. No late failures were encountered. Longterm lid position is remarkably stable after early surgical correction of severe congenital ptosis using stored fascia lata.

Long-term results of frontalis suspension using irradiated, banked fascia lata.

This study was undertaken to study the long-term rate of recurrence of ptosis and other postoperative complications after frontalis suspension using banked irradiated fascia lata. One hundred thirty-two lids of 72 patients underwent frontalis suspension between 1980 and 1989. The preoperative diagnoses included severe congenital ptosis (83%), blepharophimosis (10%), third nerve palsy (4%), and chronic progressive external ophthalmoplegia (3%). The age at the time of surgery ranged from 5 months to 19 years, with an average of 3 years and 5 months. In 46 patients (64%), surgery was done before age 3 years. The follow-up time ranged from 6 to 15 years, with a mean and median of 10 years. Good to excellent lid height was achieved immediately after surgery in all but three patients. Recurrence of ptosis occurred in 20 cases (28%), and 28 lids (21%). The time to reoperation ranged from 1 to 7 years, with an average of 3 years. Sixteen patients (80%) with recurrence were younger than 3 years of age. Reaction to donor fascia lata occurred in only two patients (3%). Only one patient suffered from excessive exposure keratopathy and required revision of the sling. Banked fascia lata is easy to use and should be considered as an alternative suspensory material in children younger than 3 years of age with congenital ptosis. The long-term reoperation rate in this cohort of patients was higher than the 5% rate reported for autogenous fascia, but lower than that previously reported for banked fascia lata (50% at 8 years).

Improved Technique for Fascial Sling Reconstruction of Severe Congenital Ptosis

Fascial sling surgery for severe congenital ptosis yields superior results when the operative result is dynamic rather than merely suspensory. The sling itself is attached as in a tendon transfer solely to the frontalis muscle, minimizing adherence to the underlying periosteum and the overlying dermis. The sling is passed behind a pulley created by the superior transverse ligament so as to produce a more normal vector of pull. The dermis of the skin is attached to the sling to create a dynamic supratarsal crease. Postoperative retraining allows the patient to achieve more than one centimeter of levator function. These operative modifications make this procedure more closely parallel the normal eyelid dynamics and yield consistently good results for this difficult problem.

Amblyopia in Congenital Ptosis

This study evaluates the association between congenital ptosis and amblyopia. Amblyopia was detected in 7 of 36 (19%) patients with congenital ptosis. Two patients (6%) with amblyopia had no contributing factors other than the presence of congenital ptosis. A statistically significant correlation between severe nonocclusive ptosis (greater than or equal to 4 mm) and the development of amblyopia was identified. No new cases of amblyopia developed after surgical repair of the ptosis, suggesting early surgery for severe nonocclusive congenital ptosis may decrease the incidence of amblyopia.

Improved Technique for Fascial Sling Reconstruction of Severe Congenital Ptosis

Improved Technique for Fascial Sling Reconstruction of Severe Congenital Ptosis

Improved Technique for Fascial Sling Reconstruction of Severe Congenital Ptosis

Improved Technique for Fascial Sling Reconstruction of Severe Congenital Ptosis