The utility of margin‑reflex distance in determining the type of surgical intervention for congenital blepharoptosis.

Aims: To evaluate the utility of margin‑reflex distance (MRD) as an alternative to levator function (LF) in choosing the appropriate surgical procedure for congenital blepharoptosis. Settings and Design: This was a retrospective, observational study. Subjects and Methods: Records of patients with simple (dystrophic) congenital ptosis who were operated and followed for ≥6 months postoperatively and whose outcomes were deemed as successful were evaluated in the study. Success was defined as a MRD at the last postoperative visit of ≥3 mm. In all cases, levator resection was performed when LF was >4 mm and frontalis suspension when LF was ≤4 mm. Statistical Analysis Used: For statistical evaluations, LF was accepted as the gold standard parameter for deciding on the surgical intervention, and the optimum cutoff point for initial MRD was determined as the point at which sensitivity and specificity was highest at the receiving operating curve for the selection of surgical procedure. Results: Of one hundred and three eyes of ninety patients (44 female/46 male), levator resection was used in 44.7% and frontalis suspension in 55.3%. When the optimum cutoff point for MRD was determined as 0.5 mm, the sensitivity was 71%, specificity was 86%, and the area under the curve that represented the discriminative power of this parameter was found to be 0.826. Conclusion: The MRD at the cutoff point of 0.5 mm may be used as an alternative to LF to determine the type of surgical intervention in patients with congenital blepharoptosis whose LF cannot be reliably obtained in clinical evaluations.

The Frequency and Aspects of Ptosis in Korean Old Age

PURPOSE: To study the frequency and aspects of ptosis in Koreans aged 50 years or older. METHODS: In this study, 377 elderly people visiting retirement center were included. Margin-reflex distance 1 (MRD1) and palpebral fissure (PF) were evaluated with an attempt to eliminate eyebrow elevation. Levator function (LF) was measured with Berke's method. If the measured MRD1 was less than 2 mm, ptosis was diagnosed and its frequency, relation to sex, age, levator function and superior deep sulcus were investigated. RESULTS: There was a correlation between decreasing MRD1, PF and LF with increasing age. Ptosis was observed in 207 subjects (54.9%), and its frequency was augmented as age increased. Although it was not statistically significant, the levator function of those with ptosis (10.0+/-1.9 mm) was lower than those without ptosis (11.3+/-1.9 mm). Questionnaires were administered and 196 respondents (51%) said that their eyelid droop had become more pronounced over time. Among these respondents, 33 (16.1%) indicated that their droopy eyelid causes discomfort by blocking their vision. Their MRD1 was 1.2+/-1.0 mm, which was significantly lower than that of the other 163 respondents (1.8+/-1.1 mm, P<0.05). CONCLUSIONS: Koreans aged 50 years or older showed a very high frequency (54.9%) of ptosis and as age increased, the frequency of ptosis also increased. Surgical correction is recommended when the ptosis causes patient discomfort due to impaired vision.

The Frequency and Aspects of Ptosis in Korean Old Age

PURPOSE: To study the frequency and aspects of ptosis in Koreans aged 50 years or older. METHODS: In this study, 377 elderly people visiting retirement center were included. Margin-reflex distance 1 (MRD1) and palpebral fissure (PF) were evaluated with an attempt to eliminate eyebrow elevation. Levator function (LF) was measured with Berke's method. If the measured MRD1 was less than 2 mm, ptosis was diagnosed and its frequency, relation to sex, age, levator function and superior deep sulcus were investigated. RESULTS: There was a correlation between decreasing MRD1, PF and LF with increasing age. Ptosis was observed in 207 subjects (54.9%), and its frequency was augmented as age increased. Although it was not statistically significant, the levator function of those with ptosis (10.0+/-1.9 mm) was lower than those without ptosis (11.3+/-1.9 mm). Questionnaires were administered and 196 respondents (51%) said that their eyelid droop had become more pronounced over time. Among these respondents, 33 (16.1%) indicated that their droopy eyelid causes discomfort by blocking their vision. Their MRD1 was 1.2+/-1.0 mm, which was significantly lower than that of the other 163 respondents (1.8+/-1.1 mm, P<0.05). CONCLUSIONS: Koreans aged 50 years or older showed a very high frequency (54.9%) of ptosis and as age increased, the frequency of ptosis also increased. Surgical correction is recommended when the ptosis causes patient discomfort due to impaired vision.

Evaluation and Treatment of True Ptosis in Double Elevator Palsy

PURPOSE: To estimate the predictable factors of postoperative true ptosis remaining after squint surgery in patients with double elevator palsy (DEP), and to analyze the factors that must be considered before the correction of true ptosis. METHODS: We retrospectively reviewed the medical records of 6 patients who had undergone strabismus surgery for DEP at the Department of Ophthalmology, Yeungnam University College of Medicine, between 1989 and 2003. The MRD (margin reflex distance) of paretic and nonparetic eye with each eye fixation, palpebral aperture, levator function, and Bell's phenomenon were analyzed before and after squint surgery. RESULTS: True ptosis was noted in 3 patients, one of whom underwent external levator resection. Postoperative Bell's phenomenon improved in 2 patients who had poor Bell's phenomenon preoperatively. Scleral show remained in 2 patients who underwent inferior rectus recession, and was taken into account before the correction of ptosis. CONCLUSIONS: Upper lid drooping in DEP patients is expected to be improved after squint surgery if preoperative MRD of paretic eye with paretic eye fixation has the same measured amount as that of non-paretic eye. MRD, Bell's phenomenon and the amount of scleral show after the squint surgery should be carefully examined and assessed before the correction of residual ptosis.

Aponeurotic Ptosis Surgery

Sixty-five levator aponeurotic surgeries were carried out to treat acquired and congenital blepharoptosis including those with very poor levator function. Margin reflex distance(MRD) was measured and postoperative drooping of the upperlid was observed carefully during the follow-up period of 6 months to 1 year. Most of these cases had a stationary level of MRD or less than 1 mm change of MRD but three cases resulted in more than 1.5 mm postoperative fall of the upperlid. This procedure also proved the excellent surgical efficacy in severe congenital ptosis with very poor levator function. In our experience, about 1 mm overcorrection at surgery provided a more satisfactory result.