Orbital septum attachment site on the levator aponeurosis sling for mild congenital blepharoptosis.

PURPOSE: This study aimed to investigate the value of the orbital septum attachment site on the levator aponeurosis (OSASLA) sling in correcting mild congenital blepharoptosis. METHODS: A total of 60 patients (92 eyes) with mild congenital blepharoptosis (levator function ≥ 8 mm) were treated in our hospital from January to October 2021, and relevant data of these patients were collected. All patients underwent OSASLA sling for ptosis correction. The distances from the superior tarsal border to the OSASLA were measured. The primary outcome was the number of postoperative changes in the marginal reflex distance 1 (MRD1). Pearson's correlation coefficient between the distance from the superior tarsal border to the OSASLA and the height of the upper eyelid elevated was analyzed. RESULTS: Fifty-eight patients (89 eyes) successfully underwent OSASLA sling surgery. The preoperative MRD1 was 1.4-3.6 mm (mean 2.1 ± 0.5 mm), and the postoperative MRD1 was 3.4-5.0 mm (mean 3.7 ± 0.6 mm). The distance from the superior tarsal border to the OSASLA sling was significantly and positively correlated with the height of the upper eyelid elevation (r = 0.7328, P < 0.0001). The eyelid margin positions of the patients did not regress substantially during 6-18 months of follow-up. CONCLUSIONS: Compared with the shortening of levator palpebrae superioris (LPS) and pleating of LPS, the OSASLA sling is a less invasive, more effective, and easy-operating surgery for mild congenital blepharoptosis.

Modified conjoint fascial sheath suspension for the correction of severe congenital blepharoptosis in pediatric patients at different ages.

Objective: To evaluate the surgical outcomes of modified combined fascia sheath (CFS) and levator muscle (LM) complex suspension for the correction of severe congenital blepharoptosis in pediatric patients. Methods: Pediatric patients with severe congenital blepharoptosis were enrolled form July 2017 to July 2021. All patients were divided into two groups according to their age (group A ≤ 7 years; group B > 7 years) and received CFS + LM suspension surgery. Main surgical outcome indexes include margin reflex distance 1 (MRD1) and MRD1 regression. Postoperative complications such as lagophthalmos (LAG), conjunctival prolapse, exposure keratopathy and trichiasis were documented. Results: Fifty patients (60 eyes) were enrolled, including 17 patients (18 eyes) in group A and 33 patients (42 eyes) in group B. The MRD1 in group A was 3.06 ± 0.64 mm at 6 months after the operation, and the MRD1 in group B was 2.64 ± 0.69 mm 6 months postoperatively which is significantly lower than that of group A (P = 0. 044). At the last visit, however, the MRD1 in group A was 3.00 ± 0.69 mm and the MRD1 in group B was 2.64 ± 0.70 mm. There was no significant difference in MRD1 between two groups in long term (P = 0.255). Additionally, there were a variety of degrees of MRD1 regression, especially in the first month after the operation in both groups (both P < 0.001). Moreover, there were 9 cases of postoperative complications in group A and 13 cases in group B. The overall occurrence of postoperative complications in group A was significantly lower than that in groups B (χ 2 = 4.413, P = 0.036). Conclusions: CFS + LM suspension, a modified CFS-based surgery, is an effective treatment for severe congenital blepharoptosis in pediatric patients. Moreover, CFS + LM suspension demonstrate excellent long-term outcomes, including good movement of the eyelid, satisfied eyelid closure and fewer postoperative complications.

Research on the expression of elastin in the conjoint fascial sheath for the correction of severe unilateral congenital blepharoptosis.

BACKGROUND: To investigate the expression of elastin in the conjoint facial sheath (CFS) in patients with severe unilateral congenital blepharoptosis in different age groups. METHODS: Twenty-seven cases of severe unilateral congenital blepharoptosis (27 eyes) were treated with CFS + LM complex suspension from January 2020 to July 2020. Within that sample, 9 patients were over 18 years old, 9 patients were 13 to 17 years old and 9 patients were 5 to 12 years old. CFS and LM specimens were collected during CFS + LM complex suspension surgery. In the CFS specimens, the elastic fibers were observed by Victoria Blue staining. The elastin expression levels of the three groups of specimens were determined and analyzed by immunofluorescent staining and Western blotting. RESULTS: Victoria Blue staining showed that elastic fibers were abundant in CFS tissue. Moreover, immunofluorescent staining showed strong positive expression of elastin in the CFS and LM. Furthermore, in the child group, the Western blot results demonstrated that the expression of elastin was higher in the CFS than in the LM (P < 0.05). Additionally, the expression of elastin was significantly higher in the CFS of children than in that of adults or adolescents (P < 0.001). CONCLUSIONS: The CFS and LM are rich in elastic fibers and elastin, although elastin expression in the CFS decreases with age. Thus, it is feasible to apply CFS + LM complex suspension to cure severe unilateral congenital blepharoptosis.

Long-term outcome of refractive errors in patients with congenital blepharoptosis who have undergone ptosis surgery.

CLINICAL RELEVANCE: Ptosis surgery induces some changes in pre-existing refractive errors and astigmatism. Monitoring refractive outcomes, planning of vision rehabilitation, and amblyopia treatment may be required following ptosis surgery. BACKGROUND: The few studies published on the outcomes of refractive error after ptosis surgery have been controversial. The aim of this study was to evaluate long-term outcomes of refractive error in patients with congenital blepharoptosis who had undergone ptosis surgery. METHODS: Patients with congenital blepharoptosis who had undergone ptosis surgery were enrolled in the study. Data on pre- and post-operative refractive errors, marginal reflex distance 1 (MRD1), and levator function were obtained. The data from fellow eyes were used as the control. RESULTS: The mean patient age of patients undergoing ptosis surgery was 19.8 ± 8 years. The mean follow-up time (time between the operation and post-up measurements) was 4.7 ± 2.1 years with a range of 2-10 years. There were no significant differences in mean refractive changes, being 0.53 ± 0.40D vs. 0.36 ± 0.45D in sphere (p = 0.19) and 0.48 ± 0.56 vs. 0.30 ± 0.23 in cylinder (p = 0.17) in operated and control eyes, respectively. Astigmatism change was, however, significantly higher in the operated eyes with an MRD1 change of ≥2.5 mm (0.84 ± 0.66 vs. 0.27 ± 0.39, p = 0.024). The changes in astigmatism in the operated eyes had a significantly positive correlation with the changes of MRD1 (r = 0.497, p = 0.019). Vectorial analysis showed no significant difference between the changes in astigmatism of the operated and control eyes (0.58 *48º vs. 0.45*53º, respectively). CONCLUSION: Spherical power of the eyes of patients with congenital ptosis who undergo ptosis surgery does not change. A significant change in astigmatism can be anticipated in eyes with more than 2.5 mm change in MRD1. There is an association between change in astigmatism and MRD1 following ptosis surgery.

Incidence of congenital heart diseases in Chinese children with non-syndromic congenital blepharoptosis: a prospective observational study of 1053 patients.

BACKGROUND: Congenital blepharoptosis (CBP) may be part of a large spectrum of birth defects presenting with other ocular or systemic conditions. Therefore, the aim of the study was to investigate the incidence of congenital heart diseases (CHD) in CBP children not associated with specific syndromes. METHODS: A total of 1053 Chinese children diagnosed with non-syndromic CBP were consecutively enrolled and their cardiac structure was evaluated by echocardiography. RESULTS: Forty children were identified with CHD. Twenty-four children had one type of structural malformation (simple CHD). Sixteen children had two or more types of structural malformation (complex CHD). CHD and complex CHD were more prevalent in patients with severe or bilateral ptosis. Multivariate analysis revealed that presence of severe ptosis and bilateral ptosis was independently associated with CHD occurrence. CONCLUSIONS: We found an increased frequency of CHD in CBP children, suggesting a clinical need for routine echocardiography evaluation in CBP, especially in children with severe or bilateral ptosis.

A New Surgical Technique Used for Correction of Congenital Blepharoptosis.

BACKGROUND: Blepharoptosis is defined as the drooping or lower displacement of the upper eyelids. Various kinds of surgical techniques and modifications have been introduced to improve the surgical outcomes, but the high recurrence rate and unsatisfying cosmetic results remain as a common problem. PURPOSE: To solve the problem mentioned above, we came up with our new surgical technique and conducted a retrospective review to verify its effectiveness. PATIENTS AND METHODS: A retrospective review was conducted among the patients diagnosed as genuine congenital blepharoptosis and receiving the surgical treatments where our unique technique was used between January 2016 and January 2019. The clinical records and preoperative and postoperative photographs were collected and evaluated. RESULTS: A total of 83 patients were included in our study, 78 (94%) of them acquired good surgical outcomes, while 4 (4.8%) of them got fair results, and 1 (1.2%) of them got a poor result. No long-term lagophthalmos, ectropion, entropion and fornix conjunctival prolapse were noted. CONCLUSIONS: Our surgical technique introduced here is effective in the management of genuine congenital blepharoptosis. LEVEL OF EVIDENCE III: For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Physiological correction of mild to moderate congenital blepharoptosis: A retrospective cohort study involving 97 Eastern Asian patients.

BACKGROUND: Conventional blepharoptosis repair methods distort the normal anatomy of levator aponeurosis and often cause a visible depressed scar in the upper eyelid. METHODS: The levator aponeurosis was dissected as a flap from the pretarsal tissue in mono-eyelid Asian patients who had mild to moderate congenital blepharoptosis. The flap base was advanced and repositioned on the tarsus. The margin of the distal flap was interposed and fused with orbicularis oculi muscles. Postoperative evaluation included ptosis correction, symmetry, and overall cosmetic outcomes. RESULTS: A total of 162 eyes on 97 patients were corrected using our method. Follow-up time ranged from 8 to 24 months (mean 12.4). In mild ptosis eyelids, out of 58 eyelids, 36.2% (21 eyelids), 56.9% (33), and 6.9% (4) required adequate correction, normal correction, and undercorrection, respectively, whereas in moderate ptosis, the results were 34.6% (36 eyelids), 53.9% (56), and 11.5% (12), respectively. For symmetry, 58.8% (57 cases), 32.0% (31), and 9.2% (9) resulted in good, fair, and poor outcomes, respectively. For cosmetic outcomes, 82.8% (48 eyelids), 15.5% (9), and 1.7% (1) of mild ptosis cases achieved good, moderate, and poor results in mild ptosis cases, whereas the results were 77.9% (81 eyes), 20.2% (21), and 1.9% (2), respectively, in moderate ptosis cases. The only complication among all cases was postoperative swelling. CONCLUSIONS: We presented a new blepharoplasty for ptosis repair that allows both satisfactory ptosis correction and cosmetic outcomes in mild to moderate congenital blepharoptosis.

Modified suture suspension by annular ligature the frontalis muscle to correct severe congenital blepharoptosis in very young patients / 中华整形外科杂志

Objective@#To explore the effect of the modified suture suspension by annular ligaturing the frontalis muscle to treat severe congenital blepharoptosis in children (age≤3).@*Methods@#From October 2016 to October 2017, 11 patients (16 eyes) with severe blepharoptosis were treated using the modified suture suspension in the Affiliated Hospital of Weifang Medical University. There were 7 males and 4 females, aged from 1 to 3 years old, with the average of 26.3 months. Three suture lines were used in three directions respectively. One end was fixed to the upper edge of the tarsus, the other end was fixed to the frontalis muscle by annular ligation. The operation effect and complications were evaluated 1 week and 6 months after the operation.@*Results@#All the incisions healed well. Hypophasis was observed in 1 eye. The exposed palpebral fissure was less than 3 mm when the eye was closed. No corneal exposure was observed in other cases. One week after surgery, the blepharoptosis of 5 patients were fully corrected (6 eyes, 37.5 %). Blepharoptosis in 5 patients were basically corrected (9 eyes, 56.2 %). One patients was over corrected (1 eyes, 6.3%). Six months after surgery, the blepharoptosis of 5 patients were fully corrected (5 eyes, 31.2 %). Blepharoptosis in 5 patients were basically corrected (9 eyes, 56.3%). However, the blepharoptosis of 1 patient was under corrected (2 eyes, 12.5%).@*Conclusions@#This modified suture suspension by annular ligature the frontalis muscle has the advantages of simple operation, low cost, stable effect, small wound, and satisfactory clinical effect.

The inflammation influence on corneal surface after frontalis suspension surgery.

AIM: To study the influence of frontalis muscle flap suspension on ocular surface by analyzing the clinical features and inflammatory cytokines. METHODS: A prospective, observational case series. Thirty-one eyes of 25 patients with severe congenital blepharoptosis who underwent frontalis muscle flap suspension surgery with at least 6mo of follow-up were included in the study. The main outcome measures were margin reflex distance 1 (MRD1), degree of lagophthalmos, ocular surface disease index (OSDI), fluorescein staining (Fl), tear break-up time (BUT), Schirmer I test, and inflammatory cytokine assay. RESULTS: The degrees of lagophthalmos significantly increased after surgery. The OSDI scores significantly increased 1wk postoperatively and then decreased 4wk after operation. The Fl scores reflected corneal epithelial defects in sixteen patients at early stage postoperatively. The BUT and Schirmer I test values remained stable and did not show change compared to those before surgery. The inflammatory cytokines in conjunctival epithelial cells (including IL-1ß, IL-6, IL-8, TNF-α, and IL-17A) significantly increased 1wk after the surgery (P<0.001), then returned to the normal level at 24wk postoperatively. The levels of inflammatory cytokine IL-1ß, IL-6, IL-8, TNF-α, and IL-17A elevated significantly and were positively correlated with OSDI and Fl scores. CONCLUSION: Frontalis muscle flap suspension surgery results in lagophthalmos in early period of post-operation and relieved after months. The elevation of inflammatory cytokines level may participate in the occurrence of corneal epithelial defects at the early postoperative stage.

Long-term functional and aesthetic evaluation of using a single rhomboid-shaped fascial strip for severe congenital unilateral blepharoptosis.

PURPOSE: Surgery for congenital blepharoptosis is often performed at approximately 4-5 years of age. A long-term follow-up is important during facial growth. We performed frontal suspension by using a single rhomboid-shaped autogenous fascial strip. We conducted a long-term evaluation of patients with severe congenital unilateral blepharoptosis. PATIENTS AND METHODS: A total of 334 patients with congenital blepharoptosis underwent surgery between 1994 and 2006. Of these, 192 patients had unilateral blepharoptosis with levator function less than 3 mm. A retrospective analysis was conducted on those patients who could be followed up postoperatively for at least 10 years and had accurate clinical photographs available. Visual acuity, palpebral fissure height (PFH), and marginal reflex distance (MRD) were evaluated from the photographs to compare both eyes. PFH and MRD were assessed as ratio. Morphological evaluation was based on patient and family comments. Statistical analysis included the t-test. RESULTS: Participants comprised 95 patients (63 male and 32 female; 43 left and 52 right). Visual acuity showed improvements. Although the postoperative MRD ratio of the affected eye was significantly improved, no clinically significant bilateral difference was seen in postoperative PFH, compared with those in the unaffected side. The surgical results were as follows: 62 excellent, 14 good, 12 fair, 3 poor, and 4 other cases in our criteria. No major complications occurred. Satisfactory result could be seen in 76 of the 95 cases. CONCLUSION: The evaluation results show that our surgical procedure appears useful for patients with unilateral congenital ptosis. Moreover, blepharoptosis surgery is useful for improving visual acuity. In this paper, we report this surgical procedure and discuss its long-term results.

Evaluation of the complex treatment for congenital blepharoptosis.

OBJECTIVE: To evaluate the results of treatment of congenital blepharoptosis (CBP) using selected surgical methods; and to evaluate concomitant visual system disorders. METHODS: Between 2001 and 2010, 52 children with CBP underwent surgical correction of CBP using the modified method of Mustarde, the original Mustarde method or frontal suspension at the Department of Plastic Surgery, Medical University of Lodz (Poland). Based on the results of ophthalmic and orthoptic examination, and standard measurements, postoperative differences in the position and symmetry of the upper eyelids, complications, and visual system abnormalities were analyzed. RESULTS: Very good results were obtained in all patients with mild unilateral CBP. The results in patients with moderate and severe unilateral CBP, and in bilateral anomaly after correction using Mustarde's method or the modified Mustarde's method, were also very good. Complications included lagophthalmos (15.4%) and undercorrection (3.8%). Visual system disorders, mainly amblyopia, resulting from strabismus, astigmatism, anisometropia and CBP, were observed in 88.5% of patients. CONCLUSIONS: Complex ophthalmic examination and measurements in individuals with CBP enable correct diagnosis, selection of appropriate treatment method and timing of surgical intervention. Postoperative results in patients with CBP supported the efficacy of the methods that shortened the levator palpebrae superioris. Supplementing with Mustarde's modified method contributed to an increase in the number of favourable postoperative results.

OBJECTIF: Évaluer les résultats du traitement de la blépharoptose congénitale (BPC) à l'aide de certaines méthodes chirurgicales et évaluer les troubles du système visuel s'y associant. MÉTHODOLOGIE: Entre 2001 et 2010, 52 enfants ayant une BPC ont subi une correction chirurgicale au moyen de la méthode modifiée de Mustarde, de la méthode originale de Mustarde ou de la suspension aux muscles frontaux au département de chirurgie plastique de l'université médicale de Lodz, en Pologne. D'après les résultats de l'examen ophtalmique et orthoptique et les mesures standards, les chercheurs ont analysé les différences postopératoires dans la position et la symétrie des paupières supérieures, les complications et les anomalies du système visuel. RÉSULTATS: Tous les patients ayant une BPC unilatérale bénigne ont obtenu de très bons résultats. Ceux dont la BPC unilatérale était modérée ou grave ou dont l'anomalie était bilatérale ont également obtenu de très bons résultats après correction par la méthode de Mustarde classique ou modifiée. La lagophtalmie (15,4 %) et la sous-correction (3,8 %) faisaient partie des complications. Les chercheurs ont observé des troubles du système visuel chez 88,5 % des patients, notamment l'amblyopie, causés par un strabisme, un astigmatisme, une anisométropie ou une BPC. CONCLUSIONS: Chez les enfants ayant une BPC, un examen ophtalmique approfondi et des mesures favorisaient un bon diagnostic, le choix de la méthode thérapeutique appropriée et la sélection du bon moment pour effectuer l'intervention chirurgicale. Les résultats postopératoires chez les patients ayant une BPC corroboraient l'efficacité des méthodes visant à raccourcir le muscle releveur de la paupière supérieure. L'ajout de la méthode modifiée de Mustarde contribuait à accroître le nombre de résultats postopératoires favorables.

Frontalis muscle transfer technique for correction of severe congenital blepharoptosis in Chinese patients: An analysis of surgical outcomes related to frontalis muscle function.

AIM: The aim of this study is to evaluate the surgical outcomes related to frontalis muscle function using the frontalis muscle transfer technique in Chinese patients with severe congenital blepharoptosis and poor levator function. MATERIALS AND METHOD: Between December 2003 and December 2011, using the frontalis muscle transfer technique, 37 patients of Chinese origin underwent surgery on 53 eyelids. The frontalis muscle function was assessed and categorized as poor (excursion ≤ 7 mm) and good (excursion > 7 mm) before the surgery. The results, including complications of the treatment procedure, were followed up and evaluated. Using the Cochran-Mantel-Haenszel statistic, the preoperative ptosis severity was compared with the degree of ptosis correction, and the preoperative frontalis muscle function was compared with the degree of ptosis correction using Fisher's exact test for paired data. A two-sided value of p < 0.05 was considered statistically significant. RESULTS: Of the total eyelids considered, sufficient postoperative correction of ptosis was achieved in 43 eyelids (81.1%), while the correction was insufficient in 10 eyelids (18.9%). Fifteen (28.3%) eyelids were either overcorrected (n = 5) or undercorrected (n = 10). The rate of lagophthalmos was 3.8%. Eyelids with preoperative frontalis muscle function >7 mm had a higher rate of sufficient correction in comparison to those with preoperative frontalis muscle function ≤7 mm (91.2% vs. 63.2%; p < 0.05). However, postoperative ptosis correction had no relationship with preoperative ptosis severity. CONCLUSION: The frontalis muscle is the main motor muscle used in the correction of severe blepharoptosis via the frontalis muscle transfer technique. Although the technique is considered to be an effective surgical method for the correction of severe blepharoptosis, the outcome of the correction procedure depends on the preoperative frontalis muscle function of the patient.

Tratamento de ptose palpebral congênita pela técnica de Lester Jones / Treatment of congenital ptosis by using the Lester Jones technique

A ptose palpebral ou blefaroptose caracteriza-se pela disfunção, ou inabilidade do paciente em realizar a abertura da fenda palpebral de maneira normal. Geralmente é decorrente do acometimento do músculo levantador da pálpebra; a forma congênita ocorre em 60% a 70%. No presente trabalho é descrito um caso de ptose palpebral congênita moderada em uma paciente de nove anos, com boa função do músculo levantador da pálpebra, em olho esquerdo. A paciente foi submetida a tratamento cirúrgico pela técnica de Lester Jones, indicada nos casos de ptose de grau moderado, apresentando um resultado estético e funcional satisfatório.

Palpebral ptosis or blepharoptosis is characterized by the dysfunction or inability of the patient to normally open the palpebral fissure. Usually, it is due to the involvement of the eyelid levator muscle. The congenital form occurs in 60%-70% of cases. In this study, we describe a case of moderate congenital palpebral ptosis in a 9-year-old patient who presented with a good eyelid levator muscle function in the left eye. The patient underwent surgical treatment with the Lester Jones technique, as indicated for cases of moderate ptosis, and achieved satisfactory aesthetic and functional results.

Is Hering's law as important in congenital blepharoptosis as in acquired ptosis?

BACKGROUND: Although Hering's law has significant importance in the planning and outcomes of eyelid surgery, it has not been applied in all cases of ptosis. OBJECTIVES: The authors evaluate whether cases of unilateral congenital ptosis require surgery on the contralateral eyelid, in keeping with Hering's law. METHODS: The records of 35 consecutive patients with unilateral congenital ptosis who had surgical repair between 2007 and 2012 were retrospectively analyzed. All patients underwent either levator resection or frontalis sling surgery. Preoperative and postoperative clinical documents and photographs were evaluated for each case, including preoperative Hering's dependence and postoperative measurements of the change in position of the nonoperated eyelid. RESULTS: There were 19 women and 16 men, and the average patient age was 9.7 ± 10 years. The mean preoperative levator function and marginal reflex distance were 6.7 ± 4.7 mm and 0.3 ± 0.47 mm, respectively. There were significant differences in age, preoperative levator function, and marginal reflex distance between patients who underwent levator resection and those who had frontalis sling surgery. In all patients, the preoperative Hering's dependence of eyelid position did not show any decrease, and the position of the contralateral eyelid postoperatively did not differ from the baseline position. CONCLUSIONS: This research shows that Hering's law does not apply to cases of congenital ptosis. This is likely due to the fibrotic levator palpebrae muscle and its special innervations. Thus, it is not necessary to perform levator resection or a frontalis sling operation on the unaffected eyelid.

Surgical Results of Levator Resection using the MLD (Margin Limbal Distance)in Congenital Blepharoptosis

In pediatric patients with congenital blepharoptosis, intraoperative decision of the amount of levator resection is difficult due to general anesthesia.We performed levator resection in 21 eyes of 17 patients with congenital blepharoptosis to evaluate the usefulness of the formula derived from the margin limbal distance (MLD)which was used to determine the amount of levator resection preoperatively. The amount of ptosis (interpalpebral fissure:IPF)was between 3.5 mm and 7.0 mm (mean 4.9 +/-1.2 mm), and less than 6.0 mm in 14 cases (66.4%).The levator function by Berke method was between 3.0 mm and 8.0 mm (mean 5.3 +/-1.7 mm), and between 5.0 mm and 8.0 mm in 13 cases (61.9%).The margin limbal distance was between 0 and 5.0 mm (mean 1.5 +/-1.4 mm), and less than 3.0 mm in 16 cases (76.2%).The amount of levator resection was between 10.0 mm and 22.0 mm, and between 16.0 mm and 18.0 mm in 10 cases (47.6%)which was most frequent. Of 4 patients (8 eyes)with bilateral blepharoptosis, excellent results (IPF > or= 8.0 mm)were achieved in 5 eyes (62.5%)and the other 3 eyes had fair results with IPF of over 6.0 mm.Three patients (75.0%)with bilateral blepharoptosis had symmetric IPF within 1.0 mm difference.In unilateral blepharoptosis, excellent results were achieved in 10 (76.9%)of 13 patients with IPF difference within 1.0 mm, and the other 3 patients had an IPF difference of 1.5 ~2.5 mm. The MLD formula gives the surgeon a good preoperative prediction of the amount of levator to resect, especially in pediatric patients with congenital blepharoptosis to undergo surgery under general anesthesia.

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.

A Clinical Study on Surgical Results of Frontalis Sling in Relation to the Operative Age

To evaluate and compare the efficacy of frontalis sling using fascia lata by the operative ages. Thirty-two congenital blepharoptosis patients(36 eyes)were divided into three groups: Group 1(below 2 years old, 12 eyes), Group 2(between 3 years and 5 years old, 14 eyes)and Group 3(over 6 years old, 10 eyes). Frontalis sling by double triangle of Crawford was performed with fascia lata, and were followed up for 1, 3 and 6 months. Success rate of frontalis suspension operation is graded as poor(below 1mm), fair(2 mm)and good(above 3 mm)based on MRD 1: In Group 1; 0%, 8.3%, 91.7%at 1 month, 16.7%, 33.3%, 50%at 3 months, 50%, 33.4%, 16.6%, at 6 months. In Group 2; 0%, 7.2%, 92.8% at 1 months, 0%, 14.3%, 85.7% at 3 months, 14.3%, 14.3% 71.4% at 6 months. n Group 3; only 10%had fair at 6 months, most had good results. There were congenital blepharoptosis combined with systemic disease and reoperations(2 cases) were done by with frontalis sling in only group 1. Therefore, it is suggested that the correction of congenital blepharoptosis be delayed until the child is 3-5 or above 6 years old, if the incidence of amblyopia is small.