Retrospective Analysis of the Efficacy and Safety of Omidenepag Isopropyl 0.002% Ophthalmic Solution in Korean Patients

Purpose@#This study aimed to analyze the clinical efficacy and safety of omidenepag isopropyl (OMDI) 0.002% in Korean patients. @*Methods@#A retrospective study was conducted involving 306 patients diagnosed with glaucoma or ocular hypertension, who were administered OMDI 0.002% from May 2021 to June 2022. The primary outcomes were the change in intraocular pressure (IOP) at months 1, 3, and 6 compared to the baseline IOP, and the reactions to the OMDI drug. @*Results@#Out of 235 patients who met the study inclusion criteria, the mean IOP was 16.5 ± 3.4 mmHg at baseline, 14.5 ± 3.0 mmHg at month 1, 14.3 ± 2.7 mmHg at month 3, and 14.7 ± 3.1 mmHg at month 6. The mean IOP reduction at month 6 was -1.6 ± 2.8 mmHg (p < 0.001). On analyzing the IOP by types of glaucoma, the mean IOP change at the 6-month point showed statistically significant results in all types, including normal tension glaucoma, primary open-angle glaucoma, and ocular hypertension (p < 0.05). The frequency of side effects in all patients was 29.8%, with the most commonly reported adverse drug reaction being hyperemia in 18.7% of the total patients. There was one case (0.4%) of uveitis after OMDI administration, but no other systemic adverse drug reactions were reported. @*Conclusions@#Omidenepag isopropyl demonstrated a statistically significant IOP-lowering effect in Korean patients with various types of glaucoma. This suggests that OMDI could potentially serve as a first-line treatment for glaucoma.

Influence of Long-term Oral Steroid Intake on Glaucoma and Ocular Hypertension

Purpose@#The aim of this study was to evaluate the risk factors associated with glaucoma or ocular hypertension (OHT) in patients taking oral corticosteroids for extended periods, and to aid in managing intraocular pressure (IOP) in patients with these risk factors. @*Methods@#A cross-sectional study was performed involving 690 patients who visited a tertiary referral hospital and had been using oral corticosteroids for more than six months. Patients' demographics, tonometry results, drug type, dosage, duration, ophthalmic history, and the use of glaucoma eye drops were analyzed to determine the risk factors associated with glaucoma or OHT. @*Results@#In a generalized linear model analysis comparing patients' eyes diagnosed with glaucoma or ocular hypertension to those without such diagnoses, no statistical difference was observed between the two groups in terms of drug type, age, and duration of oral corticosteroid use. However, the dosage was found to be statistically significant (odds ratio 1.09, p = 0.0294). @*Conclusions@#No difference in the incidence of glaucoma or OHT was found based on the type of oral steroid, age, or duration of use. However, a higher incidence of glaucoma and OHT was observed among patients taking higher doses of oral steroids. Therefore, it is suggested that using lower doses of oral steroids may be more beneficial for managing IOP.

Effect of Intraoperative Mitomycin C on the Surgical Outcomes of Ahmed Glaucoma Valve Implantation with Ciliary Sulcus Tube Placement

Purpose@#To evaluate the effect of intraoperative mitomycin C (MMC) on the surgical outcomes of ciliary sulcus (CS) Ahmed glaucoma valve (AGV) tube placement. @*Methods@#A retrospective review of medical records of 54 consecutive patients who underwent AGV implantation with tube placed in CS was performed. Consecutive cases operated without the use of intraoperative MMC from 2017 to 2019 were compared with consecutive cases operated with MMC from 2019 to 2021. Surgical failure was defined as intraocular pressure (IOP) exceeding 21 mmHg in two consecutive visits after postoperative 3 months or ≤30% IOP reduction, IOP ≤5 mmHg in two consecutive visits, or loss of light perception. Kaplan-Meier survival analysis and log-rank test were performed to compare the surgical failure rates. @*Results@#A total of 54 eyes of 54 patients were investigated. Mean follow-up period after AGV implantation was 1.4 ± 0.8 years. The MMC group showed significantly lower IOP during the 1st postoperative month (20.5 ± 8.6 mmHg vs. 15.8 ± 6.4 mmHg, p = 0.027), but the difference did not persist 6 months after the surgery (p = 0.805). The mean number of postoperative antiglaucoma medications was significantly lower in the MMC group in the 1st postoperative month (p = 0.047) but no difference was found at 6 months. No statistical difference was noted in the rates of postoperative complications. Kaplan-Meier survival analysis showed comparable survival rates between MMC group and no MMC group (p = 0.356). @*Conclusions@#The intraoperative use of MMC significantly lowered IOP in the 1st postoperative month but did not increase 6 months success rates in patients receiving AGV tube placement in CS.

Effects of Glaucoma Medication on Dry Eye Syndrome and Quality of Life in Patients with Glaucoma

Purpose@#To investigate ocular surface diseases and changes in the quality of life of patients using glaucoma medications. @*Methods@#Participants were divided into the normal (31 individuals, 62 eyes) and glaucoma medication (30 patients, 60 eyes) groups. Changes in tear break-up time, lipid layer thickness (LLT), corneal and conjunctival staining scores, ocular surface disease index (OSDI), and Visual Function Questionnaire 25 (VFQ-25) score were assessed for 1 year. @*Results@#The change in mean LLT was lower in glaucomatous eyes than in control eyes (p = 0.019) after 1 year. The results of OSDI deteriorated (p’ = 0.008), but conjunctival staining and Schirmer test results showed improvement in glaucomatous eyes compared to those in control eyes (p’ =0.035 and 0.009, respectively). The average LLT decreased at 6 and 12 months, but there was no change at 24 months. In pairwise analysis, the decrease in LLT over the first 6 months was statistically significant (p < 0.001) and remained unchanged until 24 months. Among the VFQ items, scores for near activity and social function deteriorated over 1 year in the medication group (p’ = 0.033 and 0.015, respectively). However, there was no difference in the total VFQ score. @*Conclusions@#Significant reduction in LLT and deterioration of OSDI were observed in the medication group compared to the control group. However, this deterioration was observed only in the first 6 months. There was no significant difference in the VFQ total score. Nonetheless, there were significant differences in near activity and social function between the control and medication groups. Therefore, the results of this study showed that although glaucoma medication worsened eye dryness, the change was limited and did not worsen the quality of life. Glaucoma medication should be used with the consideration that they can limit near activity and social functioning.

Hierarchical Cluster Analysis of Peripapillary Retinal Nerve Fiber Layer Damage and Macular Ganglion Cell Loss in Open Angle Glaucoma

Clinical Predictors of the Region of First Structural Progression in Early Normal-tension Glaucoma

Purpose@#This study aimed to compare the clinical characteristics of patients who showed structural progression in the peri-papillary retinal nerve fiber layer (RNFL) first against those who showed progression in the macular ganglion cell-inner plexi-form layer (GCIPL) first and to investigate clinical parameters that help determine whether a patient exhibits RNFL or GCIPL damage first. @*Methods@#A retrospective review of medical records of patients diagnosed with early-stage normal-tension glaucoma was performed. All eyes underwent intraocular pressure measurement with Goldmann applanation tonometer, standard auto-mated perimetry, and Cirrus optical coherence tomography at 6-month intervals. Structural progression was determined using the Guided Progression Analysis software. Blood pressure was measured at each visit. @*Results@#Forty-one eyes of 41 patients (mean age, 52.6 ± 16.7 years) were included in the study. In 21 eyes, structural pro-gression was first detected in the RNFL at 54.2 ± 14.8 months, while structural progression was first observed at the macular GCIPL at 40.5 ± 11.0 months in 20 eyes. The mean intraocular pressure following treatment was 13.1 ± 1.8 mmHg for the RNFL progression first group and 13.4 ± 1.8 mmHg for the GCIPL progression first group (p = 0.514). The GCIPL progression first group was older (p = 0.008) and had thinner RNFL at baseline (p = 0.001). The logistic regression analyses indicated that both age and follow-up duration until first progression predicted the region of structural progression (odds ratio, 1.051; 95% confidence interval, 1.001–1.105;p= 0.046 for age; odds ratio, 0.912; 95% confidence interval, 0.840–0.991; p = 0.029 for time until progression). @*Conclusions@#Age of glaucoma patients and time until progression are associated with the region of the first structural pro-gression in normal-tension glaucoma. Further studies exploring the association between glaucomatous progression and the location of damage are needed.

Inadvertent Subclavian Artery Catheterization: Juxta-Catheter Thrombosis with Subsequent Stroke

No abstract available.

Asymmetry of Peak Thicknesses between the Superior and Inferior Retinal Nerve Fiber Layers for Early Glaucoma Detection: A Simple Screening Method

PURPOSE: To assess whether the asymmetry in the peripapillary retinal nerve fiber layer (pRNFL) thickness between superior and inferior hemispheres on optical coherence tomography (OCT) is useful for early detection of glaucoma. MATERIALS AND METHODS: The patient population consisted of Training set (a total of 60 subjects with early glaucoma and 59 normal subjects) and Validation set (30 subjects with early glaucoma and 30 normal subjects). Two kinds of ratios were employed to measure the asymmetry between the superior and inferior pRNFL thickness using OCT. One was the ratio of the superior to inferior peak thicknesses (peak pRNFL thickness ratio; PTR), and the other was the ratio of the superior to inferior average thickness (average pRNFL thickness ratio; ATR). The diagnostic abilities of the PTR and ATR were compared to the color code classification in OCT. Using the optimal cut-off values of the PTR and ATR obtained from the Training set, the two ratios were independently validated for diagnostic capability. RESULTS: For the Training set, the sensitivities/specificities of the PTR, ATR, quadrants color code classification, and clock-hour color code classification were 81.7%/93.2%, 71.7%/74.6%, 75.0%/93.2%, and 75.0%/79.7%, respectively. The PTR showed a better diagnostic performance for early glaucoma detection than the ATR and the clock-hour color code classification in terms of areas under the receiver operating characteristic curves (AUCs) (0.898, 0.765, and 0.773, respectively). For the Validation set, the PTR also showed the best sensitivity and AUC. CONCLUSION: The PTR is a simple method with considerable diagnostic ability for early glaucoma detection. It can, therefore, be widely used as a new screening method for early glaucoma.

Diagnostic Ability of Swept-Source and Spectral-Domain Optical Coherence Tomography for Glaucoma

PURPOSE: To compare the diagnostic abilities of swept-source optical coherence tomography (OCT) [Deep Range Imaging OCT-1 (DRI-OCT)] and spectral-domain OCT (Cirrus HD-OCT) for glaucoma in Korean adults. MATERIALS AND METHODS: This retrospective study involved measuring peripapillary retinal nerve fiber layer (PP-RNFL) thickness, full macular thickness, and ganglion cell-inner plexiform layer (GC-IPL) thickness on two different OCT systems. We used three-dimensional optic disc scanning of DRI-OCT and included 12 clock-hour sectors for measurement of the PP-RNFL. Areas under receiver operating characteristic curves (AUCs) were calculated and compared to determine how well each system could distinguish control and glaucomatous patients. RESULTS: Ninety-one healthy and 58 glaucomatous eyes were included. Both systems could clearly distinguish between control eyes and eyes with moderate to severe glaucoma. Among all sectors, the AUC values of areas associated with glaucoma were >0.7 for both OCTs. The PP-RNFL sector of highest AUC value on both OCTs was the inferior sector of the clock-hour map (0.968 and 0.959 in DRI-OCT and Cirrus HD-OCT, respectively). Among macular thickness sectors, AUC values were highest on both OCTs for the outer inferior sector (0.859 and 0.853 in DRI-OCT and Cirrus HD-OCT, respectively). The GC-IPL also provided high diagnostic values (DRI-OCT and Cirrus HD-OCT were the best in the average and inferior sectors, respectively). CONCLUSION: Although the two OCT systems provided different thickness measurements, DRI-OCT exhibited as good, if not better, diagnostic ability for glaucoma as Cirrus HD-OCT in Korean adults.

Mislocation of Boundary of Localized Retinal Nerve Fiber Layer Defect in Red-free Photography of Three Glaucoma Patients

No abstract available.

Discussion of Lumbar Puncture in Infants Aged Less than 3 Months Who Visited Emergency Department

PURPOSE: This study was conducted to confirm the necessity of lumbar puncture to identify the cause of fever in febrile infants aged less than 3 months who visited an emergency department. METHODS: This was a retrospective study conducted on 399 infants aged 31 days to 90 days who visited the emergency department with fever from March 2014 to February 2016. RESULTS: Of the 399 patients, 49 patients had serious bacterial infections (SBI), and were finally diagnosed with urinary tract infection (UTI), sepsis, and bacterial meningitis. Of these, only one case was diagnosed with bacterial meningitis, and this patient was accompanied by sepsis. UTIs were present in 47 patients, and only 1 case was diagnosed with sepsis without bacterial meningitis or UTI. The Boston criteria and Philadelphia criteria included the cerebrospinal fluid (CSF) results for predicting SBI. In this study, the modified Philadelphia criteria was used, which does not include the CSF results, and there was no factor that showed a significant correlation as a result of statistical analysis. Rather, a C-reactive protein ≥50 mg/L, procalcitonin ≥2 ng/mL, and fever over 39℃C showed statistical significance with SBI. In this study, the 1 patient diagnosed with bacterial meningitis also met all three factors (C-reactive protein, 106 mg/L; procalcitonin, 40.25 ng/mL; peak body temperature, >39℃). CONCLUSION: Because the incidence of bacterial meningitis has decreased recently, when an infant under 3 months of age visits the emergency room with fever, lumbar puncture should be performed selectively to identify the cause.

Minnesota Multiphasic Personality Inventory Characteristics of Parricide Offenders with Schizophrenia in Korea

OBJECTIVE: This study aims to examine the personality characteristics in parricide offenders, by using the Minnesota Multiphasic Personality Inventory (MMPI) test, which is commonly used in clinical medicine. METHODS: A total of 73 parricide offenders with schizophrenia who were admitted to National Forensic Hospital in Gongju city between September 2014 and February 2015, and 104 comparison schizophrenia patients who had been admitted to Dankook University Hospital in Cheonan city the same hospital, completed the Korean version of the MMPI. RESULTS: The parricide offender group showed significantly higher on L, F, Hs, Hy and Pd than the comparison group. The result of the regression analysis indicated that Pd and Si significantly increased the odd ratio of the sexual offender group by 2.77 times and 0.32 times, respectively (p=0.029 and p=0.023). The offenders of parricide may have developed the following characteristics: hypochondriasis, hysteria and psychopathic deviate. CONCLUSION: These results suggested that the psychopatholgy in the offenders of parricide might be different, compared to the control group.

Effect of Anti-vascular Endothelial Growth Factor Antibody on the Survival of Cultured Retinal Ganglion Cells

PURPOSE: To investigate the effects of anti-vascular endothelial growth factor (VEGF) antibody on the survival of retinal ganglion cell (RGC)-5 cells differentiated with staurosporine under oxidative stress. METHODS: We used real-time polymerase chain reaction and Western blot to confirm the expression of VEGF, VEGF receptor (VEGFR)-1 and VEGFR-2 in RGC-5 cells differentiated with staurosporine for 6 hours. The differentiated RGC-5 cells were treated with 800 µM hydrogen peroxide (H₂O₂) for 24 hours to induce oxidative stress. Then, the survival rate of RGC-5 was confirmed by lactate dehydrogenase assay at each concentration (0, 0.01, 0.1, and 1 mg) using bevacizumab as the anti-VEGF antibody. The expression of VEGF, VEGFR-1, and VEGFR-2 was confirmed using real-time polymerase chain reaction. RESULTS: VEGF, VEGFR-1, and VEGFR-2 were all expressed in differentiated RGC-5 cells. When RGC-5 cells were simultaneously treated with bevacizumab and 800 µM H₂O₂, survival of RGC-5 decreased with bevacizumab concentration. VEGF expression in RGC-5 cells increased with increasing concentration of bevacizumab. Similar patterns were observed for VEGFR-1 and VEGFR-2, but the degree of increase was smaller than that for VEGF. CONCLUSIONS: When bevacizumab was administered to differentiated RGC-5 cells, the cell damage caused by oxidative stress increased. Therefore, given these in vitro study results, caution should be exercised with bevacizumab treatment.

Oxalic Acid from Lentinula edodes Culture Filtrate: Antimicrobial Activity on Phytopathogenic Bacteria and Qualitative and Quantitative Analyses

The culture filtrate of Lentinula edodes shows potent antimicrobial activity against the plant pathogenic bacteria Ralstonia solanacearum. Bioassay-guided fractionation was conducted using Diaion HP-20 column chromatography, and the insoluble active compound was not adsorbed on the resin. Further fractionation by high-performance liquid chromatography (HPLC) suggested that the active compounds were organic acids. Nine organic acids were detected in the culture filtrate of L. edodes; oxalic acid was the major component and exhibited antibacterial activity against nine different phytopathogenic bacteria. Quantitative analysis by HPLC revealed that the content of oxalic acid was higher in the water extract from spent mushroom substrate than in liquid culture. This suggests that the water extract of spent L. edodes substrate is an eco-friendly control agent for plant diseases.

Water Extract from Spent Mushroom Substrate of Hericium erinaceus Suppresses Bacterial Wilt Disease of Tomato

Culture filtrates of six different edible mushroom species were screened for antimicrobial activity against tomato wilt bacteria Ralstonia solanacearum B3. Hericium erinaceus, Lentinula edodes (Sanjo 701), Grifola frondosa, and Hypsizygus marmoreus showed antibacterial activity against the bacteria. Water, n-butanol, and ethyl acetate extracts of spent mushroom substrate (SMS) of H. erinaceus exhibited high antibacterial activity against different phytopathogenic bacteria: Pectobacterium carotovorum subsp. carotovorum, Agrobacterium tumefaciens, R. solanacearum, Xanthomonas oryzae pv. oryzae, X. campestris pv. campestris, X. axonopodis pv. vesicatoria, X. axonopodis pv. citiri, and X. axonopodis pv. glycine. Quantitative real-time PCR revealed that water extracts of SMS (WESMS) of H. erinaceus induced expressions of plant defense genes encoding beta-1,3-glucanase (GluA) and pathogenesis-related protein-1a (PR-1a), associated with systemic acquired resistance. Furthermore, WESMS also suppressed tomato wilt disease caused by R. solanacearum by 85% in seedlings and promoted growth (height, leaf number, and fresh weight of the root and shoot) of tomato plants. These findings suggest the WESMS of H. erinaceus has the potential to suppress bacterial wilt disease of tomato through multiple effects including antibacterial activity, plant growth promotion, and defense gene induction.

Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

PURPOSE: To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma. METHODS: The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were followed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared. RESULTS: The IOP at 1 year postoperatively was 13.39 +/- 2.25 mm Hg, 13.41 +/- 2.79 mm Hg (p = 0.981) and IOP reduction was 4.51 +/- 6.35 mm Hg, 9.11 +/- 8.27 mm Hg (p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing postoperative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 +/- 0.88 D and -0.13 +/- 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively. CONCLUSIONS: Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with patients with angle-closure glaucoma.

Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

PURPOSE: To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma. METHODS: The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were followed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared. RESULTS: The IOP at 1 year postoperatively was 13.39 +/- 2.25 mm Hg, 13.41 +/- 2.79 mm Hg (p = 0.981) and IOP reduction was 4.51 +/- 6.35 mm Hg, 9.11 +/- 8.27 mm Hg (p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing postoperative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 +/- 0.88 D and -0.13 +/- 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively. CONCLUSIONS: Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with patients with angle-closure glaucoma.

Specific Sagittal Curve Patterns of Cervical Spine in Adolescent Idiopathic Scoliosis (AIS)

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the sagittal alignment of cervical spine in AIS. SUMMARY OF LITERATURE REVIEW: Little has been known about the sagittal curve patterns of cervical spine in AIS patients. MATERIALS AND METHODS: One-hundred-thirty-three AIS patients were checked by scanographs and followed up for more than 2 years were divided into cervical kyphosis (> or =+5degrees), lordosis (< or =-5degrees) and straight (-4degrees~+4degrees) groups according to the sagittal curves of cervical spine (C2~C7). Each group was evaluated for thoracic kyphosis, lumbar lordosis, sagittal balance and Cobb's angle on coronal plane. Of the patients, 49 were treated by braces, 84 were surgically corrected (rod derotation in 52, direct vertebral rotation (DVR) in 32). RESULTS: At the initial radiographs, cervical kyphosis was found in 97, lordosis in 23 and straight in 13 patients. In the kyphosis group, cervical kyphosis showed typical patterns of angular kyphosis. Thoracic and upper T-kyphosis (T1~T5) were lower than those in the cervical lordosis group (p=0.000, 0.001, respectively.) Other factors showed no significant differences between the groups. Patients treated by conservative management or by rod derotation had no significant differences in cervical kyphosis during the follow-up periods, though the thoracic hypokyphosis was surgically corrected. On the contrary, patients who were treated by DVR restored cervical lordosis (14/32=43.8%) from initial state showed significant differences in both conservative and rod derotation groups (p=0.008, 0.002, respectively). CONCLUSIONS: Cervical kyphosis in AIS was a compensatory curve correlated with both thoracic hypokyphosis and rotational deformity. Rotational corrections should be considered during the surgical treatment.

Reliability of RTVue, Visante, and Slit-Lamp Adapted Ultrasonic Pachymetry for Central Corneal Thickness Measurement

PURPOSE: To evaluate reliability of Fourier-domain optical coherence tomography (OCT) (RTVue), time-domain OCT (Visante), and slit-lamp adapted ultrasonic pachymetry (SL-US) in the measurement of central corneal thickness (CCT). MATERIALS AND METHODS: Thirty healthy volunteers visited our clinic 3 times and fifty eyes were measured by one physician. RTVue and Visante were randomly performed, and then SL-US, in which the ultrasound probe was inserted into the Goldmann tonometry mount, was done. During the second visit, each measurement was repeated 3 times. Measurements on the second visit were averaged, and agreement among the instruments was investigated with Bland-Altman plots. RESULTS: RTVue showed smaller repeatability coefficient than Visante and SL-US (4.7, 8.3, and 7.7 microm, respectively). Intersession reproducibility of RTVue and Visante was worse than their repeatability. CCT of RTVue was estimated to be maximally different by 11.8 microm from CCT of Visante and 8.8 microm from CCT of SL-US. The repeatability coefficient of SL-US was 7.7 microm and its reproducibility was similar to the repeatability. CONCLUSION: CCT measured by RTVue showed good reliability and generally agreed with Visante and SL-US. SL-US was as reliable as triple touching conventional US even with a single touch on the cornea.

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.