Research progress of iatrogenic blepharoptosis repair after double eyelid surgery / 中国修复重建外科杂志

OBJECTIVE@#To summarize the etiology mechanism and treatment of iatrogenic blepharoptosis after double eyelid surgery in Asia.@*METHODS@#To extensively review the literature related to iatrogenic blepharoptosis after double eyelid surgery, and to summarize and analyze the related anatomical mechanism, existing treatment options, and indications.@*RESULTS@#Iatrogenic blepharoptosis is a relatively common complication after double eyelid surgery, sometimes it is combined with other eyelid deformities such as sunken upper eyelid and wide double eyelid, which makes it difficult to repair. The etiology is mainly caused by improper adhesion of tissues and scars, improper removal of upper eyelid tissue, and injury of a link of levator muscle power system. Whether blepharoptosis occurs after double eyelid surgery by incision or suture, it should be repaired by incision. The principles of repair include surgical loosening of tissue adhesion, anatomical reduction, and repair of damaged tissues. The key is to use surrounding tissues or transplanted fat to prevent adhesion.@*CONCLUSION@#When repairing iatrogenic blepharoptosis clinically, appropriate surgical methods should be selected based on the causes and severity of the blepharoptosis, combined with treatment principles, in order to achieve better repair results.

Eight years experience with botulinum toxin A and eyelid surgery in the treatment of hemifacial spasm / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To report the therapeutic outcomes of botulinum toxin A(Botox)and eyelid surgery in patients with hemifacial spasm(HFS).<p>METHODS: Patients' images and medical notes were retrospectively reviewed with subsequent analysis of both the therapeutic outcomes and complications of Botox injections. <p>RESULTS: The information of 76 patients(Female=58)with HFS who received a minimum of 4 Botox injections were included. The mean follow-up interval was 83±50(20-112)mo with an average of 16±10(4-34)injections. The peak incidence was between 55 and 64 years and the average age of onset was 66±11(32-85)years. Up to 23% of patients with HFS had aberrant vascular structures(Right=8, Left=7)in close relationship to the facial nerve(MRI=14, CT=1), where the vertebral artery(<i>n</i>=6)was the most involved vessel followed by the anterior inferior cerebellum artery(<i>n</i>=5). Patients with primary HFS had a shorter effective duration(2.5 <i>vs</i> 3.1mo, <i>P</i><0.05), a longer onset time(4.1 <i>vs</i> 3.8d, <i>P</i>=0.739)and a lower Subjective Spasm Alleviation score(SSAs)(1.7 <i>vs</i> 1.9, <i>P</i>=0.179)than those with secondary HFS. Twelve of the 19 patients with pre-existing eyelid diseases underwent surgical correction including upper blepharoplasty(<i>n</i>=12), limited myectomy(<i>n</i>=7), browplasty(<i>n</i>=7)and advancement of levator aponeurosis(<i>n</i>=5). Five(41.7%)of those with surgical correction and suboptimal response to Botox showed improvement 6mo after surgery \〖onset time(<i>P</i>=0.0256), effective duration(<i>P</i>=0.374)and SSAs(<i>P</i>=0.0161)\〗. Those 12 patients with eyelid surgery had a lower complication rate than those without eyelid surgery(23% <i>vs</i> 42%, <i>P</i>≤0.05).<p>CONCLUSION: Botox is an effective and safe treatment for HFS. We found that patients with primary HFS had a less favorable therapeutic outcome with Botox than those with secondary HFS. Eyelid surgery for patients with concurrent eyelid diseases can augment the effect of subsequent Botox injections by improving patient satisfaction and reducing complication rate.

Application of 4+ 1 photography in determining the end point of double eyelid surgery / 中华整形外科杂志

Objective@#To explore the practicability and reproducibility of judgment method and assessment indexes for the end point of double eyelid surgery using 4+ 1 photography in supine position.@*Methods@#From 2017 October to 2018 October, 158 patients were included and randomly divided into 2 groups. Photos were taken by 4 + 1 photography in supine position of 79 patients, while other 79 patients in control group were evaluated by traditional observation. By 4+ 1 photography in supine position, the surgeon stood at the head side of the patient, taking photos with eyes movement: looking straight forward, looking up, looking downward and eye-closed. It was to observe the upper eyelid creases, upper and lower tissues of double eyelid creases, and upper and lower eyelid margo palpebrae. In addition, the surgeon looked from patient′s feet to observe the indexes such as upper margo palpebrae, to make a decision whether the surgery could finish. In control group, the surgeon observed the upper eyelid creases, upper and lower tissues of double eyelid creases and upper and lower eyelid margo palpebrae. The patient has to sit if necessary.@*Results@#All 158 patients were performed double eyelid surgery successfully. Average times of valuating end point was 1.20 by 4+ 1 Photography in supine position, and 1.53 in control group. The operation time of 4+ 1 photography group is (151.65±21.58) s, and control group were (241.53±33.53) s. The satisfaction level was increased to 89.87% in 4+ 1 photography group, compared to 78.48% in control group.@*Conclusions@#The 4+ 1 Photography method is simple and easy to practice. The observation indexes are accurate and comprehensive. It is useful in determining the end point of double eyelid plasty in supine position.

Blefaroplastia inferior com suporte cantal lateral / Lower eyelid blepharoplasty with lateral canthal support

INTRODUÇÃO: A abordagem transcutânea no rejuvenescimento palpebral inferior é uma técnica versátil e que permite amplo acesso a todas as estruturas periorbitárias. Apesar disso, muitos têm optado por outras vias de acesso, como a transconjuntival, devido ao risco aumentado de mal posicionamento palpebral. A utilização de suporte cantal lateral de rotina tem sido indicada sistematicamente para minimizar este risco. O presente trabalho revisou 136 casos operados com acesso transcutâneo e reforço cantal com cantopexia e suspensão orbicular. MÉTODO: Estudo retrospectivo de casos de blefaroplastia inferior primária transcutânea com cantopexia operados entre janeiro de 2008 e janeiro de 2014. Foram avaliados, por meio de fotos e registro de prontuários, a presença de dermatocalasio, bolsas palpebrais e flacidez tarsal. A técnica cirúrgica e o índice de complicações foram obtidos a partir da descrição cirúrgica e anotações clínicas. RESULTADOS: Foram operados 136 pacientes, com follow-up pós-operatório médio de 180 dias. Consideramos como complicações pós-operatórias epífora (15%), mal posicionamento palpebral (2,94%), hematoma orbital (0%), quemose (9,5%) e sensação de corpo estranho (6%). Sete pacientes (5,1%) precisaram de revisão cirúrgica. CONCLUSÃO: A realização de suporte cantal deveria ser considerada como parte integrante da blefaroplastia inferior transcutânea. Os autores acreditam que a cantopexia seja uma boa opção nos casos primários por sua fácil execução, baixa morbidade e eficácia comprovada na prevenção da esclera aparente, do arredondamento do canto lateral do olho e ectrópio.

INTRODUCTION: The transcutaneous approach in lower eyelid rejuvenation is a versatile technique allowing broad access to all periorbital structures. Nevertheless, many surgeons opt to use different access routes such as the transconjunctival approach, to avoid the increased risk of eyelid malposition. However, the use of a routine lateral canthal support was shown to consistently minimize this risk. This study reviewed 136 cases of patients who were operated on using the transcutaneous approach and canthal support with canthopexy and orbicularis suspension. METHOD: Our study used a retrospective design to investigate patients undergoing primary transcutaneous lower blepharoplasties performed with canthopexy, between January 2008 and January 2014. We assessed the presence of dermatochalasis, eyelid bags and tarsal sagging by analyzing patients' images and medical records. We used surgical descriptions and clinical notes to study the surgical technique used and the rate of complications associated with the same. RESULTS: Our study involved monitoring the post-operative condition of 136 patients for approximately 180 days after they underwent surgery. The occurrence of any of the following was considered a postoperative complication: epiphora (15%), eyelid malposition (2.94%), orbital hematoma (0%), chemosis (9.5%), and foreign body sensation (6%). Seven patients (5.1%) required surgical revision. CONCLUSION: Our assessment revealed that canthal support must be considered as an integral part of transcutaneous lower blepharoplasty. The authors believe that canthopexy is a good option in primary cases owing to its easy implementation, low morbidity, and efficacy in preventing apparent sclera, round eye lateral corner, and ectropion.

Clinical observation of palpebral spring placement for lagophthalmos secondary to facial nerve palsy / 中华实验眼科杂志

Background The dysfunction of the blink reflex the eyelid-closure ability appears in the patients with facial paralysis,and its management is the implantation of mechanical-assisted eye-closure device in the upper eyelid.A novel device is palpebral spring implant.However,there is no similar study in China.Objective This study was to evaluate the clinical efficacy of palpebral spring placement for lagophthalmos caused by facial nerve palsy.Methods This clinical research complied with Helsinki declaration and the protocol was approved by Ethic Committee of Henan Eye Institute & Henan Eye Hospital.Written informed consent was obtained from each patient prior to the surgery.A retrospective serial case-observational study was performed.The medical records of 11 patients who underwent palpebral spring placement for hypophasis due to facial nerve palsy were reviewed at Henan Eye Hospital from August 2010 to November 2012.Palpebral spring placement was performed by the same surgeon to ensure a more even outcomes.Palpebral spring was made by nickel wire,with the diameter of 0.3 mm and implanted on tarsal plate in 11 eyes of 11 patients with symptomatic facial nerve palsy.The lower tip of Levine spring was encased into a small terylene bag and sutured to the anterior tarsal surface during the surgery.Preoperative and postoperative symptoms,upper eyelid margin to mid pupil distance (ULMD),degree of lagophthalmos and eyelid moving scope were examined and compared between before and after operation.The operating complication was followed-up for 8-38 months.Results The discomforted symptoms disappeared in all the operated eyes.The ULMD was (3.51±0.73) mm in preoperation and (3.20±0.86) mm in posteration,without significant difference between them (t=1.36,P=0.10).The degree of lagophthalmos was (5.94±1.57) mm and (1.06±0.98) mm in preoperation and postoperation respectively,showing a significant difference between them (t =9.42,P =0.00).The eyelid moving scope was (5.89±0.70) mm in postoperation,which was significantly increased in comparison with (0.11 ±0.33) mm of preoperation (t =22.97,P =0.00).The palpebral spring implant was regulated in 1 patient during the follow-up duration due to the trauma.No complication in other 10 patients appeared during the follow-up duration,such as implant exposure,metal fatigue or infection.Conclusions Palpebral spring placement is safe and effective for lagophthalmos in patients with facial nerve palsy.

Curative effect analysis of three methods of epicanthus combined with small incision for double eyelid surgery / 局解手术学杂志

Objective To explore an effective and hidden incision scar method for epicanthus correction. Methods 80 patients of bi-lateral single eyelid with epicanthus were divided into group A,group B and group C. Twenty-five patients with 50 eyes of group A received“Z” plasty correction of epicanthus,25 cases with 50 eyes of group B received the traditional“Y-V” plasty correction of epicanthus,30 cases with 60 eyes of group C treated with modified “Y-V” plasty correction of epicanthus. The curative effective was observed. Results Three groups were followed up for 6~24 months, the appearances of 25 patients in group A were significantly improved,of whom 2 cases had uni-lateral recurrence,8 cases with obvious postoperative scar. The eyelid shapes of patients in group B were natural after surgery,12 cases with obvious scar. all patients in group C were found no postoperative hypertrophic scars. Conclusion The three surgical treatment were effec-tive for epicanthus,but the design approaches of“Z” plasty correction and“Y-V” plasty correction are more complex,and postoperative scar is obvious,meanwhile the modified “Y-V” plasty correction is simple with incision hidden good shape scar formation.

Caracterización de las cirugías palpebrales con láser de CO2 / Characterization of the eyelid surgery with CO2 laser

Objetivo: Determinar la caracterización de las cirugías palpebrales con láser de CO2. Métodos: Estudio observacional, descriptivo, longitudinal prospectivo, cuya muestra estuvo constituida por 93 pacientes (136 ojos) operados con láser de dióxido de carbono en el Servicio de Oculoplastia del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" desde enero a octubre de 2009. Resultados: Según el sexo, 40 eran femeninos y 53 masculinos. Por edad, de 20 a 39 años, 9,7 %; de 40 a 59, 15 %; de 60 a 79, 48,4 %; y más de 80 años, 23,7 %. La piel tipo I se presentó en el 53,8 % de los pacientes, el tipo II en 33,3 %. El láser se utilizó como instrumento de corte y coagulación en la dermatochalasis (31,6 %) y en el ectropión (20,6 %). Como escáner en 11 queratosis seborreicas. El 94,6 % no mostró complicaciones, solo 5 pacientes. Conclusiones: Este equipo se utilizó en múltiples afecciones anexiales. La técnica quirúrgica transcutánea predominó en más de la mitad de los pacientes con dermatochalasis y la fijación cantal externa en las anomalías de posición. Las complicaciones fueron mínimas y la retracción cicatrizal fue la más frecuente.

Objective: To determine the behavior of eyelid surgery with CO2 laser. Methods: A prospective, longitudinal, observational and descriptive study whose sample consisted of 136 eyes from 93 patients, who underwent carbon dioxide laser surgery at the oculoplasty service of "Ramón Pando Ferrer" Cuban Institute of Ophthalmology from January to October, 2009. Results: Of the total number of patients, 40 were females and 53 males; 9.7% aged 20 to 39 years, 15% aged 40 to 59 years; 48.4 % were 60 to 79 years and 23.7% over 80 years. Skin type I was present in 50 patients (53,8 %), and type II in 33,3 % of cases. C02 laser was used for cutting and coagulation in dermatochalasis, accounting for 31.6% and in ectropion for 20,6 %. As a scanner it was used in 11 seborrheic keratoses. No complications were observed in 94.6% of cases; just 5 patients did for 5.4% of the total. Conclusion: The highest number of patients was older than 60 years males with skin type I. This equipment was used to treat multiple adnexal conditions, being dermatochalasis the most common followed by eyelid malpositions. The surgical transcutaneous technique dominated in more than half of patients with dermatochalasis and the external canthal fixation in positional abnormalities. This equipment was mostly used as cutting and coagulation tool. Complications were minimal and the most frequent one was scar retraction.

Blepharoptosis Correction with Stitch Method

There are various methods to correct mild ptosis and to make a double fold. However, all pre-existing methods have similar disadvantages, such as long-lasting swelling and down time. Recently, many patients prefer more convenient and minimal invasive methods with faster recovery. So we have devised a new technique to correct mild ptosis. Our technique is very similar to other non-incisional stitch methods. We try to correct ptosis through Muller's muscle tucking using the non-incisional stitch method. We think this method could be applied to mild degree ptosis. We hope to report the long-term follow up data of our cases and analysis with more efficient technique in the near future.

Cosmetic Double Eyelid Surgery: Single 5 mm-Partial Incision Method

In Asian double eyelid surgery, there have been two approaches to form a suprapalpebral fold: the buried suture (nonincision) method and the full external incision method. Usually excessive fat tissue in upper eyelid has been removed by using a full external incision method, or 2 to 3 partial incisions with buried suture method. The full external incision method is more invasive than the buried suture method, which is not suitable for patients with excessive orbital fat. From March 1999 to January 2002, we have introduced the single 5 mm-partial incision method to 216 patients. This method is applied to patients who have excessive amount of orbital fat or those who do not have excessive orbital fat but which must be removed for better result. These patients have bulging supra-crease areas when we form suprapalpebral folds with a curved wire loop preoperatively. Excessive orbital fat was removed through a single 5 mm incision in the middle of designed eyelid crease and tarso-dermal suture was performed. At another 2 to 3 points, through skin stab punctures by using 18 gauge needle, full-thickness eyelid tarso-dermal sutures were done. Pretarsal and preseptal orbicularis muscles were preserved. If muscles were removed, that could result in thinning of the overlying skin and could make suprapalpebral fold unnatural. This method has several advantages. First, we could perform the operations safely in patients who have excessive fat tissue, without a full external incision. Second,fat tissue can be removed almost totally by a single 5 mm-partial incision. Third, we can minimize the scar formation, and the possibility of complications, and make healing process and operation time shorter compared to the full incision technique. However a very delicate technique is required in this method. In patients who have a thick orbital septum, a superiorly located fat pad, and a bleeding tendency, exposure of fat tissue could be difficult and injury of levator muscle aponeurosis is possible. The complications of this method are the possibility of disappearing of the crease with the lapse of time(3 percents), and suture granuloma formation(less than 1 percent). In conclusion, patients who have excessive fat tissue in upper eyelid don't have to proceed a full incision, and can have more excellent results with this single 5 mm-partial incision method.

Corneal Astigmatic Change in Corneal Topography After Upper Eyelid Surgery

PURPOSE: The study was conducted to determine if there is a corneal astigmatic changes after upper eyelid surgery by using corneal topography and if these changes are the reason why some patients note a decrease in visual acuity. METHODS: Twenty four eyes of 12 patients with dermatochalasis who had undergone upper eyelid blepharoplasty, and 24 eyes of 12 patients who had undergone aesthetic double fold formation were included. We performed corneal topography during the postoperative 3 months and also evaluated the corneal refractive index change on thirteen points of the central cornea, which were located in the center of the corneal apex and apart from it by 1.5, 2.5, 3.5 mm along each axis corresponding to the 0 degrees, 90 degrees, 180 degrees, 270 degrees respectively. RESULTS: Corneal topography demonstrated increase in with-the-rule astigmatism by 38, 33, and 12% for dermatochalasis patients at 1week, 1month, and 3months after surgery, and by 25%, 17%, and 13% for double fold patients. However the increase in with-the-rule astigmatism seemed to be temporary, showing gradual regression. The refractive index change of thirteen points of central cornea was not significant except a few eyes with astigmatic changes greater than 1D until 1 month after surgery. There was alsoincreased astigmatism after surgery in vector-corrected analysis. CONCLUSIONS: There was a tendency of increase in with-the-rule astigmatism and those changes were temporary and regressed gradually. No patient showed significant refractive index change on the 13 points of central cornea but some showed changes greater than 1 D in the early postoperative period, causing visually significant astigmatic changes temporarily.

Efficacy of Colorado Needle in Lid Surgery

Eyelid has rare infection and good wound healing due to rich blood supply, but often lead to excessive bleeding during surgery. Thus, bleeding control in time of operation is very important to secure operation field and minimize subcutaneous hemorrhage and edema after operation. Retrospectively, we analized intra- and post-operative complications of 92 patients who had undergone eyelid surgeries by one operator using Colorado patients who had undergone eyelid surgeries by one operator using Colorado dissection needle attached to monopolar electrocautery from March to October 1997. there were 49 patients of epiblepharon or entropion, 16 patients of ptosis, 10 patients of dermatochalasis and 17 patients of blepharoplasty. In all 92 patients who had be used with Colorado needle neither complications nor side effects were developed. Therefore, we consider that the colorado needle monopolar electrocautery is an useful instrument in eyelid surgery.

Clinical observation on treatment semiptosis of upper eyelid by pleating of levator palpebrae superioris / 眼科

Objective To discuss the clinical curative effect of pleating of levator palpebrae superioris in treating semiptosis. Design Retrospective case series. Participants Forty-three eyes from 30 patients with semiptosis of upper eyelid. Methods By using pleating of levator palpebrae superioris through the skin,isolating the levator muscle was skipped in rectification. Position of upper eyelid-margin before and after operation was observed. Main Outcome Measures The position change of upper eyelid-margin in the first position of eye in 3-6 months after surgery. Results The mean follow-up period was 13.1 months (6 months to 2 years),26 cases (39 eyes) got cured with normal eyelid-margin position,3 patients were below rectification and 1 patient over-rectification. Conclusion Pleating of levator palpebrae superioris is suitable for the treatment of semiptosis of upper eyelid.