A quantitative approach to shortening the levator palpebrae superioris to correct congenital ptosis in children / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To develop a feasible method to correct congenital ptosis in children.<p>METHODS: Sixty-four patients(102 eyelids)were divided into three groups based on the degree of ptosis: mild(<2 mm); moderate(3-4 mm)and severe(>4 mm). All patients underwent the same levator resection surgery in which the suspensory system of the LPS is retained. After capturing a standard photograph of primary position, the height of the superior palpebral margin was measured preoperatively by using Image J software to calculate its ideal height required during surgery. Postoperative outcome measures included upper eyelid margin height, degree of scleral exposure and exposure keratitis. The patients were followed-up at 1wk, 1mo and 6mo postoperatively.<p>RESULTS: In the early postoperative period, except two cases with overcorrection, the positions of the eyelid upper margins were normal in all cases in the mild and moderate groups. Six months postoperatively, the eye with overcorrection in the moderate group showed improvement, while the eye in the mild group did not. Seven eyes in the severe group exhibited residual ptosis to varying degrees. The eyelids exhibited appropriate closing functionality; exposure keratitis was absent.<p>CONCLUSION:Using this preoperative quantification technique to guide surgery not only provided a gauge for LPS shortening under general anesthesia, but also increased the success rate of surgery.

Relationship between Palpebral Fissure Height and Corneal Astigmatism of Epiblepharon

PURPOSE: To study the effect of plapebral fissure height on astigmatism in epiblepharon patients. METHODS: The study consisted of 68 eyes of 34 patients who were diagnosed with epiblepharon and 88 eyes of 44 patients who had normal eyelids from September 2012 to July 2013. Data on palpebral fissure height and refractive errors were compared between the epiblepharon group and the control group. Epiblepharon patients were further divided into two subgroups depending on the degree of preoperative corneal erosion in order to study the effects of corneal erosion on corneal astigmatism. RESULTS: The mean age was 5.6 ± 2.2 years in the epiblepharon group and 6.1 ± 1.5 years in the control group (p = 0.339). The mean astigmatism was 2.28 ± 1.54 D in the epiblepharon group and 0.91 ± 1.07 D in the control group. The epiblepharon group showed higher astigmatism than the control group (p < 0.001). The mean palepebral fissure height was 6.70 ± 1.19 mm in the epiblepharon group and 7.63 ± 1.06 mm in the control group. The epiblepharon group exhibited smaller palpebral fissure height than the control group (p < 0.001). In the palpebral fissure height subgroups of the epiblepharon group, the <7.0 mm group showed higher astigmatism than the ≥7.0 mm group (p = 0.026). Higher astigmatism was associated with smaller palpebral fissure height (p = 0.022). CONCLUSIONS: Patients with epiblepharon had significantly higher corneal astigmatism, and higher astigmatism was associated with smaller palpebral fissure height.

Comparison of Palpebral Fissure Height According to Horizontal

We compared palpebral fissure height according to horizontal fixation direction in normal subjects, strabismic patients[exotropia, esotropia, abducens nerve palsy], and patients with Duane's retraction syndrome. We respectively measured the palpebral fissure height of 39 normal subjects [78 eyes], 37 exotropia patients[74 eyes], 17 esotropia patients[34 eyes], 6 patients of abducens nerve palsy[6 eyes], and 8 patients with Duane's retraction syndrome[12 eye]. Measurements were obtained from standardized photographs in primary position, 30-degree adduction and abduction and maximum adduction and abduction of both eyes. The palpebral fissure height of normal subjects and exotropia patients was maximal in primary position and minimal in maximum adduction and abduction. On the other side, the palpebral fissure height of esotropia patients was maximal in 30 degree abduction. On the base of the height in primary position, the fissure height of normal subjects was 90%in maximum abduction and 89%in maximum adduction. But the fissure height of Duane's retraction syndrome was 103%in maximum abduction and 69%in maximum adduction. In normal group and exotropia, the fissure narrowed according to the degree of adduction and abduction, and in esotropia and abducens nerve palsy, the palpebral fissure of abducting eye was wider than that of primary position. In Duane's retraction syndrome the palpebral fissure of adducting eye markedly narrowed and the difference between the fissure height in maximum adduction and maximum abduction made diagnostic value in comparison to normal group.