Transcutaneous blepharoptosis surgery - advancement of levator aponeurosis.
Ontology highlight
ABSTRACT:
SUBMITTER: Waqar S
PROVIDER: S-EPMC3041000 | biostudies-literature | 2010 Dec
REPOSITORIES: biostudies-literature
Publications
Transcutaneous blepharoptosis surgery - advancement of levator aponeurosis.
Waqar Salman S McMurray Catherine C Madge Simon N SN
The open ophthalmology journal 20101214
Ptosis surgery has seen many advances in the last few decades, the most important of which have emerged as a result of better understanding of the anatomy and physiology of the eyelid and orbit. Anterior approaches such as a levator aponeurosis advancement, tarsoaponeurectomy and posterior repair involving resection of Muller's muscle have proven to be effective in most cases. The focus of this article is a discussion of the indications, operative techniques, success rates and complications of t ...[more]
Similar Datasets
Project description:Conventional levator aponeurosis plication is a widely accepted technique for correction of mild to moderate ptosis. However, this method is associated with a high recurrence rate. The objective of this study was to investigate the clinical efficacy of levator aponeurosis posterior layer plication technique for correction of mild to moderate ptosis.A convenience sampling approach was used to recruit 450 patients with mild to moderate blepharoptosis at the Guangzhou Eye-Nose-Face Aesthetic Plastic Surgery Hospital between August, 2015 and December, 2017. All participants were treated with levator aponeurosis posterior layer plication technique. The primary outcome was the postoperative change in marginal reflex distance 1 (MRD1). The paired t test was used to determine the clinical efficacy. Outcomes were assessed at 1 week, 1 month, 3 months, and 6 months after surgery.The mean preoperative MRD1 was 1.7?±?0.5?mm, and the mean postoperative MRD1 at 6-month follow-up was 3.7?±?0.4?mm (P?<?.0001). According to the postoperative survey, 427 (94.9%) patients were satisfied with surgical outcomes.This modified levator aponeurosis plication technique is a simple and effective procedure for correction of mild to moderate blepharoptosis. It results in good MRD1 and high patient satisfaction.
| S-EPMC7220425 | biostudies-literature
Project description:BackgroundTreatments for severe blepharoptosis are well documented and include the most common operations for restoring upper eyelid ptosis, which are levator surgery and frontal muscle transfers; however, the choice of treatment is still controversial. There are different approaches to the restoration of upper eyelid ptosis, and the choice will be based on ptosis severity and the surgeon's skill and experience.MethodsTwo hundred and fourteen patients presenting with a levator function of between 2 and 4 mm received ptosis correction between 1991 and 2010 at our clinic. Of these, 71 patients underwent Müller aponeurosis composite flap advancement for correction of 89 eyelids, and frontalis muscle transfer was performed on 143 patients (217 eyelids). Postoperative results were evaluated with an average follow-up period of 23 months.ResultsThe preoperative average for marginal reflex distance (MRD1) in the Müller aponeurosis composite flap advancement group was 1.25 mm, and in the frontal muscle transfer group, it was 0.59 mm. The area of corneal exposure (ACE) was 57.2% in the Müller aponeurosis composite flap advancement group and 53.6% in the frontal muscle transfer group. The postoperative average distance was not significantly different for the 2 techniques. In the Müller aponeurosis composite flap advancement group, MRD1 was 2.7 mm and ACE was improved to 73.5%. In the frontal muscle transfer group, MRD1 was 2.3 mm and ACE was 71.2%. Undercorrection and eyelid asymmetry were the most frequently observed postoperative complications for both techniques.ConclusionsIn our study, we confirmed that Müller aponeurosis composite flap advancement and the frontalis transfer technique are both effective in the correction of severe blepharoptosis; our results showed no significant differences between the 2 techniques.
| S-EPMC4236361 | biostudies-literature
Project description:Purpose:We further optimized and evaluated the safety of the magnetic levator prosthesis (MLP) for temporary management of severe blepharoptosis, and compared efficacy and comfort against the ptosis crutch. Methods:The interpalpebral fissure (IPF) of participants (n = 12) with ptosis was measured during attempted eyelid opening, volitional closing, and spontaneous closing with no device, ptosis crutch, or the MLP. A 10-point scale documented comfort. Additionally, a 20 minute and then 1 week trial of the MLP was offered. Safety measures were skin erythema rating, change in visual acuity, and change in corneal staining. Results:The MLP and crutch opened the eye (IPF 11.2 and 9.3 mm), but the MLP allowed better volitional closure (IPF 1.0 vs. 4.9 mm, P = 0.009), but was no better in allowing spontaneous blink (IPF 7.5 vs. 7.7 mm, P = 0.722). Both devices were equally comfortable (both median 8/10 comfort, P = 0.46). With extended use, opening with the MLP showed IPF 9.24 mm at 20 minutes and 9.46 mm at 1 week, and volitional closure was IPF 0.95 and 0.52 mm, respectively. Closure on spontaneous blink improved with extended wear to IPF 5.14 and 5.18 mm, respectively (P = 0.002). Two participants exhibited moderate skin erythema and one had increased corneal staining without change in acuity. Conclusions:The MLP is safe and feasible for temporary correction of severe ptosis. Translational Relevance:First group data in patients showing successful reanimation of the eyelid with magnetic force.
| S-EPMC5777174 | biostudies-literature
Project description:BackgroundSevere blepharoptosis with poor levator function (LF) has traditionally been managed with exogenous frontalis suspension but complications such as lagophthalmos, infection, and rejection are often reported.ObjectivesThe aim of this study was to design a function-preserving frontalis orbicularis oculi muscle (FOOM) flap to correct severe blepharoptosis with poor LF. The long-term surgical outcome of the technique was assessed.MethodsThis retrospective study included only adult patients with severe blepharoptosis and poor LF, all of whom had their surgery performed by the senior surgeon over a 6-year period. Clinical assessment of LF, palpebral fissure height (PFH), marginal reflex distance 1 (MRD1), duration of follow-up, and postoperative complications were recorded.ResultsA total of 34 patients and 59 eyelids were recorded during a mean follow-up period of 17.7 months. Postoperative evaluation yielded mean [standard deviation] improvements of PFH gain of 5.62 [1.61] mm (P < 0.001), and MRD1 and PFH increases of 4.03 [0.82] mm (P < 0.001) and 8.94 [0.81] mm (P < 0.001), respectively. All patients demonstrated normalization of orbicularis function: no lagophthalmos was observed at the 8-month postoperative follow-up. Recurrence of ptosis was recorded in 4 eyelids (6.78%). Revisions were performed in 2 eyelids (3.39%). No infection or granuloma was noted.ConclusionsThe function-preserving FOOM flap is a useful vector for frontalis suspension. Not only does it effectively address lagophthalmos as well as other complications, but it provides aesthetically pleasing outcomes in patients with severe blepharoptosis and poor LF.Level of evidence: 4
| S-EPMC8240737 | biostudies-literature
Project description:PurposeExamine the effect of force modulation via angular translation of a static magnetic field for customizable treatment of severe blepharoptosis.MethodsPrototype adjustable-force magnetic levator prostheses (aMLP) consisted of a spectacle-mounted magnet in rotatable housing and small eyelid-attached magnets embedded in a biocompatible polymer. Interpalpebral fissure (IPF) of 17 participants with severe blepharoptosis was continuously measured for one minute at five spectacle magnet angles, with order randomized and participant and data analyst masked. The hypothesis that angular position affected opening IPF (o-IPF), minimum blink IPF (m-IPF), and comfort ratings (1-10) was tested.ResultsThe aMLP improved o-IPF from 4.5 mm without the device to 6.2 mm on the lowest force setting (P < 0.001) and 7.1 mm on the highest setting (P < 0.001) and allowed for complete volitional blink regardless of setting (average m-IPF 0.4 mm and no change with aMLP; P = 0.76). Spontaneous blink without the device (2.0 mm) was affected on the highest force setting (m-IPF 3.9 mm; P < 0.001) but only marginally so on the lowest setting (3.0 mm; P = 0.06). Comfort (7.6/10) did not vary with the angle (P > 0.36). Profile analysis found substantial individual responses to angle (P < 0.001), confirming the value of customization.ConclusionsAngular translation provided adjustable force, which had a statistically and clinically meaningful impact on eye opening and the completeness of the spontaneous blink. This quantitative evidence supports continued use of the angular translation mechanism for force adjustment in the customizable magnetic correction of severe blepharoptosis.Translational relevanceEvidence for the benefit of customizable magnetic force via angular translation in a larger sample of participants than reported previously.
| S-EPMC10697171 | biostudies-literature
Project description:PurposeAnterior approach white line advancement presents a novel surgical option for correction of blepharoptosis. The technique draws on several advantages of other approaches. The aim of this study was to present outcomes using this technique at a minimum follow-up of 18 months.Patients and methodsParticipants having undergone anterior approach white line advancement ptosis correction at a single institution were retrospectively recruited at a minimum of 18 months' follow-up. A total of 18 independent eyelid measurements were recorded at final review. Outcomes included long-term rate of surgical success, upper eyelid margin-reflex distance (MRD1) at both early and late post-operative follow-up, inter-eyelid asymmetry, complications, re-operation rate, patient satisfaction, and quality-of-life improvement using the Glasgow Benefit Inventory (GBI). Pre- and post-operative MRD1, as well as inter-eyelid asymmetry, were compared using a two-tailed t-test.ResultsIn total, 82 eyelids of 47 participants were included with a mean follow-up of 2.3 years (range 1.5-3.7). Surgical success was achieved in 91.5%, with a final mean MRD1 of 3.5?mm (95% confidence 3.2-3.7). An increase of 2.4?mm (2.1-2.8) in eyelid height was observed between baseline and long-term follow-up (P<0.0001). No significant change was observed between early and late post-operative follow-up. Pre-operative asymmetry was reduced from 1.0?mm (0.7-1.3) to 0.4?mm (0.3-0.5; P<0.0001). Patient satisfaction was 95.7% with a mean GBI score of +21.8 (13.2-30.3).ConclusionsAnterior approach white line advancement presents an excellent option for patients undergoing ptosis correction with favourable long-term results. Comparisons are made with other techniques with respect to anatomical, functional, and surgical factors.
| S-EPMC5733292 | biostudies-other
Project description:BACKGROUND:Frontalis suspension surgery is considered the procedure of choice in cases of blepharoptosis. Among all the materials used in this type of surgery, ophthalmic and plastic surgeons prefer to use autologous Fascia Lata. However, during years, other autogenous and exogenous materials have been introduced. OBJECTIVES:The aim of this study was therefore that of systematically reviewing the functional results and the rate of complications of different synthetic materials, as compared to autogenous Fascia Lata. The primary objective was to determine the rates of Successful Surgeries (SSs) of these materials. The secondary objective was to assess the onset of complications. The following materials were investigated: Fascia Lata, Mersilene, polytetrafluoroethylene (PTFE) and Silicon. DATA SOURCE AND METHODS:Following the Prisma procedure, on January 30th, 2016 we used the following electronic databases to select the studies: MEDLINE and Scopus. RESULTS:The search strategy retrieved 48 publications that met the eligibility criteria of the systematic review. All studies were non-comparative. PTFE (n = 5) showed the best rate of SSs among the materials compared (statistically significant). Surgeries performed with autogenous Fascia Lata (n = 19) had a 87% rate of success those performed with Mersilene (n = 12)had 92% and those performed with Silicon (n = 17)88%. PTFE had the best outcome, with 99% success rate. As for complications, surgeries performed with PTFE had a higher rate of suture infections (1.9%) as compared to Fascia Lata, but lower incidence for all other complications. CONCLUSIONS:Although most studies were good quality cohort studies, the overall quality of this evidence should be regarded as low due to their non-comparative design. Our data suggest that PTFE seems to be the most valid alternative material for frontalis suspension surgery, with low recurrence rates and good cosmetic and functional results.
| S-EPMC5025102 | biostudies-other
Project description:PurposeThis study aims to evaluate the usefulness of creating images of expected appearance after blepharoptosis surgery using mirror image processing software.MethodsThis prospective, observational study included 60 sides from 30 patients with bilateral aponeurotic blepharoptosis who underwent levator resection or aponeurotic repair on both sides. Before surgery, facial photographs were taken after the eyelid on one side was lifted with a curved hook. The mirror images were created from these photographs and were merged with the original photographs for making the whole facial images, which were shown to each patient at the preoperative counseling. At 1 month postoperatively, we asked patients about the usefulness of the mirror images to predict the postoperative appearance at the preoperative counseling and the similarity between the expected and the resultant postoperative appearance using questionnaires. Margin reflex distance-1, eyebrow height, and pretarsal skin height measured on predictive images were compared with those measured at 1 month postoperatively.ResultsTwenty-nine patients (96.7%) favorably responded to the usefulness of the mirror images to predict the postoperative appearance, and twenty-five patients (83.3%) accepted the similarity between the expected appearance and the actual postoperative appearance. The predictive images showed significantly lower margin reflex distance-1, higher eyebrow height, and higher pretarsal skin height than the postoperative results (P < 0.001).ConclusionThe creation of expected postoperative images was a useful simulation procedure before blepharoptosis surgery for patients to predict the probable postoperative appearance.
| S-EPMC8035113 | biostudies-literature
Project description:Background and aimEyelid position and contour abnormality could lead to various diseases, such as blepharoptosis, which is a common eyelid disease. Accurate assessment of eyelid morphology is important in the management of blepharoptosis. We aimed to proposed a novel deep learning-based image analysis to automatically measure eyelid morphological properties before and after blepharoptosis surgery.MethodsThis study included 135 ptotic eyes of 103 patients who underwent blepharoptosis surgery. Facial photographs were taken preoperatively and postoperatively. Margin reflex distance (MRD) 1 and 2 of the operated eyes were manually measured by a senior surgeon. Multiple eyelid morphological parameters, such as MRD1, MRD2, upper eyelid length and corneal area, were automatically measured by our deep learning-based image analysis. Agreement between manual and automated measurements, as well as two repeated automated measurements of MRDs were analysed. Preoperative and postoperative eyelid morphological parameters were compared. Postoperative eyelid contour symmetry was evaluated using multiple mid-pupil lid distances (MPLDs).ResultsThe intraclass correlation coefficients (ICCs) between manual and automated measurements of MRDs ranged from 0.934 to 0.971 (p < .001), and the bias ranged from 0.09 mm to 0.15 mm. The ICCs between two repeated automated measurements were up to 0.999 (p < .001), and the bias was no more than 0.002 mm. After surgery, MRD1 increased significantly from 0.31 ± 1.17 mm to 2.89 ± 1.06 mm, upper eyelid length from 19.94 ± 3.61 mm to 21.40 ± 2.40 mm, and corneal area from 52.72 ± 15.97 mm2 to 76.31 ± 11.31mm2 (all p < .001). Postoperative binocular MPLDs at different angles (from 0° to 180°) showed no significant differences in the patients.ConclusionThis technique had high accuracy and repeatability for automatically measuring eyelid morphology, which allows objective assessment of blepharoptosis surgical outcomes. Using only patients' photographs, this technique has great potential in diagnosis and management of other eyelid-related diseases.
| S-EPMC8805858 | biostudies-literature
Project description:PURPOSE: To present the outcomes of levator plication (levatorpexy) surgery by posterior approach for correction of ptosis of different aetiologies in Indian eyes. METHODS: Retrospective review of clinical notes and clinical photos of consecutive ptosis patients who underwent levatorpexy from January 2017 to September 2018. Surgery was considered successful if the following four criteria were simultaneously met: a postoperative MRD1 of ≥2 mm and ≤4.5 mm, inter eyelid height asymmetry of ≤1 mm, no overcorrection compared to the opposite eye, and a satisfactory eyelid contour determined by patient. RESULTS: Thirty six eyelids of 36 patients (mean age, 23.6 years; 25 females) underwent unilateral levatorpexy with the left eyelid affected in 66.6 %. Twenty one congenital (58.3%) (C), 12 (33.3%) aponeurotic (A) and 3 (8.3%) complex ptosis (CX) had a mean levator function of 9.8 mm (range, 6 to 15). Mean pre and post operative margin reflex distance (MRD 1) was 0.611mm (range, -1 to 3 mm) and 3 .00 mm (range, 2 to 4 mm) respectively. At the final follow up of 12 months, four patients remained under corrected (11.1%). At the final follow up of twelve months, the success rate was 78 percent. CONCLUSION: Posterior approach for ptosis repair offers a scar less, minimally invasive, easy to revise, and successful lid height correction in congenital and acquired ptosis.
| S-EPMC9198536 | biostudies-literature