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Objective: To evaluate the effectiveness of levator resection and frontal sling surgery in patients with ptosis due to third cranial nerve (3rd CN) paralysis. Methods: A total of 16 patients who underwent frontal sling surgery (n=9, group 1) and levator resection (n=7, group 2) during follow-up due to ptosis due to 3rd CN paralysis in the oculoplastic surgery unit of our clinic were included in the study. The surgical procedure, preoperative levator muscle function test, marginal reflex distance 1 (MRD1) and palpebral fissure height (PFH) were recorded during follow-up. The MRD1 and PFH values of the patients in both groups were recorded in the postoperative 1st month and 12th month examinations, and during the last examination. All data were statistically compared between the two groups. Results: Seven (43.8%) patients were female and 9 (56.3%) were male. Preoperative mean MRD1 values in group 1 and group 2 were -1.78±1.56 mm (-4-0) and -1.29±0.76 mm (-2-0), respectively. In groups 1 and 2, both MRD1 and PFH showed a statistically significant increase compared with preoperative measurements (p=0.277). While postoperative success was 88.8% in the 1st month in group 1, it was 55.5% in the 12th month. In group 2, postoperative success rates were 85.7% in the 1st month and 71.4% in the 12th month examinations. In the comparison between the groups, MRD1 and PFH did not differ statistically (p=0.216). Conclusion: Although patients with ptosis due to 3rd CN paralysis are difficult to treat, they can be effectively and safely treated with frontal sling surgery or levator resection. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study is to introduce a new modification on the classic technique of levator muscle tucking for correction of mild to moderate blepharoptosis and to evaluate its functional and aesthetic outcome. Patients and methods This is a tertiary-center study that included 180 patients with mild to moderate ptosis with good levator function (≥8 mm) according to Beard’s classification. Patients with severe congenital, recurrent, mechanical, traumatic ptosis, third nerve palsy, Marcus–Gunn jaw winking syndrome, absent Bell’s phenomenon, or associated ophthalmoplegia were excluded. A recently introduced resection tucking procedure with a spindle excision of the levator aponeurosis was performed. The procedure outcome was assessed functionally by measuring the distance between the upper lid margin and the superior limbus in bilateral cases and accordingly they were classified as very good (2 mm), good (2–4 mm), and poor (5 mm) as well as comparing the preoperative to the postoperative margin reflex distance (MRD1) in unilateral cases. Assessing the aesthetic outcome was done by measuring the eyelid height symmetry, presence of lid crease, lid contour, and patients’ postoperative satisfaction. Results The success rate of the procedure was 92.1% [very good (77.7%) and good (14.4%), P < 0.0001]. The MRD1 improved significantly from a preoperative value of 3.28±0.44 mm to 4.44±0.57 mm postoperatively (P < 0.0001). Regarding the aesthetic outcome, symmetrical lid height was achieved in 86.1% of the unilateral cases and in 84% of the bilateral cases, while symmetry of the lid crease was reported in 88.8% of the cases and regularity of the lid contour in 91.6% of the cases. Postoperative patients’ satisfaction was reported by 83% of the patients. The time of procedure was 27.4±4.6 min/eye. Conclusion This modified technique of levator tucking was performed in a short time and proved to be an effective technique, with minimal complications and high aesthetic satisfaction outcome.

This retrospective observational case series is to evaluate the histopathological findings of drooping eyelids in patients with infantile-onset Pompe disease and assess the feasibility of levator muscle resection combined with conjoint fascial sheath suspension for ptosis correction. It included six patients from a single tertiary referral center with ptosis and infantile-onset Pompe disease between January 1, 2013, and December 31, 2021. They most suffered from recurrent ptosis after initial surgical correction (6/11 eyes, 54.55%). The recurrence rate was high in eyes with levator muscle resection alone (4/6 eyes, 66.67%). No recurrence of ptosis was observed in eyes with levator muscle resection combined with conjoint fascial sheath suspension. The follow-up period was approximately 16–94 months. Histopathological examination revealed that the levator muscle had the most abundant glycogen accumulation-related vacuolar changes, followed by Müller's muscle and extraocular muscles. No vacuolar changes were observed in the conjoint fascial sheath. For patients with infantile-onset Pompe disease-related ptosis, performing levator muscle resection alone is not sufficient, while utilizing conjoint fascial sheath suspension can achieve the desired long-term outcomes with minimal recurrence. These findings may have important implications for the management of ophthalmic complications in patients with infantile-onset Pompe disease.

In patients with severe blepharoptosis, the function of the levator muscle is usually weak. Even if a large amount of levator is resected, under-correction and recurrence often occur postoperatively. Frontalis suspension is the first choice for severe ptosis; however, the external orbital lifting force of the frontalis causes non-physiological eyelid movement. Conjoint fascial sheath (CFS) is a fibrous tissue which can provide dynamic movement of upper eyelids and has been applied for the treatment of mild and moderate blepharoptosis in recent years. This study aims to assess the efficacy and safety of CFS suspension combined with levator muscle advancement for treating severe blepharoptosis. A retrospective study included 44 patients (60 eyelids) with severe ptosis who underwent the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 (MRD1) were measured. Surgical outcomes, symmetry results and complications were evaluated postoperatively. At the 12–18 months follow-up, adequate or normal correction was achieved in 56 eyelids (93.3%), and 37 patients (84.1%) presented good or fair symmetry results. The most common complication was conjunctival prolapse, which was observed in six eyelids (10.0%), followed by lid fold deformity and under-correction. No exposure keratitis was recorded. In conclusion, the modified technique can physically elevate the eyelid with limited tissue injury and is effective for the correction of severe ptosis. Both satisfactory functional and esthetic results were achieved, and severe complications (such as exposure keratitis) were not observed. [ABSTRACT FROM AUTHOR]

Background: Conjoint fascial sheath suspension can achieve pleasing surgical efficacy and dynamic eyelid movement in the treatment of severe ptosis. In recent years, the palpebral margin incision technique has been applied for double-eyelid blepharoplasty, which is characterized by inconspicuous scarring, short convalescence, and natural-looking outcome. However, studies of the application of this technique in the treatment of ptosis are scarce. This article aims to evaluate the efficacy and safety of conjoint fascial sheath suspension for treating severe blepharoptosis through palpebral margin incision. Methods: From March 2019 to January 2021, 32 patients (37 eyelids) underwent treatment with the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 were documented. Correction effects, symmetry results, and complications were also evaluated postoperatively. Results: Adequate or normal correction was achieved in 33 eyelids (89.2%), and 31 patients (96.9%) obtained good or fair symmetry results. Common complications were undercorrection and conjunctival prolapse, which were both observed in four eyelids (10.8%), followed by overcorrection and hematoma. Conclusions: The modified technique provides physical eyelid elevation and inconspicuous scarring and is effective for treating severe ptosis. Satisfactory functional and esthetic results could be obtained simultaneously without severe complications. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. 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. [ABSTRACT FROM AUTHOR]

ObjectiveTo 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.MethodsPediatric 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.ResultsFifty 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

SUMMARY: The construction of superior palpebral fold gained popularity in the far East and at the present time is the most frequently performed aesthetic operation in the Orient. Various incisional techniques have been reported to form upper eyelid crease, which also a confusion for plastic surgeons who lack clinical experience. It is essential to review the evolution of these incision techniques and outlined the pros and cons of each method. This study reviewed the anatomy theory of superior palpebral fold, and reported incision techniques according to different connecting tissue utilized.

Objective To observe the clinical efficacy of modified conjoint fascial sheath (CFS) suspension combined with levator muscle resection in the treatment of severe congenital ptosis. Methods From January 2017 to January 2019, 30 patients with severe congenital ptosis were divided into modified group (15 patients) and traditional group (15 patients). These patients were treated by modified method and traditional method, respectively. The postoperative efficacy was observed during the follow-up. The CFS suspension combined with levator muscle resection was performed in both groups. The modified method was to openorbital septum and not to open levator aponeurosis of upper margin of tarsal plate. Results All patients in both groups were followed up for 6 to 12 months. Postoperative palpebral fissure height (PFH), margin regles distance 1 (MRD1), operative time, incidence rate of postoperative complications and patients' satisfaction were compared. The ptosis in 30 patients was well corrected without serious complications. There was no significant difference in PFH and MRD1 between 2 groups (P>0.05).The operative time was (38.36±0.49) min in modified group and (46.25± 0.51) min in traditional group (P<0.05). The incidence rate of complications was 4.17% in modified group, which was lower than that of 20.83% in traditional group (P<0.05). The patients' satisfaction was 93.33% in modified group, which was significantly higher than that of 73.33% in traditional group (P< 0.05). Conclusion The modified CFS suspension combined with levator muscle resection is a reliable and simple method in the treatment of severe congenital ptosis. The complications are less and patients' satisfaction is high. It should be considerable for clinical promotion and application. [ABSTRACT FROM AUTHOR]

Objective To explore the long-term efficacy of modified conjoint fascia sheath (CFS) suspension combined with partial shortening of levator muscle (LM) and single CFS suspension in the treatment of congenital severe ptosis. Methods From January 2017 to January 2020, a total of 126 patients (220 eyes) with severe ptosis were collected. All patients were divided into 2 groups according to the surgical methods. There were 68 patients (104 eyes)in the control group, including 36 patients with bilateral severe ptosis, 32 patients with severe ptosis on one side and mild to moderate ptosis on the other side. Single CFS suspension was performed in the control group. There were 58 patients (116 eyes) with bilateral severe ptosisin the observation group. The modified CFS suspension and LM shortening was performed in the observation group. Results The clinical efficacy of both groups were observed and recorded at 6 months after operation. In the observation group, the non-recurrent amount of upper eyelid regression was (0.51±0.11) mm, the satisfaction rate of upper eyelid morphology was 96.55%, complete eyelid closure rate was 65.52%, incidence rate of upper eyelid hysteresis was 37.93% and recurrence rate of one year was 5.17%. In the control group, the non-recurrent amount of upper eyelid regression was (1.21±0.19) mm, the satisfaction rate of upper eyelid morphology was 79.41%, complete eyelid closure rate was 39.42%, incidence rate of upper eyelid hysteresis was (86.54%) and recurrence rate of one year was 21.15%. The difference between 2 groups was statistically significant (P<0.05). Conclusion The modified conjoint fascia sheath suspension combined with partial shortening of levator palpebrae superioris complex is safe and effective in the correction of congenital severe ptosis. The complications are less and patients' satisfaction is high. It should be considerable for clinical promotion and application. [ABSTRACT FROM AUTHOR]

Blepharoptosis, or ptosis of the eyelid, refers to drooping of the upper eyelid that usually results from a congenital or acquired abnormality of the muscles that elevate the eyelid. Ptosis may be the presenting sign or symptom of a serious neurologic disease. Regardless of the etiology, when ptosis obstructs vision, it is disabling. The appropriate management requires recognition of the underlying cause. This review article highlights the various aspects of ptosis evaluation and management.

Objective To explore the clinical therapeutic effect of conjoint fascial sheath suspension in the correction of severe congenital blepharoptosis. Methods From January 2015 to 2018, 26 patients(47 eyes) suffered from severe congenital blepharoptosis underwent conjoint fascial sheath suspension were retrospectively analyzed. The correction degree of blepharoptosis, closure condition of eyelid and occurrence of adverse reactions were followed up and recorded. Results All patients were followed-up for 12 months after operation. There were 2 cases (3 eyes, 6.38%) of insufficient correction. The remaining 24 patients (44 eyes, 93.62%) with severe congenital blepharoptosis were completely corrected. No recurrence or overcorrection occurred. There were 2 cases(2 eyes, 4.26%) of conjunctival prolapse and cured after corticosteroid hormone eye drops treatment and pressure dressing. No other severe complications occurred. Conclusion The application of conjoint fascial sheath suspension in the correction of severe congenital blepharoptosis was safe and effective. The postoperative appearance was natural. [ABSTRACT FROM AUTHOR]

To establish a treatment protocol for severe blepharoptosis. This protocol helps to achieve improved accuracy and more stable correction outcome. The levator muscle function was evaluated pre-operation. When the levator function was less than 1 mm, the frontalis suspension technique was performed; when the levator function was more than 1 mm, the techniques of levator resection, combined excision of the tarsus and levator, and tarsus–levator–CFS suspension were performed sequentially until a satisfactory correction result was achieved. A total of 389 patients with severe ptosis (561 eyes) were included; 102 eyes received levator resection, 314 eyes received combined excision of the tarsus and levator, 53 eyes received tarsus–levator–CFS suspension, and 92 eyes received frontalis suspension. In total, a satisfactory correction result was achieved in 466 eyes, while 95 cases still presented with under-correction. The symmetry findings showed that 107 (27%) cases presented good symmetry, 203 (52%) cases presented moderate symmetry, and 79 (21%) showed poor symmetry. This new treatment protocol overcomes the drawbacks of the traditional strategy by standardizing the correction procedure, leading to improved accuracy and more stable correction results. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the intermethod agreement between the tomographic ultrasound imaging (TUI), considered as the gold standard, and the OmniView‐VCI in the diagnosis of levator ani muscle (LAM) avulsion and in the measurement of levator‐urethral gap (LUG). Methods: We acquired dynamic 4D transperineal ultrasound volumes from 114 women. Each data set was analyzed on maximal pelvic floor contraction by TUI and OmniView‐VCI techniques to check for LAM avulsion. Moreover, we measured LUG using both TUI and OmniView‐VCI, twice by an operator and once by another to assess intraobserver and interobserver reproducibility. Reproducibility and intermethod agreement were studied by means of intraclass correlation coefficient (ICC) and Cohen's kappa coefficient. Results: In the diagnosis of ani levator avulsion, the two techniques showed a good agreement (Cohen's κ = 0.691, 95% confidence interval [CI], 0.522‐0.860; P <.001); we also reported a good intraobserver and interobserver agreement (Cohen's κ = 0.738, 95% CI, 0.597‐0.879; P <.001, and Cohen's κ = 0.864, 95% CI, 0.750‐0.978; P <.001, respectively). LUG measurements by OmniView‐VCI technique showed high intraobserver (ICC 0.895; 95% CI, 0.866‐0.918) and interobserver (ICC 0.821; 95% CI, 0.774‐0.858) reproducibility. High intermethod agreement was demonstrated between the two methods (ICC 0.813; 95% CI, 0.764‐0.853). The area under the receiver‐operating characteristic curve of LUG in predicting avulsion was 0.931 (0.868‐0.994, 95% CI; P <.001) with 24 mm showing the best sensitivity (82%) and specificity (97%). Conclusions: OmniView‐VCI is a reliable method for LUG measurement and for levator avulsion diagnosis. [ABSTRACT FROM AUTHOR]

Objective To explore an effective surgical method for the correction of severe blepharoptosis. Methods A total of 29 patients (35 affected eyes) with congenital or recurrent severe blepharoptosis were treated with modified combined fascial sheath suspension. An efficacy evaluation and satisfaction survey were performed at 6 months after surgery. Results During the follow-up from 6 to 12 months, patients showed rapid eye opening. The movement of the eyelid and eyeball was coordinate. Thirty eyes were cured, 5 were basically corrected, and the cure rate was 100% (35/35). No recurrence or upper eyelid retraction occurred. The survey showed that 24 of the 29 patients were satisfied with the results, 3 were basically satisfied, and 2 were unsatisfied. The satisfaction rate was 93.1% (27/29). Conclusion Modified combined fascial sheath suspension was a safe and effective method in the correction of congenital and recurrent severe blepharoptosis. The operation was safe and effective and patients' satisfaction rate was high. This method was worth promoting in clinical practice. [ABSTRACT FROM AUTHOR]