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Objective To investigate biomechanical properties of double eyelid surgery and its clinical application in upper blepharoplasty .Methods In the mild ptosis correction combined with double eyelid surgery ,the main force from levator was assigned to upper tarsus to open eyes .At the same time ,not only it could ensure the enough height of palpebral fissure ,but also had relatively sta-ble and persistent double eyelid .For those who had sunken upper eyelid ,were given fat transposition and/or autologous fat grafting .For those who had medial epicanthal fold ,to achieve a pleasing eye ap-pearance ,we performed epicanthoplasty .Results After 6 months to 2 years of follow-up ,15 cases had unsatisfactory results and underwent secondary surgery .The revision reason was as follows :7 pa-tients had asymmetry double eyelid width ,3 patients had insufficient correction for ptosis ,2 patients had shallower and narrower double eyelid line .In 3 cases ,the correction of the upper sunken was in-sufficient .The remaining 164 patients with mild ptosis were well corrected ,and the double eyelid was stable and natural ,and the results were satisfactory .There were no major complications .Conclusions During mild blepharoptosis correction combined with double eyelid surgery ,reasonable treatment of the biomechanical balance has certain clinical significance for avoiding postoperative complications and improving the effect of double eyelid surgery .
ABSTRACT
@#AIM:To develop a feasible method to correct congenital ptosis in children.<p>METHODS: Sixty-four patients(102 eyelids)were divided into three groups based on the degree of ptosis: mild(<2 mm); moderate(3-4 mm)and severe(>4 mm). All patients underwent the same levator resection surgery in which the suspensory system of the LPS is retained. After capturing a standard photograph of primary position, the height of the superior palpebral margin was measured preoperatively by using Image J software to calculate its ideal height required during surgery. Postoperative outcome measures included upper eyelid margin height, degree of scleral exposure and exposure keratitis. The patients were followed-up at 1wk, 1mo and 6mo postoperatively.<p>RESULTS: In the early postoperative period, except two cases with overcorrection, the positions of the eyelid upper margins were normal in all cases in the mild and moderate groups. Six months postoperatively, the eye with overcorrection in the moderate group showed improvement, while the eye in the mild group did not. Seven eyes in the severe group exhibited residual ptosis to varying degrees. The eyelids exhibited appropriate closing functionality; exposure keratitis was absent.<p>CONCLUSION:Using this preoperative quantification technique to guide surgery not only provided a gauge for LPS shortening under general anesthesia, but also increased the success rate of surgery.
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PURPOSE: To study the effect of plapebral fissure height on astigmatism in epiblepharon patients. METHODS: The study consisted of 68 eyes of 34 patients who were diagnosed with epiblepharon and 88 eyes of 44 patients who had normal eyelids from September 2012 to July 2013. Data on palpebral fissure height and refractive errors were compared between the epiblepharon group and the control group. Epiblepharon patients were further divided into two subgroups depending on the degree of preoperative corneal erosion in order to study the effects of corneal erosion on corneal astigmatism. RESULTS: The mean age was 5.6 ± 2.2 years in the epiblepharon group and 6.1 ± 1.5 years in the control group (p = 0.339). The mean astigmatism was 2.28 ± 1.54 D in the epiblepharon group and 0.91 ± 1.07 D in the control group. The epiblepharon group showed higher astigmatism than the control group (p < 0.001). The mean palepebral fissure height was 6.70 ± 1.19 mm in the epiblepharon group and 7.63 ± 1.06 mm in the control group. The epiblepharon group exhibited smaller palpebral fissure height than the control group (p < 0.001). In the palpebral fissure height subgroups of the epiblepharon group, the <7.0 mm group showed higher astigmatism than the ≥7.0 mm group (p = 0.026). Higher astigmatism was associated with smaller palpebral fissure height (p = 0.022). CONCLUSIONS: Patients with epiblepharon had significantly higher corneal astigmatism, and higher astigmatism was associated with smaller palpebral fissure height.
Subject(s)
Humans , Astigmatism , Eyelids , Refractive ErrorsABSTRACT
PURPOSE: Most surgeries to correct congenital ptosis in children are performed with the patient under general anesthesia, which makes the postoperative outcome unpredictable. We analyzed the factors influencing postoperative changes in the fissure height of congenital ptosis patients with poor levator function under general anesthesia after frontalis suspension surgery. METHODS: We reviewed the medical charts of 79 congenital ptosis patients with poor levator function (4 mm or less) who underwent frontalis suspension with autogenous fascia lata under general anesthesia between January 2001 and December 2004. We considered lagophthalmos induced by general anesthesia as the baseline lid level, and the lid was elevated in proportion to the amount of ptosis, as assessed by photographic analysis. Photographs were taken and then analyzed using the Scion Map analysis program to measure the fissure height objectively at 1 week, 1 month, and 3 months. RESULTS: The fissure height formed by frontalis suspension surgery increased progressively and stabilized 1 month after the operation. Levator function had no significant effect on postoperative changes in fissure height. However, a more severe preoperative ptosis and a higher lagophthalmos were associated with a relatively smaller increase in adjusted lid height during the follow-up period. CONCLUSIONS: A good postoperative outcome was achieved by adjusting the lid height to a higher level in eyes with higher lagophthalmos. Especially when confronted with the dilemma of how to correct asymmetric ptosis, higher elevation of lid height in eyes with more severe preoperative ptosis and higher lagophthalmos while under (general) anesthesia should be helpful in the prediction of postoperative surgical outcomes.
Subject(s)
Child , Humans , Anesthesia , Anesthesia, General , Fascia Lata , Fascia , Follow-Up StudiesABSTRACT
PURPOSE: Most surgeries to correct congenital ptosis in children are performed with the patient under general anesthesia, which makes the postoperative outcome unpredictable. We analyzed the factors influencing postoperative changes in the fissure height of congenital ptosis patients with poor levator function under general anesthesia after frontalis suspension surgery. METHODS: We reviewed the medical charts of 79 congenital ptosis patients with poor levator function (4 mm or less) who underwent frontalis suspension with autogenous fascia lata under general anesthesia between January 2001 and December 2004. We considered lagophthalmos induced by general anesthesia as the baseline lid level, and the lid was elevated in proportion to the amount of ptosis, as assessed by photographic analysis. Photographs were taken and then analyzed using the Scion Map analysis program to measure the fissure height objectively at 1 week, 1 month, and 3 months. RESULTS: The fissure height formed by frontalis suspension surgery increased progressively and stabilized 1 month after the operation. Levator function had no significant effect on postoperative changes in fissure height. However, a more severe preoperative ptosis and a higher lagophthalmos were associated with a relatively smaller increase in adjusted lid height during the follow-up period. CONCLUSIONS: A good postoperative outcome was achieved by adjusting the lid height to a higher level in eyes with higher lagophthalmos. Especially when confronted with the dilemma of how to correct asymmetric ptosis, higher elevation of lid height in eyes with more severe preoperative ptosis and higher lagophthalmos while under (general) anesthesia should be helpful in the prediction of postoperative surgical outcomes.
Subject(s)
Child , Humans , Anesthesia , Anesthesia, General , Fascia Lata , Fascia , Follow-Up StudiesABSTRACT
We compared palpebral fissure height according to horizontal fixation direction in normal subjects, strabismic patients[exotropia, esotropia, abducens nerve palsy], and patients with Duane's retraction syndrome. We respectively measured the palpebral fissure height of 39 normal subjects [78 eyes], 37 exotropia patients[74 eyes], 17 esotropia patients[34 eyes], 6 patients of abducens nerve palsy[6 eyes], and 8 patients with Duane's retraction syndrome[12 eye]. Measurements were obtained from standardized photographs in primary position, 30-degree adduction and abduction and maximum adduction and abduction of both eyes. The palpebral fissure height of normal subjects and exotropia patients was maximal in primary position and minimal in maximum adduction and abduction. On the other side, the palpebral fissure height of esotropia patients was maximal in 30 degree abduction. On the base of the height in primary position, the fissure height of normal subjects was 90%in maximum abduction and 89%in maximum adduction. But the fissure height of Duane's retraction syndrome was 103%in maximum abduction and 69%in maximum adduction. In normal group and exotropia, the fissure narrowed according to the degree of adduction and abduction, and in esotropia and abducens nerve palsy, the palpebral fissure of abducting eye was wider than that of primary position. In Duane's retraction syndrome the palpebral fissure of adducting eye markedly narrowed and the difference between the fissure height in maximum adduction and maximum abduction made diagnostic value in comparison to normal group.
Subject(s)
Humans , Abducens Nerve , Abducens Nerve Diseases , Duane Retraction Syndrome , Esotropia , ExotropiaABSTRACT
To investigate the change in upper eyelid position after cataract operation, We studied 40 eyes of 40 patients prospectively who underwent phacoemulsification and intraocular lens implantation. Levator function and vertical palpebral lid fissure height were measured preoperatively and at postoperative day 1, 7, 28 and 56 in and the surgical and the fellow eyes. Postoperative mean vertical lid fissure height decreased compared with preoperative mean vertical lid fissure height in both eyes. The postoperative decrease in vertical lid fissure height tended to decrease with times and these trends had statistically significant correlation between both eyes. This suggests that both eyes are affected by factors unassociated with the cataract surgery and it is most apparent in the immediate postoperative period. In conclusion, we recommend not only the surgical eye but the fellow eye should be evaluated preoperatively and postoperatively to understand the eyelid position after cataract operation.