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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 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.

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.

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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.

Background Various techniques have been proposed for the treatment of cavovarus feet (CVF). The aim of this study was to report outcomes of the revisited Meary’s dorsal closing wedge tarsectomy for fixed CVF secondary to Charcot-Marie-Tooth (CMT) disease. Methods All CVF operated on between 1977 and 2011 were included. The tarsectomy design was modified from its original description and systemically combined with a plantar fascia release, a Dwyer osteotomy and a proximal extension osteotomy of the 1st metatarsal bone if required. Outcomes were assessed by 2 functional scores and radiographically. Results Among the 26 feet (20 patients), the Wicart and Seringe score was very good or good, fair and poor in respectively 58%, 23% and 19% of the feet. Hindfoot and midfoot AOFASs were of 95.5 and 75 respectively. All radiographic measures were significantly improved. Conclusions This complete revisited procedure is an efficient and safe surgical technique for the treatment of the CMT disease CVF. Level of evidence Level IV.

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.

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.

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.

Summary The correction of neglected talipes equinus varus is a challenging problem. The dangers of soft tissue breakdown, and neurovascular damage, as well as unsatisfactory function, have widely been reported. A safe method with the use of a ring fixateur is presented, minimizing the risk of soft tissue or neurovascular damage. Prior to progressive correction by means of the ring fixateur, an anterolateral tarsectomy is performed. The correction is stabilized by a subtalar reorienting bone block arthrodesis and transfer of the anterior tibial tendon. A case of a 26-year-old patient with bilateral severe talipes equinus varus is reported.

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.

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.

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.

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.