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PURPOSE To evaluate the efficacy of Muller's muscle-conjunctival resection combined with tarsectomy for the treatment of congenital ptosis. METHODS A retrospective, noncomparative case series was performed on 38 eyes of 36 patients who underwent Muller's muscle-conjunctival resection combined with tarsectomy for the treatment of congenital ptosis. Age range was 2-25 years (mean: 7.86 years). Follow-up measurements taken up to 4 years after procedure were compared with baseline values. RESULTS Thirty-six patients presenting with congenital ptosis underwent Muller's muscle-conjunctival resection combined with tarsectomy. All patients had fair-to-good levator function of 5-10 mm. A mean improvement in the margin reflex distance-1 of 2.79 mm (p value < 0.0001) was noted. All cases except one achieved excellent lid height and postoperative symmetry of the eyelids. CONCLUSIONS Muller's muscle-conjunctival resection combined with tarsectomy is a safe and effective procedure in the treatment of congenital ptosis in patients with moderate-to-good levator function. The surgery is rapid with quick recovery time. No complications were noted.The authors describe a retrospective case analysis of patients who underwent Muller's muscle-conjunctival resection combined with tarsectomy, for the treatment of congenital ptosis with moderate-to-good levator function, demonstrates excellent results.

Aims Evaluation of failure rate and outcomes between skin and muscle surgery and lamellar tarsectomy procedure in major trichiasis of the upper lid. Design Quasi-randomized clinical study. Methods and subjects One hundred individuals with major trichiasis of the upper lid were enrolled and assigned to either skin and muscle surgery (group A) or a lamellar tarsectomy procedure (group B). Participants were examined at 6 and 12 months. The primary outcome measure (failure rate) was the percentage of participants having five or more eyelashes touching the globe or having surgery performed at any follow-up time in both groups. The secondary outcomes included failure time and changes in both visual acuity and corneal opacity. Results Risk failure over 6 months was 40% in group A and 10% in group B. Absolute risk reduction was 30% (95% CI=14.08-45.92%). Cumulative risk failure over 12 months was 20% in group A and 0.00% in group B after the second intervention. Absolute risk reduction was 20% (95% CI=8.58-31.42%). The number needed to treat (NNT) was 3.3 patients (95% CI=2.2-7.1). The mean number of rubbing lashes was greater in the skin and muscle group than in the lamellar tarsectomy group for 6 and 12 month examinations (0.002, 0.005). The change in visual acuity between the two groups was not significant. Recurrent trichiasis was noticed earlier, 6 weeks after surgery, in the skin and muscle group participants, and later, 3 months after surgery, in the lamellar tarsectomy group participants. Conclusion The lamellar tarsectomy procedure is a good choice for management of major trichiasis of the upper lid. The subjective symptoms and lid margin conjunctivalization were improved in lamellar tarsectomy participants. Absence of new corneal opacity or a change in existing corneal opacification was noticed at the 12 months follow-up study.

Khaled Hamdi Elbaklish, Safaa M Saleh, Wael Adel Gomaa Ophthalmology Department, Ain Shams University, Cairo, EgyptCorrespondence: Khaled Hamdi ElbaklishOphthalmology Department, Ain Shams University, Abbassia, Cairo 11566 EgyptTel +201000057550Email khaled.hamdy62@yahoo.coffigmAims: Evaluation of failure rate and outcomes between skin and muscle surgery and lamellar tarsectomy procedure in major trichiasis of the upper lid.Design: Quasi-randomized clinical study.Methods and subjects: One hundred individuals with major trichiasis of the upper lid were enrolled and assigned to either skin and muscle surgery (group A) or a lamellar tarsectomy procedure (group B). Participants were examined at 6 and 12 months. The primary outcome measure (failure rate) was the percentage of participants having five or more eyelashes touching the globe or having surgery performed at any follow-up time in both groups. The secondary outcomes included failure time and changes in both visual acuity and corneal opacity.Results: Risk failure over 6 months was 40% in group A and 10% in group B. Absolute risk reduction was 30% (95% CI=14.08–45.92%). Cumulative risk failure over 12 months was 20% in group A and 0.00% in group B after the second intervention. Absolute risk reduction was 20% (95% CI=8.58–31.42%). The number needed to treat (NNT) was 3.3 patients (95% CI=2.2–7.1). The mean number of rubbing lashes was greater in the skin and muscle group than in the lamellar tarsectomy group for 6 and 12 month examinations (0.002, 0.005). The change in visual acuity between the two groups was not significant. Recurrent trichiasis was noticed earlier, 6 weeks after surgery, in the skin and muscle group participants, and later, 3 months after surgery, in the lamellar tarsectomy group participants.Conclusion: The lamellar tarsectomy procedure is a good choice for management of major trichiasis of the upper lid. The subjective symptoms and lid margin conjunctivalization were improved in lamellar tarsectomy participants. Absence of new corneal opacity or a change in existing corneal opacification was noticed at the 12 months follow-up study.Keywords: tarsectomy, rubbing, lashes, trichiasis, lid &nbsp

Purpose To report the surgical technique and outcomes for adjustable ptosis correction using a posterior levator advancement with minimal superior tarsectomy. Methods A retrospective single-center study was conducted on patients who underwent adjustable ptosis repair via posterior levator advancement with minimal superior tarsectomy by a single surgeon from 2002 to 2018. Patients with greater than 1 mm asymmetry between eyes or contour abnormalities underwent nonsurgical adjustment in the office within 6 days of surgery. Results A total of 79 patients (146 eyelids) were included in this study. The patients were female (67%), underwent bilateral surgery (87%) with mean age of 63 years (range, 20-92). The mean improvement in marginal reflex distance 1 at postoperative month 1 was 2.56 ± 1.04 mm (p ≤ 0.0001). Postoperative symmetry of 1 mm or less between eyes was achieved in 96.6% of patients. Only 8 eyes (5.4%) underwent in-office adjustment postoperatively. No demographic or clinical differences were noted in eyes that required adjustments. Postoperative complications included dry eyes that resolved by 3 months (13.6%), suture cyst (1.4%), corneal abrasion (1.4%), and persistent eyelid edema (1.4%). Surgical revision was required in 2.8% of eyes. Conclusions The adjustable posterior levator advancement with minimal superior tarsectomy is an effective surgical technique for ptosis repair with the added benefit of in-office adjustability to correct minor asymmetries.

Made available in DSpace on 2018-12-11T17:15:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-03-04 Purpose: To describe a new technique to treat congenital distichiasis. Methods: Case series of three distichiatic patients undergoing a novel surgical technique combining splitting of the lid margin with the distichiatic lashes, marginal tarsectomy in the affected area, and tarsoconjunctival graft obtained from the upper region of the tarsus. The graft was sutured at the exposed region of the marginal tarsectomy. Results: Good cosmesis was obtained in all cases and the lids margins healed completely with good surgical outcome and no lashes contacted the cornea postoperatively. Conclusions: The split lamellae with a composite tarsoconjunctival graft results in satisfactory functional and cosmetic outcomes. The upper tarsal region represents an ideal donor site. Oculoplastic Division King Khaled Eye Specialist Hospital Department of Ophthalmology Complejo Asistencial de Palencia Department of Ophthalmology King Saud University College of Medicine Department of Ophthalmology Faculdade de Medicina de Botucatu UNESP Department of Ophthalmology Faculdade de Medicina de Botucatu UNESP

Purpose To determine if Muller's muscle and conjunctiva resection with or without tarsectomy is an efficacious procedure for the treatment of severe involutional blepharoptosis. Methods A retrospective chart review was performed for all consecutive patients with severe involutional blepharoptosis during a 12-year period treated by a single surgeon (AMP) with a Muller's muscle and conjunctiva resection with or without tarsectomy. The inclusion criteria was good levator function (≥10 mm eyelid excursion), adequate response to phenylephrine (change in eyelid height ≥1.5 mm), and severe involutional blepharoptosis (margin-to-reflex-distance-1 ≤0 mm). Results One hundred eyelids of 69 patients were identified that met the inclusion criteria. Mean preoperative margin-to-reflex-distance-1 was -0.65 mm and mean postoperative margin-to-reflex-distance-1 was 3.00 mm for all patients. For patients treated with Muller's muscle and conjunctiva resection without tarsectomy, mean preoperative and postoperative margin-to-reflex-distance-1 was -0.51 mm and 2.98 mm with 97.5% of the patients obtaining a lift greater than 1.5 mm. Conclusions The results demonstrate that Muller's muscle and conjunctiva resection with or without tarsectomy does provide another alternative to the surgeon for the management of severe involutional blepharoptosis.

PURPOSE To quantitatively determine how accurately conjunctival Mullerectomy with or without tarsectomy (CM ± T) blepharoptosis repair restores eyelid contour. METHODS The charts of all patients undergoing unilateral CM ± T blepharoptosis repair at the Cole Eye Institute between June 2012 and September 2014 were reviewed. Preoperative and postoperative digital images were used for eyelid contour analysis. Eyelid contour was measured according to a previously described technique measuring 13 radial mid-pupil eyelid distances (MPLDs) in pixels at 15° intervals from 0° to 180°. Eyelid contour was computed taking the ratio of the corresponding radial MPLD on either side of margin reflex distance (105/75, 120/60, 135/45, 150/30, 165/15, and 180/0) using ImageJ software (National Institutes of Health, Bethesda, MD). Ratios were compared between the preoperative and postoperative images using paired t test with statistical significance set at p < 0.05. RESULTS One hundred and six cases of unilateral CM ± T were performed during the study period and 20 cases met inclusion criteria. In the ptotic eyelid, the postoperative eyelid and the unoperated eyelid groups, the average temporal-to-nasal MPLD ratios at corresponding angles from the midline were closer to 1 from 45° to 135°. Then, further from the midline, at more obtuse angles, the temporal MPLD was greater than the nasal MPLD (i.e., the ratio was greater than 1) in all 3 groups. CONCLUSIONS There was no significant difference in any corresponding MPLD or temporal/nasal MPLD ratio between the postoperative eyelid and the postoperative control eyelid. This technique for CM ± T blepharoptosis repair adequately restores eyelid contour.

Purpose To determine the predictability of a new algorithm for determining the amount of tissue resection for conjunctival Mullerectomy with or without tarsectomy blepharoptosis repair. Methods Consecutive case series of all patients undergoing conjunctival Mullerectomy with or without tarsectomy ptosis repair from October 1999 to September 2001. Each patient underwent excision according to a new algorithm for determining the amount of tissue excision. The amount resected was determined by the following formula: 9 mm of conjunctiva and Muller muscle + x mm of tarsus, where x = distance of undercorrection after phenylephrine testing. Results Sixty-eight consecutive patients underwent 70 cases of conjunctival Mullerectomy with or without tarsectomy ptosis repair on 117 eyelids, using a new algorithm for tissue excision. Forty-seven cases were bilateral and 23 were unilateral. Postoperative symmetry was found in 58 of 67 patients (87%) after 1 surgery. Patient satisfaction based on symmetry, contour, and height after 1 repair was achieved in 64 of 67 patients. There were no overcorrections. Two patients underwent successful reoperation with a second conjunctival Mullerectomy with or without tarsectomy operation. Conclusions This modified algorithm and technique quantifies conjunctival Mullerectomy with or without tarsectomy ptosis surgery and yields predictable results.

PURPOSE To describe a technique using a single suture to perform combined upper eyelid blepharoplasty and Mueller's muscle-conjunctiva resection. METHODS Retrospective surgical case series. RESULTS The procedure was performed in 24 eyelids of 12 patients, with 3 cases including a 1-mm tarsectomy. Average improvement in margin-to-reflex distance 1 was 2.5 mm, and 22 of 24 cases (92%) achieved final margin-to-reflex distance 1 within 1 mm of the target predicted by phenylephrine testing. Surgical revision was required in 1 case of overcorrection and 1 case of recurrent ptosis. CONCLUSIONS Combined upper eyelid blepharoplasty and Mueller's muscle-conjunctiva resection can be performed with a single suture while maintaining the surgical effectiveness of both the procedures.

Recent advances in local anesthetic techniques have led to suggestions that buffered solutions for infiltration increase patient comfort. The use of an eutectic mixture of local anesthetics cream has however proved to be disappointing. The use of monopolar electrocautery, carbon dioxide lasers, and high-frequency radio wave electrosection provide the surgeon with new modes of cutting and coagulation. Lower lid blepharoplasty via a conjunctival approach may avoid many of the complications of the anterior approach. Such complications may also be minimized by careful preoperative planning and frequently the inclusion of a lateral canthopexy in the surgical procedure. The lid height after anterior and posterior levator resection can now be set more accurately with adjustable suture techniques. A new technique combining a superior tarsectomy with levator resection is described. A range of materials for brow suspension are now available. Autogenous fascia lata remains the material of choice when available.

The authors report the case of a 5 year-old boy who up to 2 years old presented normal eyes, when his right eye started to deviate upward and laterally, until be hidden under the superior lid. At the surgery, a strong passive limitation to infraduction of this eye was felt. He had already been operated on in another clinic, but the surgeon could not succeed in hooking his superior rectus. With great difficulty, the only thing that we could do was a free tenotomy of the superior rectus. As the eye was equilibrated in a moderate abduction, we performed an 8 mm recession of the lateral rectus. As there was still a small hypertropia and exotropia postoperatively, we performed in a second operation an eight millimeters resection of the medial rectus, a recession with anterior transposition of the inferior oblique and an advancement of the inferior rectus according to the Romero-Apis technique, in order to avert circulatory problems to the anterior segment of the eye. As he presented a small blepharoptosis, we did, in a third surgery, a tarsectomy according to the Fasanella-Servat technique, with good result. He ended with good eye position, almost no limitation of the horizontal movements and - 3 limitation of up and down ductions. The magnetic resonance imaging showed an altered image of the superior rectus, suggesting fibrosis post myositis. Os autores relatam o caso de um menino de 5 anos que, até os 2 anos, possuía olhos normais, quando seu olho direito começou a desviar para cima e lateralmente, até chegar a esconder-se sob a pálpebra superior. À cirurgia, notou-se forte limitação passiva de abaixamento desse olho. Ele já havia sido operado em outra clínica, mas o colega não conseguiu enganchar o reto superior. Numa segunda operação, o único que conseguimos foi uma tenotomia livre do reto superior; como o olho ficou equilibrado em abdução, fizemos um retrocesso de 8 mm do reto lateral. Como restou moderada exotropia e pequena hipertropia, numa terceira operação fizemos uma ressecção de 8 mm do reto medial, um retrocesso com transposição anterior do oblíquo inferior e um avançamento do reto inferior segundo a técnica de Romero-Apis, para evitar transtornos circulatórios ao segmento anterior do olho. Como restou pequena blefaroptose, realizamos, numa quarta operação uma tarsectomia segundo Fasanella-Servat. O paciente terminou com o olho direito bem posicionado, sem limitações aos movimentos horizontais e limitação de -3 dos verticais. A imagem de ressonância magnética demonstrou alterações do reto superior, sugerindo fibrose após miosite.

Purpose: To describe a tarsal transfer procedure, which we have named the tarsal switch, to correct the eyelid malpositions and camouflage the socket defects of acquired anophthalmos. Methods: The technique consists of an upper eyelid tarsectomy, with transfer of the autologous tarsoconjunctival graft to the posterior lamella of the lower eyelid. Results: The operation was performed in 21 anophthalmic patients. In 16 patients with eyelid malpositions, excellent results (within I mm of the fellow eye) were attained in 100% of the patients with ptosis, and in 88% of patients with lower eyelid retraction. In the remaining 5 patients, orbital volume loss with secondary implant migration, inferior prosthetic displacement and eyelid asymmetry predominated. In these patients the anophthalmic orbital defects and eyelid asymmetry were masked well. Patient satisfaction was high and complications were few during an average follow-up interval of 16 months. Conclusion: The tarsal switch procedure is useful in managing the eyelid malpositions and masking the orbital deficiencies of the anophthalmic socket.

During the past two centuries, several methods of ptosis repair have been described and refined, but each method has typically been subject to cycles of popularity, neglect and reincarnation. Repair of ptosis through partial resection of the tarsus is one such example. Although Sir William Bowman included tarsectomy with his historic levator resections, the French ophthalmologist, A.P.L. Gillet de Grandmont was the first to specifically emphasize resection of tarsus for the correction of ptosis. Yet contemporary advocates of tarsectomy for ptosis repair have generally failed to recognize Gillet de Grandmont’s contribution and his role in the history of ptosis surgery. For this reason, a review of this subject is presented.

The management of severe unilateral blepharoptosis is problematic. In the presence of poor levator function, conventional surgical techniques frequently do not adequately elevate a ptotic eyelid. From May 1988 through July 1991, we used 4- to 5-mm external resections of the superior tarsus in conjunction with a maximal aponeurectomy (Whitnall's sling procedure) to augment blepharoptosis correction in selected cases of severe unilateral blepharoptosis. Seventeen (68%) of 25 patients with poor levator function blepharoptosis who underwent this new surgical procedure achieved a lid height within 1 mm of the opposite lid with good or excellent ocular function, cosmesis, and eyelid crease formation. Mild to moderate degrees of exposure keratopathy developed early in the postoperative period in all patients. This exposure keratopathy ultimately resolved in most patients. Superior tarsectomy safely augments the blepharoptosis correction of a Whitnall sling procedure in severe blepharoptosis, improving the results of aponeurotic surgery in patients with severe unilateral blepharoptosis.

INanearlier communication (Boase, 1950)itwassuggestecl that aureomycin (Lederle) dropswereveryeffective inthetreatmenit of trachoma. Thatopinion wasbasedonasmallnumberofcases, noneofwhom hasreappeared witharelapse. Thepresent report deals with36cases, thelast fourincluded beingatadisadvantage asthesupply ofaureomycin gaveoutafter onlythree days'treatment.Twentycasesreceived dropsonly, tenreceived dropsand oralcapsules, andsixoralcapsules only.Thedrops,madeup bydissolving thepowderindistilled water, wereadministered at intervals varying fromonetofourhours.Therewerenocomplaints ofirritation (Ainslie, 1950).Itwasfoundthat2-liourly intervals werethemostconvenient forthenursing staff, allowing four orfive instillations aday.No treatment wasgivenatnight. Capsules weregiventhreetimesa dayineleven cases, andfive timesadayinfivecases.Withtheexception offourAsiatics, thepatients werenatives ofUgandaandweretreated inhospital, thelongest in-patient staybeing22daysandtheshortest four days.Infourcases(20,21,23,and25)treatment wascurtailed infavourofa bilateral tarsectomy. The chiefparticulars are tabulated overleaf; fourcases(7,11.17,and20)aregivenin detail.

The manner in which tarsectomy influences the trachomatous process is analyzed with particular attention to the mechanical factor of relieving the lid pressure. Corneal involvement and beginning entropion are accepted as indications for this procedure. In the technique of simple tarsectomy an incision through skin and orbicularis is favored. A new method of intermarginal tarsectomy with transplantation of mucosa is proposed for cases of advanced trachoma with misplacement of cilia.

This method evolved from modifications of tarsectomy has something in common with the old operation of peritomy for pannus, and yields very favorable results as here reported.

This committee report approves in the main the findings and criticisms contained in the report on Indian administration by the Institute for Government Research. Exception is taken to the idea that trachoma is a food deficiency disease. Indiscriminate resort to tarsectomy in the treatment of trachoma is condemned. Failure of the Indian service to provide adequately for medical care should be remedied by transferring the management of health matters among the Indians to the United States Public Health Service.

An operation for entropion/trichiasis is presented which is applicable to both upper and lower lids, and for grades of distortion from mild to severe. It is suitable for gross trachomatous lid disease in Aboriginal patients, and also for the discomfort of chronic cicatricial trichiasis in aged Caucasians. No new procedure is proposed. The method combines features of several well tried operations to free the inturned lid margin and resuture it in proper apposition.

In five cases, a simplified anterior tarsal resection corrected complicated upper eyelid blepharoptosis and contour abnormalities. One case of residual blepharoptosis after levator muscle resection was corrected by resecting an amount of tarsus equal to the desired amount of correction. Two cases of upper eyelid blepharoptosis resulting from overcorrected levator muscle recession were corrected in the same manner. In one case of residual segmental blepharoptosis of the upper eyelid causing a contour abnormality, we resected a segment of tarsus corresponding to the amount of blepharoptosis in the affected segment of the eyelid. In one patient who developed a contour abnormality after a Fasanella procedure with segmental blepharoptosis nasally and overcorrection temporally, a segment of tarsus resected nasally and inserted temporally created an even contour. Anterior tarsal resection is a simple method of revising the upper eyelid level of contour in situations where the upper eyelid anatomy has been distorted by previous surgery.

In cases of ptosis demonstrating a fair to good levator action, some procedure utilizing the principals described by Blascovic1is still considered the operation of choice. In an attempt to shorten the operative time and simplify the technical difficulties often encountered especially by the ophthalmic surgeon who does ptosis surgery only "occasionally," many modifications of this procedure have been devised and described. In this paper we are presenting another modification of Blascovic's original levator resection intended only for cases of minimal ptosis (3 to 4 mm.) with some function of the levator showing a fair lid fold and in the absence of the "jaw-winking" phenomenon of Marcus Gunn. In our last 4 cases of minimal ptosis we have utilized a simplified and fast procedure (10 min.). Essentially the operation consists of a resection of the levator (or better Muller's and levator), tarsus, and conjunctiva. For this reason, it may