Combination of conjoint fascia sheath suspension and levator palpebrae superioris shortening for treatment of congenital severe blepharoptosis / 中华医学美学美容杂志

Objective:To investigate the therapeutic effect of conjoint fascia sheath suspension and levator palpebrae muscle shortening on congenital severe blepharoptosis.Methods:From June 2014 to December 2018, 30 cases (40 eyes) of congenital severe ptosis were treated in Ningbo First Hospital and Shaoxing Women and Children＇s Hospital. All patients were corrected by conjoint fascia sheath suspension and levator palpebrae muscle shortening. Six months after operation, the distance between the middle point of upper eyelid margin and corneal reflex point was measured to evaluate the correction effect of blepharoptosis; the improvement of upper eyelid appearance was evaluated by 5-point Likert scale (LS), and the incidence of complications was counted.Results:Thirty patients (40 eyes) were followed up for 6-12 months. Correction effect showed that preoperative marginal reflex distance (MRD) was (0.10±0.05) and postoperative MRD was (3.80±0.55); the difference was statistically significant ( t=0.95, P<0.05); 38 eyes (95%) were corrected and 2 eyes (5%) were undercorrected; appearance of upper eyelid showed that preoperative LS was (0.50±0.05) and postoperative LS (3.80±0.55); the difference was statistically significant ( t=0.98, P<0.05). Only one case was complicated with keratitis caused by improper early nursing after incomplete closure exposure, and the patient was cured by sealing the eyes combined with drug conservative treatment. Conclusions:Combined conjoint fascial sheath suspension and levator palpebrae shortening in the treatment of severe blepharoptosis has significant effect, with the advantages of simple operation, small surgical trauma, low recurrence rate, low incidence of complications, high predictability of surgical results and high satisfactory rate of patients.

Efficacy of conjoint fascial sheath and frontalis muscle flap suspension in treatment of congenital severe blepharoptosis: a systematic review and meta-analysis / 中华医学美学美容杂志

Objective:To evaluate the efficacy of combined fascia sheath suspension (CFS) and frontalis muscle flap suspension in the treatment of severe congenital blepharoptosis.Methods:We searched PubMed, EMbase, Cochrane Library, web of science and Chinese Hownet, Wanfang, VIP, CBM and other databases to collect randomized and non-randomized controlled trials comparing the efficacy of CFS and frontalis muscle flap suspension in the treatment of severe congenital ptosis, from the establishment of literature retrieval database to March 2020; two researchers used RevMan 5.3 software to select and exclude the literature, extract the data and evaluate the quality, set up appropriate effect index and conduct Meta-analysis.Results:Eleven studies included 661 patients, There were 312 cases in study group and 349 cases in control group. The results of Meta analysis showed that the OR of the two groups was 4.88 with 95% CI (2.69, 8.85); the OR of failure rate was 0.20, with 95% CI (0.11, 0.37); the OR of complications was 0.22, with 95% CI (0.14, 0.34). All three groups of data were statistically significant ( P<0.05). Conclusions:The available evidence shows that the combined fascia sheath suspension (CFS) is effective in the treatment of severe congenital blepharoptosis compared with frontalis muscle flap suspension, but the complications of CFS are lower and the satisfaction is higher; these findings have yet to be validated by more high-quality studies due to limitations in the quality and quantity of studies included.

Clinical effects of conjoint fascial sheath suspension and frontalis muscle flap suspension in correction of severe blepharoptosis: a Meta-analysis / 中华医学美学美容杂志

Objective:To evaluate the clinical effects of conjoint fascial sheath suspension and frontalis muscle flap suspension in correction of severe blepharoptosis.Methods:The databases of China National Knowledge Infrastruction (CNK), WANGFANG DATA, VIP, PubMed, Cochrane Library and Web of Science (SCIE) databases were searched. All relevant studies were collected from February 2002 to April 2019, and the clinical effects of conjoint fascial sheath suspension and frontalis muscle flap suspension in correction of severe blepharoptosis were studied. The correction effective rate, complication rate and recurrence rate between two operations were Meta analyzed.Results:A total of seven randomized controlled trial studies including 387 eyes of 315 patients were subject to final analysis. The conjoint fascial sheath suspension group had 158 patients (192 eyes) and frontalis muscle flap suspension group had 157 patients (195 eyes). The results showed that the correction effective rate of conjoint fascial sheath suspension was higher than frontalis muscle flap suspension. There were statistically significant difference between the two groups ( P<0.05). The rate of complication and recurrence were lower. There were statistically significant difference between the two groups ( P<0.05). Conclusions:The clinical effects of conjoint fascial sheath suspension are better than frontalis muscle flap suspension in correction of severe blepharoptosis.

Conjoint fascial sheath suspension in treatment of severe blepharoptosis caused by inadequate suspension system tension / 中华医学美学美容杂志

Objective:To evaluate the safety and efficacy of conjoint fascial sheath (CFS) suspension surgery for severe blepharoptosis caused by low-tension suspension system.Methods:A total of 62 cases with severe blepharoptosis caused by low-tension suspension system received CFS suspension correction surgery from September 2014 to September 2017 were collected and followed up with a range of 12-36 months. The MRD-1, curve of upper eyelid, appearance and complications were recorded and underwent statistical analysis to evaluate the effect based on functionality, aesthetics and complication.Results:The postoperative MRD-1 was + 1 mm ~+ 4 mm compared with preoperative -3 mm ~+ 1 mm. The difference in the mean change was statistically different ( t=5.893, P<0.05). The satisfactory rate was 92.1% (82 cases), 7.9% (7 cases) were improved, and no case was invalid. There were no cases of recrudescence. Conclusions:Severe blepharoptosis can be caused by the inadequate tension of the upper eyelid suspension system. Laxity and abnormality of fixed structures may be major cause of decreasing levator aponeurotic tone. CFS suspension prevents further damage to the previous fixed structures, so it should be the first choice for such cases.

Effect of shortening of levator palpebrae complex on combined fascial sheath suspension in severe blepharoptosis / 中华医学美学美容杂志

Objective:To explore the treatment of levator complex in conjoint fascial sheath suspension correction on severe ptosis, and to seek a reliable and less complications operation.Methods:From October 2016 to February 2020, 40 eyes of 24 patients with severe ptosis (6 males and 18 females, aged from 10 to 73 years, with an average of 34.4 years) were divided into study group and control group. 20 eyes in study group were treated with combined fascia sheath suspension and levator palpebrae muscle complex tension-free shortening correction, while 20 eyes in control group were treated with combined fascia sheath suspension and levator palpebrae muscle complex tension-free shortening correction The effects and complications of the two groups were compared.Results:Follow-up studies were conducted at 1 week, 3 month and 6 months after operation. There was no significant difference between the two methods at different time points after operation, and the incidence of complications in the study group was less than that in the control group at 1 week after operation.Conclusions:Combined with fascial sheath suspension and levator palpebrae muscle complex tension-free shortening in the treatment of severe blepharoptosis has less complications and reliable curative effect in the early postoperative period, but it still needs to be improved to obtain more lasting curative effect.

Treatment of recurrent severe blepharoptosis after frontal muscle flap suspension and levator palpebrae superioris shortening with conjoint fascia sheath suspension / 中华医学美学美容杂志

Objective@#To investigate the clinical effect of conjoint fascial sheath (CFS) suspension to correct the complications caused by the frontal muscle flap suspension and levator palpebrae superioris shortening in the treatment of severe blepharoptosis.@*Methods@#From February 2017 to April 2018, 19 severe blepharoptosis patients (21 eyelids) were operated before by the frontal muscle flap suspension and levator plapebrae superioris shortening, and repaired through the technology of CFS suspension.@*Results@#There were 19 cases, 17 cases operated by CFS suspension showed a good appearance and basically symmetrical of two eyes, and the other 2 cases obtained satisfactory results though reoperation. There were no complications of exposure keratitis, ectropion and infection occurred. Meantime the effect was satisfactory according to the follow-up ranging from 3 months to 12 months.@*Conclusions@#The application of conjoint fascial sheath (CFS) suspension shows a promising procedure in the treatment of severe blepharoptosis caused by the frontal muscle flap suspension and levator palpebrae superioris shortening.

The clinical analysis of conjoint fascial sheath suspension on the treatment of severe blepharoptosis after levator muscle resection / 中华整形外科杂志

Objective@#To evaluate the safety and efficacy of Conjoint Fascial Sheath (CFS) suspension in the treatment of severe blepharoptosis, after levator muscle resection.@*Methods@#In total of 336 patients with severe blepharoptosis after levator muscle resection, received CFS suspension from December 2010 to December 2016 in Beijing Lomeye Cosmetic Surgery Clinic. They were followed up for 12—60 months.The margin reflex distance, curve of upper eyelid, appearance and complications were recorded preoperatively and postoperatively. The outcome was evaluated based on function, aesthetics and complication.@*Result@#Functional satisfaction assessment: In the 495 eyes of 336 patients, 426 eyes (86.1%) were completely corrected, 65 eyes (9.1%) were improved, while 4 eyes (0.8%) had no improvement. One patients had conjunctival edema, recovered after conservative treatment. There was no serious complication.@*Conclusions@#CFS suspension is an effective method for severe blepharoptosis after levator muscle resection, with advantages of repeatability and feasibility, less trauma and predictable outcome.

Clinical analysis of conjoint fascial sheath suspension in treatment of severe blepharoptosis / 第二军医大学学报

ObjectiveTo evaluate the clinical effect of conjoint fascial sheath (CFS) suspension in treatment of severe blepharoptosis. Methods A total of 43 patients (68 eyes) with severe blepharoptosis were treated with CFS suspension in Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jul. 2016 to Sep. 2018. The clinical data of the 68 eyes with severe blepharoptosis were retrospectively analyzed. The correction effect of this method was evaluated by the margin reflex distance (MRD1) and its improvement, the radian of eyelid margin, the shaping of double eyelid line and complications. The patients were followed up for 3-12 months. Results Blepharoptosis was effectively corrected after CFS suspension. Three months after operation, MRD1 was improved by (3.84±0.55) mm and blepharoptosis was significantly improved versus before operation (P<0.01). According to MRD1 improvement, 66 eyes (97.06%, 66/68) were satisfactory and 2 eyes (2.94%, 6/68) were improved, with the upper eyelid margin being symmetrical and the radian being natural. The upper eyelid regained part of the movement one week after operation; and 3 months after operation, all patients could completely close the eyes. There were few postoperative complications: 2 cases had exposed keratitis in the early stage, which was cured after drug treatment; and there were no other complications such as eyelid ectropion, trichiasis, eye movement disorder, or diplopia. Conclusion CFS suspension is effective for correction of severe blepharoptosis, with the advantage of good appearance, natural activity, minor trauma, easy repetition, less complications, and high satisfaction rate with curative effect, and it is worth popularizing in clinic.

The clinical analysis of conjoint fascial sheath suspension on the treatment of pediatric congenital moderate-severe ptosis / 中华整形外科杂志

Objective@#To investigate the functional and cosmetic outcomes of conjoint fascial sheath(CFS) suspension surgery in pediatric congenital ptosis.@*Methods@#Forty-four moderate to severe ptosis patients(58 eyes) underwent CFS suspension surgery from December 2013 ot December 2014. With 12 to 36 months follow-up, the levator function, margin reflx distance, curve of upper eyelid, appearance and complications were recorded and analyzed, to evaluate the effect based on functionality, aesthetics and complication.@*Results@#①Functional assessment: in the 58 eyes of 44 cases, the satisfactory rate was 91.4%(53 eyes), 2 eyes(3.45%)were under—corrected, 3 eyes(5.17%) were over corrected. The mean preoperatively LF was 2.5 mm, which was increased postoperatively to 6.1 mm at the final visit.The average marginal reflex distance (MRD) was 0.1 mm preoperatively. After at least one year, average MRD was 3.8 mm (P<0.05). ②Cosmetic satisfaction assessment: According to satisfaction surveys, the rate of excellence and good was 88.64%, 6.81% fair, and 4.54% poor. ③Complications: the most common complication was reoperation, which was performed in 2 eyelids (3.45 %) because of incomplete correction and 3 eyes(5.17%) over corrected. Only one case of cornea exposure which recovered after conservative treatment.@*Conclusions@#CFS suspension was an effective treatment for moderate-severe congenital ptosis, showing good long term result.

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.

Clinical effects of CFS-based surgical correction approaches of blepharoptosis with minimally invasive treatment / 中华医学美学美容杂志

Objective To explore a simple and effective way to correct mild and moderate blepharoptosis,and also to analyze the causes and precautions for postoperative complications.Methods The degree of blepharopotsis was evaluated and mild to moderate patients were selected.Under local anesthesia,a suture with two needles was suspended horizontally under the conjunctiva at the position of CFS in the upper fornix of conjunctiva.The needles went through the tissue between the levator palpebrae muscle and Müller's muscle and went out at the same point of conjunctival surface at the upper edge of the tarsal plate.The needles were pierced again from the original point,went through the entire eyelid and then went out at the small incision on the skin surface,then the two ends of the line were tied knot,and the knot was buried in the subcutaneous tissue.In this way,blepharoptosis was corrected and no obvious wound and knot were found.Results 21 cases (31 eyes) were followed up for more than 6 months;18 cases (27 eyes) were completely corrected,2 cases (3 eyes)were improved and 1 case was ineffective.The effective rate was 96.77 ％,and the satisfactory rate was 87.1％.Conclusions Minimally invasive blepharoptosis correction from CFS power source is a minimally invasive surgery that is worth popularizing because of its ideal effect and rapid recovery.

Clinical efficacy of conjoint fascial sheath of the levator and superior rectus attached to conjunctival fornix suspension surgery in treatment of severe blepharoptosis / 中华医学美学美容杂志

Objective To investigate the clinical efficacy of conjoint fascial sheath (CFS) of the levator and superior rectus attached to the conjunctival fornix suspension surgery and the modified frontails muscle suspension in the treatment of severe blepharoptosis.Methods There were 15 eyes of 11 patients in the group with CFS suspension and 12 eyes of 10 patients in the other group with frontails muscle suspension.Follow-up was conducted for 1 week to 6 months.The surgical results were compared with statistical analysis.Results Among the patients 2 cases of palpebral fissure was closed poorly,1 cases of upper eyelid had poor shape,4 cases of upper lid was lag,2 cases of recurrence in group with modified frontails muscle suspension,and compared with 1 case of less straightening phenomenon in the group with CFS suspension.All the others,palpebral fissures were completely closed,the appearance of double eyelid was good,with no exposure keratitis.In terms of postoperative curative effect in 6 months observation,group with CFS suspension had less complications and was of advantages in the symmetry of upper eyelid fissure.The effect of correction post operation and upper eyelid back amount in the group with CFS suspension were better than those with the frontails muscle suspension in 6 months.There was significantly statistical difference.Conclusions The surgery with CFS suspension is of advantages of aesthetic appearance,high security,natural look,high satisfaction from patients,less complications and more in line with the physiology,which is worthy of clinical reference.

Comparative study on conjoint fascial sheath suspension and the simple frontalis muscle suspension for moderate or severe ptosis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the curative effect of conjoint fascial sheath suspension and the simple frontalis muscle suspension for moderate or severe ptosis.METHODS:In March 2013 to March 2016 in our hospital, 46 patients with moderately severe ptosis(68 eyes) were taken as the research objects.According to random number table method, they were divided into study group and the control group, 23 cases in each group.Study group(34 eyes) received the joint fascial sheath suspension (CFS), the control group(34 eyes) received frontalis muscle suspension.The degree of ptosis correction, upper eyelid retracted, satisfaction and complications of two groups were compared.RESULTS:The corrected rate of the treatment group was higher than that of the control group, the difference was statistically significant (P<0.05).After treatment, the upper eyelid retracted of the study group was significantly lower than that of the control group, the difference was statistically significant (P<0.05).The satisfaction of the treatment group was higher than that of the control group, the difference was statistically significant (P<0.05).The incidence of complications in the study group was significantly less than that in the control group, and the difference was statistically significant (P<0.05).CONCLUSION:Conjoint fascial sheath suspension is more effective on the treatment of severe ptosis than the simple frontalis muscle suspension, and has advantages such as less trauma, repeatable, and less complication.

Comparative study on conjoint fascial sheath suspension and levator muscle resection for moderate or severe congenital ptosis / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM:To compare the curative effect of conjoint fascial sheath( CSF) suspension and levator muscle resection for moderate or severe congenital ptosis.?METHODS: Forty - three patients ( 74 eyes ) with moderate or severe ptosis were treated by CSF suspension or levator muscle resection randomly, and followed up for 6mo. The normalization rates of the two operations were then compared by statistical method, and the complications of the two operations were analyzed.?RESULTS: The two operations appeared no significant difference on the normalization rate for moderate congenital ptosis (P>0. 05), while the normalization rate of CSF suspension on severe congenital ptosis was significantly higher than that of levator muscle resection (P<0. 05). Less complication was happened in the CSF suspension group than in the levator muscle resection group.?CONCLUSION:CSF suspension is more effective on the treatment of severe congenital ptosis than levator muscle resection, and has advantages such as less trauma, repeatable, and less complication.