Simultaneous posterior eyelid ptosis repair and strabismus surgery: a single-stage approach / Cirurgia reparadora simultânea de blefaroptose posterior e de estrabismo: abordagem de estágio único

ABSTRACT Purpose: Blepharoptosis with coexisting strabismus can be observed in adults, and both these conditions affect cosmetic appearance and have psychosocial effects. Both also commonly require surgery, which is typically performed using a sequential approach. This study aimed to evaluate the efficacy of simultaneous Müller's muscle-conjunctival resection with or without tarsectomy and strabismus surgery in adult patients with ptosis and coexisting strabismus. Methods: Patients with ptosis and coexisting strabismus who underwent simultaneous Müller's muscle-conjunctival resection with or without tarsectomy and horizontal strabismus surgery were retrospectively evaluated. Analysis included measurement of the angle of deviation in prism diopters, margin reflex distance, eyelid height asymmetry, and complications following surgery. Success of Müller's muscle-conjunctival resection with or without tarsectomy was defined as a margin reflex distance of ≥3.5 and ≤5 mm with a difference between the two upper eyelids of <1 mm. Strabismus success was defined as alignment with ±10 prism diopters of orthotropia. Results: The patients comprised three women and five men with a mean age of 37.12 years (range, 22-62 years). The strabismus stage of the surgery was performed first in all patients. Upper eyelid symmetry outcomes were assessed as perfect (<0.5 mm) in four patients and good (≥0.5 mm, <1 mm) in four patients. Success of Müller's muscle-conjunctival resection with or without tarsectomy was achieved in six of eight patients (75%), and strabismus success was achieved in all patients. No revision eyelid or strabismus surgery was required following simultaneous surgery in any of the patients. Conclusion: Müller's muscle-conjunctival resection with or without tarsectomy combined with strabismus surgery may be an alternative approach for use in patients with ptosis and coexisting strabismus.

RESUMO Objetivo: Blefaroptose e estrabismo podem ser coexistentes em adultos e ambos afetam a aparência estética e o domínio psicossocial. Ambos também geralmente requerem cirurgia, realizada tradicionalmente em uma abordagem sequencial. O objetivo do presente estudo foi avaliar a eficácia da execução simultânea da ressecção musculoconjuntival de Müller, com ou sem cirurgia de tarsectomia, e da cirurgia de estrabismo em pacientes adultos com ptose e estrabismo coexistentes. Métodos: Foram retrospectivamente avaliados pacientes com ptose e estrabismo coexistentes submetidos simultaneamente à ressecção musculoconjuntival de Müller, com ou sem tarsectomia, e à cirurgia de estrabismo horizontal. A análise incluiu a mensuração do ângulo de desvio das dioptrias de prisma, a distância do reflexo à margem, a assimetria da altura palpebral e quaisquer complicações após a cirurgia. A ressecção musculoconjuntival de Müller, com ou sem sucesso na tarsectomia, foi considerada bem-sucedida com uma distância reflexo-margem medindo entre 3,5 e 5 mm, e uma diferença entre as duas pálpebras superiores menor que 1 mm. O sucesso da cirurgia de estrabismo foi definido como um alinhamento com ± 10 dioptrias prismáticas de ortotropia. Resultados: Os pacientes foram 3 mulheres e 5 homens, com média de idade de 37,12 anos (faixa de 22 a 62 anos). A parte de estrabismo da cirurgia foi realizada primeiro em todos os pacientes. Os resultados da simetria palpebral superior foram avaliados como perfeitos (<0,5 mm) em 4 pacientes, bons (≥0,5 mm, <1 mm) em 4 pacientes e regulares (≥1 mm) em nenhum. A ressecção musculoconjuntival de Müller, com ou sem sucesso na tarsectomia, teve sucesso em 6 dos 8 pacientes (75%) e a intervenção para o estrabismo foi bem-sucedida em todos os pacientes. Não foi necessária cirurgia de revisão da pálpebra ou do estrabismo após a cirurgia simultânea em nenhum paciente. Conclusão: A ressecção musculoconjuntival de Müller, com ou sem tarsectomia, pode ser combinada com a cirurgia de estrabismo em uma abordagem alternativa para pacientes com ptose e estrabismo coexistentes.

Tarsal buckling como complicação de correção cirúrgica de ptose congênita / Tarsal buckling as a complication of surgery to treat congenital ptosis

RESUMO O presente trabalho objetivou relatar um caso de tarsal buckling associado a prolapso conjuntival e à inversão de pálpebra superior como complicação da correção cirúrgica de ptose residual. Paciente do sexo feminino, 15 anos, portadora de ptose palpebral residual unilateral em olho direito, secundária à correção parcial da ptose palpebral congênita operada na infância. A segunda abordagem cirúrgica foi realizada com ressecção da aponeurose do músculo levantador da pálpebra superior, que evoluiu com inversão conjuntival da pálpebra superior. A fragilidade estrutural do tarso é a principal hipótese para justificar o tarsal buckling subsequente à cirurgia. Houve resolução completa do tarsal buckling, porém houve também persistência da ptose palpebral. O tarsal buckling é, portanto, uma complicação cirúrgica incomum, que pode ocorrer na correção da ptose palpebral, em que há rotação posterior da metade superior do tarso, fazendo com que este se curve verticalmente sobre seu eixo, favorecendo o prolapso conjuntival. A suspeição diagnóstica e a reabordagem cirúrgica precoce favorecem a resolução da condição e previnem possíveis complicações visuais.

ABSTRACT This paper aimed to report a case of tarsal buckling associated with conjunctival prolapse and upper eyelid inversion as a complication of surgical correction of residual ptosis. A 15-year-old female patient with unilateral residual eyelid ptosis in the right eye, secondary to partial correction of congenital blepharoptosis operated in childhood. The second surgery was performed with resection of the upper eyelid levator muscle aponeurosis, which progressed to conjunctival inversion of the upper eyelid. The structural fragility of the tarsus is the main hypothesis to justify tarsal buckling after surgery. There was complete resolution of tarsal buckling, but persistence of blepharoptosis. Tarsal buckling is an infrequent surgical complication that can occur in correction of blepharoptosis, when there is posterior rotation of the upper half of the tarsus, causing it to curve vertically on its axis and favoring conjunctival prolapse. Establishing diagnosis and early reoperation favor resolution of the condition and avoid possible visual complications.

Fifteen years of experience with frontalis suspension using polytetrafluoroethylene (Gore-Tex®) suture in blepharoptosis repair / 15 anos de experiência em suspensão frontal com fio de politetrafluoretileno (Gore-Tex®) na correção de ptose palpebral

ABSTRACT Purpose: To review the outcomes of frontalis suspension surgeries with the use of polytetrafluoroethylene in patients with blepharoptosis. Methods: A retrospective observational study analyzed the outcomes of frontalis suspension surgeries performed in a single institution from 2003 to 2018. All procedures were performed with closed incision and single pentagon techniques. Outcomes were classified as satisfactory or unsatisfactory, with satisfactory defined as a margin reflex distance of >3 mm and <1 mm between eyelids and unsatisfactory as hypocorrection, surgical complications, and asymmetry. Results: We included a total of 76 eyelids from 52 patients in our study. Within a mean postoperative follow-up of 16.8 ± 18.5 months (range, 3-95), 59 (77.6%) eyelids had a satisfactory outcome, and 17 (22.4%) were unsatisfactory (8 cases of asymmetry, 3 granulomas, 3 suture extrusions, 2 abscesses, and 1 case of cellulitis). Nine eyelids from the unsatisfactory group required reoperation. Among the patients with a follow-up of ³12 months (38 surgeries), lasting results were observed in most eyelids, except for 2 late-onset suture extrusions. Conclusion: The use of polytetrafluoroethylene in frontalis suspension surgery was shown to be predictable, safe, and lasting. Our findings support previous studies that have shown adequate functional results and low complication rates.

RESUMO Objetivo: Revisar os resultados de cirurgias de sus pensão ao músculo frontal com o uso de fio de politetrafluoretileno em pacientes com blefaroptose. Métodos: Em um estudo observacional retrospectivo, foram analisados os resultados das cirurgias de músculo frontal de uma instituição, realizadas entre 2003 e 2018. Todos os procedimentos foram realizados com incisão fechada e técnica de pentágono. Os desfechos foram classificados como satisfatórios ou insatisfatórios com definição satisfatória definida como distância margem-reflexo >3mm e <1mm entre as pálpebras e insatisfatória como hipocorreção, complicações cirúrgicas e assimetria. Resultados: Incluímos um total de 76 pálpebras de 52 pacientes em nosso estudo. Com um tempo médio de seguimento pós-operatório de 16,8 ± 18,5 meses (intervalo 3-95), 59 (77,6%) pálpebras apresentaram desfecho satisfatório e 17 (22,4%) insatisfatórios (8 casos de assimetria, 3 granulomas, 3 extrusões de sutura, 2 abscessos e 1 caso de celulite). Nove pálpebras do grupo insatisfatório necessitaram de reoperação. Entre os pacientes com seguimento ³12 meses (38 cirurgias), resultados duradouros foram observados na maioria dos casos, exceto por 2 extrusões de sutura de surgimento tardio. Conclusão: O uso de politetrafluoretileno na cirurgia de músculo frontal mostrou ser previsível, seguro e duradouro, Nossos achados corroboram com estudos prévios que mostraram resultados funcionais adequados e baixos índices de complicação.

Entrópio palpebral severo pós cirurgia de correção de ptose / Severe eyelid entropion after ptosis correction surgery

Resumo Paciente de 69 anos evoluiu com entrópio palpebral severo após cirurgia de correção de ptose palpebral pela técnica de reinserção da aponeurose do músculo levantador da pálpebra superior. Realizada reintervenção onde foi diagnosticado uma fixação da aponeurose em uma posição muito inferior e feita uma refixacação no 1/3 superior do tarso, com melhora do quadro funcional e estético com boa satisfação da paciente. Devido às suturas em topografia mais inferior, o tarso adquire forma de U em decorrência do dobramento no centro da placa tarsal e da rotação inferior da sua metade superior resultando no entrópio. Este caso ressalta a importância do cuidado quanto a localização da inserção da aponeurose do MLPS, principalmente nos paciente idosos, como forma de evitar o encurvamento vertical do tarso.

Abstract Sixty-nine (69) year old patient with severe upper eyelid entropion following surgical correction of ptosis through levator muscle aponeurosis advancement and reinsertion. The aponeurosis advancement appeared to be much lower than typically intended, and surgical repair was performed via aponeurosis re-fixation into the superior 1/3 of the tarsal plate, with subsequent improvement in the aesthetic and functional outcome, and a satisfied patient. Due to the inferiorly located tarsal sutures, the tarsal plate acquires a U-shape due to a central fold and an inferior rotation of its upper half, resulting in entropion formation. This case highlights the importance of taking great care when advancing the levator muscle in ptosis due to levator aponeurosis dehiscence, particularly in elderly patients, so as to avoid vertically folding the superior tarsal plate.

Accidental lacrimal gland removal during resection of the levator palpebrae superioris muscle / Remoção acidental da glândula lacrimal em cirurgia de ressecção do músculo levantador da pálpebra superior

ABSTRACT Accidental removal of the lacrimal gland is a rare complication of ptosis surgery. We report two children who underwent large unilateral levator palpebrae superioris resections (LPSr). After surgery, both patients developed dry eye. Post-operatively, the parents of both patients noticed no tears in the affected eye when their child cried. Computed tomography proved the absence of the lacrimal gland in the operated eye in both patients. Oculoplastic surgeons should pay close attention to the anatomy of the levator muscle and its proximity to surrounding tissues in order to avoid lesions on important orbital structures, including the lacrimal gland, and to avoid the development of long-term dry eye.

RESUMO A remoção acidental da glândula lacrimal é uma complicação rara da cirurgia de ptose. Relatamos duas crianças que foram submetidas à grandes ressecções unilaterais do músculo levantador da pálpebra superior que desenvolveram olho seco após a cirurgia. No pós-operatório, os pais notaram ausência de secreção lacrimal durante o choro no olho operado. Tomografia computadorizada de órbitas comprovou ausência da glândula lacrimal no olho submetido à cirurgia, em ambos os casos. Cirurgiões oculoplásticos devem estar atentos à anatomia do músculo levantador e estruturas relacionadas para evitar lesões em importantes estruturas orbitais como as da glândula lacrimal que podem induzir permanente olho seco.

Frontalis sling surgery: do we really need the Wright needle? / Suspensão ao músculo frontal: realmente precisamos da agulha de Wright?

ABSTRACT Purpose: The aim of this study is to describe a variation in technique of the frontalis sling surgery with silicone rods and its results, using an alternative needle with similar effectiveness to the Wright needle at a reduced cost. Methods: This was a prospective, interventional, noncomparative study of patients with severe ptosis who underwent surgical correction using a simple and modified frontalis sling surgery technique. Patients were included in this study from January 2012 to January 2014. 23 surgeries were performed on 15 patients. The minimum "follow-up" was 12 months. Results: Most patients had congenital ptosis (86%) and the average preoperative margin reflex distance 1 (MRD1) was -1.1 mm (range -3 to 0 mm). 1 week post-operation, this was 2.7 mm ( 1.8 to 3.8 mm), 1.8 mm after 1 month and 1.7 mm (1 to 2.5 mm) after one year. The satisfaction rate was 80% (12 patients). Among the dissatisfied patients, one had extrusion and infection with subsequent explantation of the wire, one had asymmetry greater than 2 mm and one had persistent lagophthalmos and punctate keratitis, with subsequent explantation of silicone. Conclusion: The use of silicone rods with tarsal fixation using an alternative needle was effective in the treatment of severe ptosis with few complication rates, a low rate of dissatisfaction and good stability of the results in the follow-up period.

RESUMO Objetivos: O objetivo deste estudo é descrever uma variação da técnica cirúrgica da suspensão ao músculo frontal com fio de silicone e seus resultados, utilizando uma agulha alternativa à agulha de Wright, com a mesma eficácia e melhor razão custo-benefício. Métodos: Foram analisados prospectivamente todos os casos de blefaroptose severa submetidos à correção cirúrgica, utilizando a técnica de suspensão ao músculo frontal modificada, no período de janeiro de 2012 à janeiro de 2014. Foram realizadas 23 cirurgias em 15 pacientes. O "follow-up" mínimo foi de 12 meses. Resultados: A grande maioria dos pacientes apresentavam blefaroptose congênita (86%), a média da distância margem reflexo pré-operatória foi de -1,1mm (-3 a 0 mm), no pós-operatório de 1 semana foi de 2,7 mm (1,8 a 3,8 mm), após 1 mês foi de 1,8 mm e após 1 ano, de 1,7mm (1 a 2,5 mm). O índice de satisfação foi de 80% (12 pacientes). Dos 3 pacientes insatisfeitos, 1 teve extrusão e infecção com posterior explante do fio, 1 apresentou assimetria maior que 2mm e 1 evoluiu com lagoftalmo persistente e ceratite puntacta, com posterior explante do silicone. Conclusão: O uso do fio de silicone com fixação tarsal usando uma agulha alternativa, se mostrou eficaz no tratamento da blefaroptose severa, com poucas complicações, baixo índice de insatisfação e boa estabilidade dos resultados no período de seguimento.

Ptose miogênica na distrofia muscular oculofaríngea / Miogenic ptosis in oculopharyngeal muscular dystrophy

RESUMO Relato de caso de distrofia muscular oculofaríngea, doença genética de herança autossômica dominante e uma das causas de ptose miogênica adquirida. A paciente apresentou quadro de ptose palpebral bilateral e disfagia, achados clínicos típicos da doença, foi submetida a tratamento cirúrgico da ptose, com bom resultado estético e funcional.

ABSTRACT The authors report a case of oculopharyngeal muscular dystrophy, an autosomal dominant genetic disease, which leads to miogenic ptosis. This patient presented bilateral palpebral ptosis and dysphagia and underwent ptosis surgical treatment, with a good functional and aesthetic result.

Ptose palpebral causada por Paquidermoperiostose / Palpebral ptosis caused by Pachydermoperiostosis

A paquidermoperiostose é uma síndrome caracterizada por acometimento cutâneo e ósseo, e em alguns casos ocorre comprometimento palpebral leve. É uma síndrome rara, idiopática ou hereditária, com provável herança autossômica dominante de penetrância variável. Descreve-se o caso de um paciente com ptose grave por paquidermoperiostose elucidando sua fisiopatologia e conduta cirúrgica aplicada.

Pachydermoperiostosis is a rare disorder characterized by the involvement of skin and bone, and in some cases it can have a mild adverse effect in the eyelid. Although the etiology is still unclear, idiopathic or hereditary cases, in an autossomal dominant inheritance, have been reported. This study is a case report of a patient with severe blepharoptosis due to pachydermoperiostosis, which describes the surgical procedure and the physiopathology of the condition.

Tratamento cirúrgico da blefaroptose congênita / Surgical treatment of congenital blepharoptosis

A blefaroptose é o posicionamento inadequado da pálpebra superior, estando abaixo de sua posição normal na posição primária do olhar, a qual seria 0,5 – 2mm abaixo do limbo superior. Pode causar bloqueio parcial ou completo do campo visual superior, além do comprometimento estético. As causas são categorizadas em congênitas ou adquiridas. É considerada congênita se presente ao nascimento ou diagnosticada no primeiro ano de vida. As principais técnicas utilizadas para o tratamento da ptose congênita são a ressecção da aponeurose do músculo levantador da pálpebra superior (MLPS) e a suspensão frontal. A medida da função do MLPS é o parâmetro mais importante na escolha da técnica cirúrgica. Quando a função é fraca, a suspensão frontal é mais indicada; a ressecção supramáxima do MLPS também pode ser empregada. Acima de 4 ou 5mm de função do MLPS, prefere-se a ressecção da aponeurose. Para a cirurgia de suspensão frontal, vários são os materiais utilizados, portanto apresentamos uma comparação entre os estudos mais relevantes. Discutiremos também particularidades em casos mais complicados, como as Síndromes da Blefarofimose e de Marcus-Gunn, além de técnicas cirúrgicas menos utilizadas e as complicações relatadas.

The blepharoptosis is the improper positioning of the upper eyelid, being below its normal position in primary gaze, which is 0.5 - 2mm below the superior corneal limbus. It may block partially or completely the upper visual field, and lead to aesthetic commitment. The causes are categorized as congenital or acquired. It is considered congenital if present at birth or diagnosed during the first year of life. The main techniques used for the treatment of congenital ptosis are the resection of the levator muscle aponeurosis and the frontalis suspension. The function of the levator muscle is the most important parameter to define the surgical technique. When the function is weak, the frontalis suspension is more appropriate; the supra-maximal resection of the levator muscle may also be employed. With function above 4 or 5mm, the resection of the aponeurosis is preferred. For the frontalis suspension surgery, various materials can be used, so we present a comparison of the most relevant studies. We also discuss some characteristics in more complicated cases, such as the Blepharophimosis syndrome and the Marcus-Gunn syndrome, and surgical techniques less performed and complications reported.

Tear function and ocular surface after muller muscle- conjunctival resection.

Tear function and ocular surface after muller muscle- conjunctival resection Suat Hayri Uğurbaş, Atilla Alpay, Burak Bahadır,1 and Sılay Cantürk UğurbaşDepartment of Ophthalmology, Bülent Ecevit University, Zonguldak, Turkey1Department of Pathology, Bülent Ecevit University, Zonguldak, TurkeyCorrespondence to: Dr. Atilla Alpay, Bülent Ecevit Universitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı Kozlu Zonguldak 67600, E-mail: moc.liamtoh@yaplaallita Author information ► Article notes ► Copyright and License information ► Received 2010 Nov 2; Accepted 2012 Apr 11. Copyright : © Indian Journal of OphthalmologyThis is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Go to:Abstract.Muller muscle-conjunctival resection (MCR) is a surgical technique to correct mild and moderate ptosis. In this study, tear function tests and ocular surface are evaluated in patients who underwent unilateral surgery. Sixteen patients with normal preoperative tear function who underwent unilateral MCR were evaluated prospectively. The fellow eyes of the patients were taken as the control group. A dry eye assessment questionnaire, Schirmer testing, tear film break-up time, fluorescein stain, Rose-Bengal stain, and conjunctival impression cytology were used to assess the tear film functions and ocular surface changes in the operated and non-operated eyes. There was no statistically significant difference in the tear function tests and goblet cell densities between the operated and non-operated eyes. The results indicate that an MCR procedure has no apparent effect on tear function tests and goblet cell density in patients with normal preoperative tear function. Keywords: Blepharoptosis surgery, conjunctiva, tear Muller's muscle-conjunctival resection (MCR) is a form of posterior approach surgery for ptosis correction. Although this technique has been reported to give excellent results, there is a question of its effect on tear film components. There are several studies concluding no significant effect of MCR on tear production.[1] These studies are based on Schirmer testing (ST) and questioning of dry eye symptoms only. In this study, we studied all of dry eye tests including a dry eye questionnaire, ST, tear film break-up time (TBUT), vital staining, meibomian gland evaluation and conjunctival impression cytology. Go to:Materials and Methods.Thirty-two eyes of 16 patients who underwent unilateral ptosis surgery were enrolled in the study. The fellow eyes of the patients were taken as the control group. A complete ophthalmologic examination of patients was performed including preoperative Schirmer and TBUT tests. The patients with other ocular disease, dry eye, history of a systemic disease that would affect ocular surface, history of contact lens use, and prior conjunctival surgery were excluded from the study. All patients underwent ptosis repair by an MCR with a technique similar to the described by Putterman.[1] A subjective dry eye questionnaire was given to the patients questioning various dry eye symptoms, frequency of dryness, grittiness, burning, redness, crust formation on lashes and stickiness of eyelids in the morning.[2] Responses were graded as follows: 0 - never; 1 - rare; 2 - sometimes; 3 - frequently; or 4 - always. The total score was calculated with the sum of symptom grades in each eye. Schirmer and TBUT tests were performed after an application of a drop of proparacaine hydrochloride 0.5%. The procedure was repeated 3 times, and the average of measurements was recorded. Fluorescein staining was recorded for 5 regions of the cornea (superior, inferior, nasal, temporal, central) and 4 regions of the conjunctiva (superior, inferior, nasal, temporal). Each region was graded from 0 to 4. The total staining score was the sum of the scores of all regions. Rose-Bengal staining (RBS) of the conjunctiva was performed by using a Contacare Rose-Bengal ophthalmic Strip (Contacare, Baroda, India); initially wetted with non-preserved buffered saline and then instilled on the inferior bulbar conjunctiva. An evaluation of RBS was similar to fluorescein staining. The eyelid margin was checked for meibomian gland disease (MGD) with slit lamp examination. Grade-0 indicated that all glands were unblocked. Grade-1 indicated 1 to 2 blocked glands. Grade-2 indicated 3 to 4 blocked glands with thick secretions but without expression of glands. Grade-3 indicated that half of the glands were blocked. Grade-4 indicated more than half of the glands were blocked with viscous secretions. Grade-1 or higher was considered as MGD positive.[3] Impression cytology specimens were collected from the temporal and nasal conjunctiva of each eye using Nitrocellulose (Sartorius, Göttingen, Germany) filter paper. Specimens were stained with periodic acid-Schiff stain. The quantitative studies of conjunctival goblet cells and squamous metaplasia of conjunctival epithelial cells were conducted by taking photographs with a calibrated grid under a light microscope. Five non-overlapping areas of each randomly-selected sample were photographed and averaged for a single score. The Goblet cell densities were reported as cells per square millimeter with standard deviations. The specimens were also assigned a grade of conjunctival epithelial squamous metaplasia according to Nelson's grading scheme.[4] The results were analyzed by using paired t-test and Wilcoxon matched pair test. P < 0.05 was considered statistically significant. Go to:Results.The patients consisted of 11 women and 5 men. The mean age was 51.4 ± 19.5 (range 14 - 76) years. Patients were followed-up for mean 18.5 ± 10.2 (4 - 40) months. The mean subjective dry eye questionnaire score was 2.68 ± 3.98 points in operated eyes and 2.00 ± 2.63 points in control eyes. There was no significant difference between 2 groups (P = 0.54). There was no difference in the ST and TBUT scores before and after surgery in both operated and in the control eyes (P = 0.79, P = 1.00, respectively). The mean fluorescein and RBS scores, meibomian gland disease score and squamous metaplasia grading score of operated and non-operated eyes of each patient also showed no significant differences [Table 1]. Table 1Tear function and ocular surface examinationsAn impression cytology analysis showed no statistically significant change in goblet cell densities between operated and the control eyes (> 0.05).

Tratamento da ptose palpebral com emprego de retalho em asa do músculo orbicular / Eyelid ptosis treatment using bat flap of the orbicular muscle

Este trabalho foi realizado com o objetivo de demonstrar a possível utilização do músculoorbicular para o tratamento de ptose palpebral em casos em que não exista ação ou funçãodo músculo elevador das pálpebras, utilizando-se um retalho bipediculado do músculo orbicularpalpebral em sua porção superior em forma de “asa”, fixado à aponeurose inferiorsuperciliar do músculo frontal da face, tal avaliação foi realizada no período entre 1992 e2009.

The objetive of this scientific research was to demonstrate the possibility of use of theorbicular muscle in cases that function and action of the elevator muscle of the eylid doesnot exist, using a bipedicular flap of the orbicular muscle in its superior portion in formof a “wing” fixated to the inferior aponeurosis of frontal muscle in the supraciliar region.This study was performed between the years 1992 and 2009.

Treatment of severe congenital blepharoptosis with suspension by m. Frontalis / 眼科

26 eyes (16 cases) of severe congenital blepharoptosis were treated with direct suspension b m. Frontalis with satisfactory results. The procedure included separation of the skin and subcutaneous tissue through an incision at the eyelid fold upward to expose the tarsal plate and to reach m. Frontalis, from which a strip is isolated to be sutured to the front surface of the tarsal plate at a proper level, so as to provide effective forceful suspension without inducing deformity, entropiou or ectropion of the eyelid.