Comparison between frontalis suspension and levator resection in treatment of blepharoptosis: a meta-analysis / 中华医学美学美容杂志

Objective:To compare the postoperative efficacy and complications of frontalis suspension and levator resection in the treatment of blepharoptosis.Methods:According to the Cochrane systematic review method, we searched PubMed, Medline, Cochrane Library, Wanfang database, VIP Database, and China Knowledge Network database. The randomized and non-randomized controlled trials for comparing frontalis suspension and levator resection in the treatment of blepharoptosis were included. Revman 5.3 Meta analysis software was used.Results:A total of 13 clinical trials were involved in this study, including 1308 patients. Frontalis suspension was performed in the experimental group and levator resection was performed in the control group. The OR value of postoperative efficacy between the 2 groups was 2.91, 95% CI (1.57-5.39), P<0.01, the difference was statistically significant. Postoperative lagophthalmos after frontalis suspension was better [ MD=-1.05, 95% CI (-1.43--0.68), P<0.01], the difference was statistically significant. The OR value of undercorrection between the 2 groups was 0.24, 95% CI(0.16-0.36), P<0.01, the difference was statistically significant. Conclusions:The postoperative efficacy after frontalis suspension is higher. Postoperative complications after frontalis suspension are less.

Endoscope-assisted harvest of autogenous fascia lata in frontalis suspension surgery: A minimally invasive approach revisited

Purpose: To report endoscope-assisted fascia lata harvest (EAFH) as a minimally-invasive technique for correction of severe blepharoptosis. Methods: This was a retrospective case series between January 2013 and April 2017. Medical records of all consecutive patients who underwent frontalis suspension by EAFH in the study period were reviewed and outcome was analyzed. Results: Fourteen patients (10 males) were included in the study. Mean age of the group was 18.14 + 17.03 years (range 4-65 years) and 11 patients had simple congenital blepharoptosis. Blepharophimosis syndrome was seen in 3 patients. Eleven patients had bilateral blepharoptosis. The mean preoperative and postoperative MRD1 was –1.60 ± 0.87 mm and +2.12 ± 1.37 mm respectively. Mean lengths of the incision and fascial harvest were 2.25 ± 0.43 cm and 13.0 ± 2.35 cm (range 10-17 cm) respectively. The median follow-up of patients was 4.57 + 4.03 months (range 1-15 months). Complications included a wound dehiscence in two patients and these were resutured. The donor sites healed well in all patients leaving a small thigh scar and none needed scar revision. Conclusion: EAFH is a promising minimally-invasive technique performed with a small incision and achieved adequate length of fascial harvest.

Clinical study on conjoint fascial sheath suspension in the treatment of moderate and severe ptosis / 局解手术学杂志

Objective To investigate whether the conjoint combined with fascial sheath( CFS) suspension can be used as an effective method for correction of moderate and severe ptosis. Methods Thirty-five patients (39 eyes) with moderate or severe ptosis were treated in our hospital from January 2014 to March 2017 by means of CFS suspension,frontalis suspension and shortening of levator palpebrae superior-is,and all the patients were followed up for 3～12 months. Results The CFS suspension and the other two operations appeared effective;and compared with the other two methods,the difference was statistically significant(P<0. 05). The CFS suspension for the treatment of moderate and severe ptosis with a higher positive rate(95％) and the positive rate of the other two methods was 67％. In terms of complications,the CFS suspension showed eyelid dysraphism incidence rate was exposure keratitis occurred in 85. 7％ and entropion occurrence rate of 4. 7％;with the other two methods,the surgical eyelid dysraphism occurred in 100％ and the conjunctival prolapse occurred in 5. 6％. Conclusion The CFS suspension in correction of moderate and severe ptosis has the advantages of less trauma,less complications and good correction effect.

Técnica de crawford en el tratamiento de la ptosis palpebral congénita / Crawford´s technique in the treatment of congenital palpebral ptosis

OBJETIVO: evaluar los resultados quirúrgicos de la técnica de Crawford mediante el empleo de silastic y polipropileno 4.0 y las complicaciones presentadas. MÉTODOS: se realizó un estudio descriptivo y prospectivo de 12 pacientes (16 párpados) con ptosis palpebral congénita desde enero 2009 a diciembre 2010 en la consulta de Oculoplastia del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Fueron excluidos los que tenían cirugía anterior de dicha enfermedad. RESULTADOS: el 83,3 % fueron del sexo masculino y el 91,6 % menores de 9 años de edad; de ellos, 4 casos de 0 a 2 y de 6 a 8, respectivamente; 3 casos en el grupo de 3 a 5 y solo 1 caso mayor de 9 años. El 75 % fueron ptosis congénita simple y el 56 % severas. La ptosis resultó corregida en 13 párpados para el 81 %. Con el uso desutura polipropileno 4.0, dos párpados se encontraron hipocorregidos (12,6 %) y seis corregidos (37,5 %); con silastic, un párpado quedó hipocorregido, (6,3 %) y siete corregidos (43,7 %). Se presentó el 25 % de complicaciones, 3 párpados hipocorregidos y un granuloma supraciliar. CONCLUSIONES: la ptosis resultó más frecuente en menores de 8 años del sexo masculino. Predominó la ptosis congénita simple, unilateral y severa. La técnica de Crawford resultó efectiva en la mayoría de los casos y similar con los dos materiales empleados.

OBJECTIVE: to evaluate the surgical outcomes of the Crawford technique through the use of silastic and polypropylene 4.0 materials and the identified complications. METHODS: a prospective and descriptive study of 12 patients (16 eyelids) with congenital ptosis conducted from January 2009 to December 2010 in the oculoplasty surgery in "Ramón Pando Ferrer" Cuban Institute of Ophthalmology. Those patients with prior surgery to treat this disease were excluded. RESULTS: in the study group, 83,3 % were males and 91,6 % were younger than 9 years old, 4 cases aged 0-2 and 6 8 years, respectively, 3 cases aged 3 to 5 and only one case older than 9 years. Seventy five percent of treated cases had simple congenital ptosis and 56 % suffered the severe form. Ptosis was corrected in 13 eyelids for 81 %. Using polypropylene sutures 4.0, two eyelids were undercorrected (12,6 % ) and 6 corrected (37,5 %) whereas the use of silastic resulted in one undercorrected eyelid (6,3 %) and 7 corrected ( 43,7 %). There was a 25 % complication rate, three undercorrected eyelids and one superciliary granuloma. CONCLUSIONS: ptosis was more frequent in male children younger than 8 years. Simple congenital ptosis predominated, either unilateral or severe. Crawford technique was effective in most cases and with similar results using both materials.

Effect of the Simultaneous Operation of Levator Resection and Frontalis Suspension for Congenital Ptosis

PURPOSE: To determine retrospectively if a simultaneous frontalis suspension could change the result of undercorrection observed during levator resection in congenital ptosis patients with poor levator functions. METHODS: Eight eyes in the present study were from 5 infants, 4 infants had congenital ptosis and 1 infant had blepharophimosis. The average age was 3.3 years (range: 1.5 to 6.9 years). If the upper lid margin was not positioned on the superior limbus after performing levator resection under general anesthesia, the height of the upper lid margin was controlled by simultaneous frontalis suspension. RESULTS: The average follow-up period was 29.8 months. After surgery on both eyes, all 8 cases showed good results and sudden relapse did not occur. Exposed corneal erosion was observed in 6 eyes, but with artificial tears, eye drops, and ointment there were significant improvements within 1 month in all cases. At final examinations, 6 out of 8 eyes showed excellent or good results; undercorrection in 2 eyes was observed and the lateral portion of ptosis in 1 eye was observed as an eye complication. CONCLUSIONS: If undercorrection caused by levator resection occurs in patients with congenital ptosis, the combination of frontalis suspension surgery may reduce undercorrection and any recurrence that might appear after surgery.

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.

Use of the Levator Muscle as a Frontalis Sling in Monocular Elevation Deficiency

PURPOSE: For the correction of ptosis in monocular elevation deficiency (MED) patients, levator resection or frontalis sling operation with various materials has been used. The authors present a case of a monocular elevation deficiency patient who was treated for ptosis using the levator muscle as a frontalis sling. CASE SUMMARY: A six-year-old male patient with left monocular elevation deficiency underwent a frontalis sling operation using a levator muscle. The patient had received left inferior rectus recession, left medial rectus resection and left lateral rectus recession with transposition. An upper eyelid skin crease incision was made, and the anterior surface of the levator muscle was exposed as far as the Whitnall ligament. A levator muscle flap was then formed from aponeurosis by incising the full width of the levator horizontally, just below the Whitnall ligament and anchored to the frontalis muscle. The surgical result was satisfactory as the preoperative MRD1 was 0.5 mm and the postoperative MRD1 was 2.5 mm. There were no complications such as keratitis or wound problems. CONCLUSIONS: The levator muscle flap can be an effective frontalis suspension material to correct ptosis in an MED patient with poor levator function.

Changes in Postoperative Fissure Height after Frontalis Suspension Using Autogenous Fascia Lata

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.

Changes in Postoperative Fissure Height after Frontalis Suspension Using Autogenous Fascia Lata

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.

The Changes in Tear Film and Ocular Surface Associated with Lagophthalmos after Frontalis Suspension

PURPOSE: We investigated the incidence of exposure keratopathy, cornea protective changes in tear film such as corneal sensitivity, tear film stability, and tear secretion after frontalis suspension, and the correlation of these with lagophthalmos. METHODS: The corneal sensitivity test, tear film break-up time (tBUT) measurement, and basic secretion test were performed prospectively in patients who had undergone frontalis suspension. RESULTS: The mean lagophthalmos was highest at postoperative 1 week and then gradually decreased. There were no significant changes in corneal sensitivity, tBUT or tear secretion after surgery. No significant differences were found in those parameters between eyes with lagophthalmos of 3 mm or more and those less than 3 mm, nor did these parameters differ between eyes with clear cornea and exposure keratopathy. Only tBUT at postoperative 1 week was significantly shorter in eyes with lagophthalmos 3 mm or more than those less than 3 mm. The average level of lagophthalmos in eyes with exposure keratopathy (15/33 eyes, 45.4%) was more than 3mm at every follow-up period, which was significantly higher than for eyes with a clear cornea. CONCLUSIONS: Tear physiology tends to maintain normal function despite poor blinking induced by lagophthalmos. The cornea is thought to be protected by these functions of tear film. The factor most influential on cornea status was the level of lagophthalmos, and exposure keratopathy should be carefully examined during postoperative period in eyes with higher lagophthalmos, especially more than 3 mm.

Frontalis Suspension Using Silicone Rod

PURPOSE: To evaluate the surgical results and complications in patients with blepharoptosis who underwent frontalis suspension using a silicone rod. METHODS: A total of 31 lids of 23 patients with blepharoptosis and poor levator function underwent a pentagon-shaped loop silicone sling surgery in which six skin incisions were made. Eighteen patients had congenital ptosis, two blepharophimosis-ptosis syndrome, two blepharoptosis with superior rectus muscle weakness, and one third nerve palsy. RESULTS: With a mean age of 14 years and a mean follow-up of 16 months, good-to-excellent lid height was achieved in 27 lids (87%) of 20 patients and poor results with undercorrection in 4 lids (13%) of 3 patients. Three of the 4 lids with poor results had reoperation and satisfactory results were achieved. Transient exposure keratitis occurred postoperatively in 7 lids (23%) and persistent exposure keratitis in 2 lids (6%). During the follow-up period, extrusion of the sling and infection did not occur; ptosis recurred in 4 lids (13%). CONCLUSIONS: Silicone rod can be adjusted easily after frontalis suspension, but it needs to pay close attention because the string can be broken during the operation or follow-up period. It is considered that additional follow-ups for a long-term recurrence rate of ptosis are necessary and sufficient explanation to the patients and family and their understanding are need.

The effect of Frontalis suspension Ptosis repair using Fascia lata in congenital unilateral ptosis

PURPOSE: This study was undertaken to determine the amount of ptosis correction in congenital unilateral ptosis patients who had been performed frontalis suspension with autologous fascia lata under general anesthesia. METHODS: The subjects consisted of 27 patients with unilateral ptosis who had been performed frontalis suspension with autologous fascia lata under general anesthesia. At 1,4,8,and 12 weeks, the width of interpalpebral fissure was measured with videocamera. RESULTS: The mean preoperative interpalpebral fissure was 3.9+/-1.2 mm. At intraoperation, the mean interpalpebral fissure was 4.5+/-0.4 mm. The mean postoperative interpalpebral fissures were 6.8+/-0.6 mm, 7.8+/-0.8 mm, 6.8+/-0.8 mm, and 6.7+/-0.8 mm at 7+/-1, 29+/-3, 57+/-4, and 96+/-9 days. In preoperative severe ptosis group (ptosis amount 4 mm), the mean postoperative interpalpebral fissure was smaller than the other group. CONCLUSIONS: The postoperative interpalpebral fissure was stabilized after the 2-month follow-up. The results of this study suggest that the amount of ptosis correction should be modified in consultation with preoperative ptosis amount.

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.

The Surgical Treatment of Ptosis with Marcus-Gunn(Jaw-Winking) Phenomenon

The authors operated 7 cases with severe ptosis and moderate to severe jaw-winking phenomenon, with the extirpation of the levator muscle above Whitnall's ligament on affected eye and the bilateral frontalis suspension with preserved fascia lata. Seven patients observed for up to 22.5 months have had cosmetically and functionally desirable results with disappearance of jaw-winking phenomenon.

The Clinical Study On the Surgical Methods of Synkinetic Ptosis Treatment

Synkinetic ptosis refers to abnormal vertical movement of upper eyelid. This abnormal elevation of the eyelid results from opening or closing of the mouth, chewing, sucking, and movement of jaw outward or toward the contralateral side. A number of other stimuli for the phenomenon have been described. These include smile, sternocleidomastoid contraction or tongue protrusion, inspiraion, and voluntary nystagmus. This type of ptosis was most commonly seen with a congenital Marcus-Gunn jaw-winking syndrome. Usually this movement is thought to be due to a congenital misdirection of some of the 5th cranial nerve fibers into the branch of the 3rd cranial nerve that supplied the levator muscle. We experienced 6 cases of synkinetic ptosis, among them, interesting enough, one was typical elevation of upper lid in smile due to misdirection between the oculomotor and facial nerve fibers. The cosmetic problem was the first purpose of the surgery. So, we performed a levator extirpation with frontalis suspension on 4 cases who had the severe jaw-winking phenomenon and undertook only fron talis suspension on 2 cases and one of whom had poor superior rectus function. In the cases who have undergone levator extirpation with frontalis suspension, synkinetic movement was improved in all. However, in those who underwent the frontalis suspension procedure, the synkinetic phenomenon still remained in spite of acceptable improvement of blepharoptosis in primary position.

The Use of a Preserved Dural(LYODURA(R)) in the Congenital Ptosis Surgery

LYODURA(R) is commercial name of a cleaned, desantigenized, desenzymatised, rendered free of pyogenics, sterilized by gamma rays, and lyophilized dura. Frontalis suspension with LYODURA(R) was performed to a total of 16 patients(21 lids) of congenital ptosis with levator muscle function of 3mm or less in the ptbtic lid. The follow-up period ranged from 2 to 39 weeks with a mean of 19.6 weeks. Postoperative lid levels were judged good, fair, and poor. Good results occurred in 12 of 21 procedures(57.1 %) and fair results in 6 of 21 prqcedures(28.6%). The summation of these two indicates an overall satisfactory result of 18 of 21 cases(85.7%).

The Use of a Preserved Dural(LYODURA(R)) in the Congenital Ptosis Surgery

LYODURA(R) is commercial name of a cleaned, desantigenized, desenzymatised, rendered free of pyogenics, sterilized by gamma rays, and lyophilized dura. Frontalis suspension with LYODURA(R) was performed to a total of 16 patients(21 lids) of congenital ptosis with levator muscle function of 3mm or less in the ptbtic lid. The follow-up period ranged from 2 to 39 weeks with a mean of 19.6 weeks. Postoperative lid levels were judged good, fair, and poor. Good results occurred in 12 of 21 procedures(57.1 %) and fair results in 6 of 21 prqcedures(28.6%). The summation of these two indicates an overall satisfactory result of 18 of 21 cases(85.7%).

Frontalis suspension in congenital ptosis using Lyodura(R)

Lyodura(R) is a commercial name of a cleaned, desantigenized, desenzymatized, rendered free of pyogenics, sterilized by gamma rays, and lyophilized dura. Frontalis suspension with Lyodura(R) was performed on a total of 16 patients (21 lids) of congenital ptosis with levator muscle function of 3mm or less in the ptotic lid. The follow-up period ranged from 2 to 39 weeks with a mean of 19.6 weeks. Postperative lid levels were judged good, fair, and poor. Good results occurred in 12 of 21 procedures (57.1%) and fair results in 6 of 21 procedures (28.6%). The summation of these two indicates an over all satisfactory result of 18 of 21 cases (85.7%).