Search

PURPOSE To examine the efficacy of ptosis correction with a Muller muscle-conjunctival resection with or without tarsectomy (MMCR±T), combined with bandage contact lens (BCL) use, in corneal graft patients. METHODS Seven patients with corneal grafts who underwent MMCR±T for treatment of ptosis were evaluated retrospectively. A BCL was applied to the grafts at the end of the surgery. The collected data included preoperative and postoperative visual acuity, marginal reflex distance 1 (MRD-1), presence of Hering's dependency by the phenylephrine test, symmetry outcomes, and complications after MMCR±T. RESULTS The average duration between the penetrating keratoplasty and MMCR±T was 14 months, with a follow-up time of 10.4 months after MMCR±T. Hering's dependency was observed in four (57.2%) patients before MMCR±T, and MRD-1 was increased in all patients based on preoperative phenylephrine tests. The mean preoperative MRD-1 was -0.14 ± 0.55 mm, and the mean postoperative MRD-1 was 2.35 ± 0.89 mm (p < 0.0001). Symmetry outcomes of perfect (

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.

The Fasanella-Servat procedure is a useful technique for ptosis correction of 3 mm or less, with levator function greater than 10 mm. The procedure has been successfully used for congenital, neurogenic, myogenic, traumatic, and bilateral ptosis. It can also be useful for correction of eyelid contour abnormalities, such as from previous surgery or trauma, by skewing the clamp to one side. This procedure has the advantage of high reliability with appropriate preoperative criteria and is minimally invasive and quick to perform. It may be less likely to cause overcorrection or contour abnormalities than levator advancement surgery. The operation is very useful for small degrees of ptosis, and the likelihood of overcorrection is low. As with any surgery, proper patient selection is of paramount importance. In summary, this operation remains a highly useful technique for ptosis correction, even in modern oculoplastic surgery.

The Fasanella–Servat operation is one of the simplest operations for ptosis and is used mainly in mild to moderate blepharoptosis with good levator function. It can correct up to 2 mm of congenital ptosis and 2.5–4 mm of acquired ptosis. Since its creation in 1961, the operation has become more refined. Many of its modifications have been oriented at increasing the amount of correction of ptosis, secure a proper contour, and preventing ocular surface abrasions. Proper patient selection is fundamental for its effectiveness.

Objectives : This paper aims to report the clinical effectiveness of acupuncture & herbal treatment on ptosis, which has no way to be treated but the operative method like a tarsectomy. Methods : This study was carried out, from February 2003 to December 2003, to the twenty patients who were diagnosed as an acquired ptosis and treated by acupuncture and herbal treatment in the department of Acupuncture & Moxibustion, Daejon University Oriental Hospital. The selected acupoints were hasamhwang(下三黃) in normal side, BL 2, BL 60(崑崙), BL 66(通谷), ST 41(解谿), ST 44(內處), LI 4(合谷), LI 5(陽谿), guhu(球後), emi(魚尾) in abnormal side. The method of acupuncture insertion for each point was neutral(平補平瀉). The treatment frequency was once a day. And all patients were administered the Bojungikkitanggamibang(補中益氣揚加味方), which is known to be able to rise up the Gi of spleen(脾氣). Result & Suggestion : The treatment result showed that excellent was 95%(19) and poor was 5%(1). Through this result, we can know that oriental medical treatment for ptosis is effective. But continuous study about oriental medical treatment for ptosis is needed hereafter.

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.

A 39-year-old man with pachydermoperiostosis is presented. He had enlarged, thickened upper eyelids that made it difficult for him to open his eyes. Eyelid correction was performed by resecting the excessive skin and orbicularis muscle in a fusiform shape and shortening the levator aponeurosis by plication. A wedge resection of the lateral third of the upper lid shortened the horizontal width and also changed the unpleasant fan shape to a better shape, with a natural curvature of the lid. The authors also performed a 5-mm transconjunctival tarsectomy. Visual impairment was corrected with a satisfactory aesthetic outcome.

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.

The condition of eyelid ptosis can vary both in its cause and manifestations. Many types of ptosis repair techniques are available, including aponeurosis shortening, levator muscle shortening, and frontalis sling techniques. Additional methods include tarsectomy and mullerectomy procedures. The frontalis sling operation has been practiced for many years and has been described using a variety of alloplastic materials, autologous fascia lata, homograft fascia, and even frontalis muscle. Although many of the techniques that have been described can be useful, in the majority of cases we prefer to use autologous fascia lata. The purpose of this article is to describe some of the technical variations that can make this surgery easier to perform and more predictable in the final result. Procurement of autologous fascia lata with donor site closure, placement of the graft into the upper lid and brow area, and adjustment methods of the fascia sling during surgery and the postoperative period are important. Innovations in these technical aspects of the frontalis sling operation are described in this report.

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.

A 94-year-old monocular woman with a posterior communicating artery aneurysm developed a compressive third nerve palsy with complete blepharoptosis and abduction of her seeing eye. It was believed that she was not a good neurosurgical candidate for aneurysm repair. Her ptosis was managed successfully with an in-office Whitnall sling procedure combined with a superior tarsectomy. The author describes this safe and effective method for surgical management of complete ptosis with zero levator function.

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.

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