Modified suture suspension by annular ligature the frontalis muscle to correct severe congenital blepharoptosis in very young patients / 中华整形外科杂志

Objective@#To explore the effect of the modified suture suspension by annular ligaturing the frontalis muscle to treat severe congenital blepharoptosis in children (age≤3).@*Methods@#From October 2016 to October 2017, 11 patients (16 eyes) with severe blepharoptosis were treated using the modified suture suspension in the Affiliated Hospital of Weifang Medical University. There were 7 males and 4 females, aged from 1 to 3 years old, with the average of 26.3 months. Three suture lines were used in three directions respectively. One end was fixed to the upper edge of the tarsus, the other end was fixed to the frontalis muscle by annular ligation. The operation effect and complications were evaluated 1 week and 6 months after the operation.@*Results@#All the incisions healed well. Hypophasis was observed in 1 eye. The exposed palpebral fissure was less than 3 mm when the eye was closed. No corneal exposure was observed in other cases. One week after surgery, the blepharoptosis of 5 patients were fully corrected (6 eyes, 37.5 %). Blepharoptosis in 5 patients were basically corrected (9 eyes, 56.2 %). One patients was over corrected (1 eyes, 6.3%). Six months after surgery, the blepharoptosis of 5 patients were fully corrected (5 eyes, 31.2 %). Blepharoptosis in 5 patients were basically corrected (9 eyes, 56.3%). However, the blepharoptosis of 1 patient was under corrected (2 eyes, 12.5%).@*Conclusions@#This modified suture suspension by annular ligature the frontalis muscle has the advantages of simple operation, low cost, stable effect, small wound, and satisfactory clinical effect.

Tratamento de ptose palpebral congênita pela técnica de Lester Jones / Treatment of congenital ptosis by using the Lester Jones technique

A ptose palpebral ou blefaroptose caracteriza-se pela disfunção, ou inabilidade do paciente em realizar a abertura da fenda palpebral de maneira normal. Geralmente é decorrente do acometimento do músculo levantador da pálpebra; a forma congênita ocorre em 60% a 70%. No presente trabalho é descrito um caso de ptose palpebral congênita moderada em uma paciente de nove anos, com boa função do músculo levantador da pálpebra, em olho esquerdo. A paciente foi submetida a tratamento cirúrgico pela técnica de Lester Jones, indicada nos casos de ptose de grau moderado, apresentando um resultado estético e funcional satisfatório.

Palpebral ptosis or blepharoptosis is characterized by the dysfunction or inability of the patient to normally open the palpebral fissure. Usually, it is due to the involvement of the eyelid levator muscle. The congenital form occurs in 60%-70% of cases. In this study, we describe a case of moderate congenital palpebral ptosis in a 9-year-old patient who presented with a good eyelid levator muscle function in the left eye. The patient underwent surgical treatment with the Lester Jones technique, as indicated for cases of moderate ptosis, and achieved satisfactory aesthetic and functional results.

Silicone sling frontalis suspension for correction of congenital blepharoptosis.

There are many techniques for treating congenital blepharoptosis. A new surgical technique for ptosis with poor levator function in which Seiff Silicone Suspension set is used in frontalis sling procedure is described in a 12 year old female child with simple unilateral congenital blepharoptosis. This procedure requires less surgical time, provides good cosmesis and early recovery.

Surgical Results of Levator Resection using the MLD (Margin Limbal Distance)in Congenital Blepharoptosis

In pediatric patients with congenital blepharoptosis, intraoperative decision of the amount of levator resection is difficult due to general anesthesia.We performed levator resection in 21 eyes of 17 patients with congenital blepharoptosis to evaluate the usefulness of the formula derived from the margin limbal distance (MLD)which was used to determine the amount of levator resection preoperatively. The amount of ptosis (interpalpebral fissure:IPF)was between 3.5 mm and 7.0 mm (mean 4.9 +/-1.2 mm), and less than 6.0 mm in 14 cases (66.4%).The levator function by Berke method was between 3.0 mm and 8.0 mm (mean 5.3 +/-1.7 mm), and between 5.0 mm and 8.0 mm in 13 cases (61.9%).The margin limbal distance was between 0 and 5.0 mm (mean 1.5 +/-1.4 mm), and less than 3.0 mm in 16 cases (76.2%).The amount of levator resection was between 10.0 mm and 22.0 mm, and between 16.0 mm and 18.0 mm in 10 cases (47.6%)which was most frequent. Of 4 patients (8 eyes)with bilateral blepharoptosis, excellent results (IPF > or= 8.0 mm)were achieved in 5 eyes (62.5%)and the other 3 eyes had fair results with IPF of over 6.0 mm.Three patients (75.0%)with bilateral blepharoptosis had symmetric IPF within 1.0 mm difference.In unilateral blepharoptosis, excellent results were achieved in 10 (76.9%)of 13 patients with IPF difference within 1.0 mm, and the other 3 patients had an IPF difference of 1.5 ~2.5 mm. The MLD formula gives the surgeon a good preoperative prediction of the amount of levator to resect, especially in pediatric patients with congenital blepharoptosis to undergo surgery under general anesthesia.

Result of Frontalis Suspension with Supramid Extra II(r) in Congenital Blepharoptosis

In the correction of congenital blepharoptosis, there are banked fascia lata, silicone band or rod, palmaris longus tendon, Gore-Tex, Mersilene, Supramid and etc. used for frontalis suspension. A retrospective study on the results and recurrences of 63 patients[79 eyes] who were diagnosed as congenital blepharoptosis and received frontalis suspension with Supramid Extra II(r) from Jan.1994 to Dec.1998. was done. The patients were consisted of 36 males and 27 females and the average age at the time of operation was 18 months[3.5 months~58 months]. The postoperative results were satisfactory in all the patients, yet recurrence was found in 26 patients between 4.5 months and 56 months after surgery. The results of 48 patients who could be followed up for over a year showed a 52%[25 patients] recurrence rate with a mean follow-up time of 41.3 months. The mean recurrence time was 30.7 months after operation. The use of Supramid Extra II(r) in frontalis suspension has benefit such as easy availability and favorable handling characteristics, but due to its high recurrence rate, it prompts the need for patient education and a follow-up period of over 4 years.

A Clinical Study on Surgical Results of Frontalis Sling in Relation to the Operative Age

To evaluate and compare the efficacy of frontalis sling using fascia lata by the operative ages. Thirty-two congenital blepharoptosis patients(36 eyes)were divided into three groups: Group 1(below 2 years old, 12 eyes), Group 2(between 3 years and 5 years old, 14 eyes)and Group 3(over 6 years old, 10 eyes). Frontalis sling by double triangle of Crawford was performed with fascia lata, and were followed up for 1, 3 and 6 months. Success rate of frontalis suspension operation is graded as poor(below 1mm), fair(2 mm)and good(above 3 mm)based on MRD 1: In Group 1; 0%, 8.3%, 91.7%at 1 month, 16.7%, 33.3%, 50%at 3 months, 50%, 33.4%, 16.6%, at 6 months. In Group 2; 0%, 7.2%, 92.8% at 1 months, 0%, 14.3%, 85.7% at 3 months, 14.3%, 14.3% 71.4% at 6 months. n Group 3; only 10%had fair at 6 months, most had good results. There were congenital blepharoptosis combined with systemic disease and reoperations(2 cases) were done by with frontalis sling in only group 1. Therefore, it is suggested that the correction of congenital blepharoptosis be delayed until the child is 3-5 or above 6 years old, if the incidence of amblyopia is small.