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1.
Zhonghua Yan Ke Za Zhi ; 57(11): 844-849, 2021 Nov 11.
Artigo em Chinês | MEDLINE | ID: mdl-34743470

RESUMO

Objective: To evaluate the demographics, etiology composition, clinical characteristics and surgical outcomes of acquired ptosis patients. Methods: Retrospective case-series study. The clinical records of 176 consecutive patients (312 eyes) with acquired ptosis were reviewed from January 2009 to December 2018 in the Ophthalmology Department of Tianjin Medical University General Hospital. The demographics, etiology composition, clinical characteristics, surgical strategies and outcomes were analyzed. Results: There were 59 male (33.5%) and 117 female (66.5%) patients suffering acquired ptosis, with an average age of (64±7) years. The disease was bilateral in 136 cases and unilateral in 40 cases. There were four etiological components of acquired ptosis: 145 cases (82.4%) of aponeurotic ptosis, 17 cases (9.6%) of neurogenic ptosis, 10 cases (5.7%) of myogenic ptosis and 4 cases (2.3%) of traumatic ptosis. The clinical characteristics of acquired ptosis varied significantly depending on etiology. Ptosis surgeries were performed on 152 cases (279 eyes), and the success rate was 92.1% (140/152). Surgical procedures included levator aponeurosis surgeries on 148 cases (275 eyes), frontal muscle suspensions on 2 cases (2 eyes) and conjunctival-Müller's ectomies on 2 cases (2 eyes). Conclusions: Acquired ptosis is more likely to occur in senile and female populations with bilateral eyelids involved mostly. Aponeurotic ptosis is the predominant type of acquired ptosis. The treatment is performed according to the clear etiological diagnosis based on clinical features, and operations are efficient for most patients with acquired ptosis. (Chin J Ophthalmol, 2021, 57: 844-849).


Assuntos
Blefaroplastia , Blefaroptose , Idoso , Blefaroptose/etiologia , Blefaroptose/cirurgia , Pálpebras/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Estudos Retrospectivos
2.
PLoS One ; 16(10): e0258688, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34710107

RESUMO

In this study, we aimed to evaluate the characteristics of astigmatism preoperatively and 1 month postoperatively in patients with age-related ptosis (AP) and contact lens-related ptosis (CLP), and investigate surgery-induced astigmatism (SIA) using the Jaffe vector analysis and the Cravy method. Consecutive patients who underwent blepharoptosis surgery between January 2019 and December 2019 were included. The patients were divided into AP and CLP groups. Computerized corneal topography was used to assess the magnitude and axis of corneal astigmatism. Astigmatism was classified as with-the-rule (WTR), against-the-rule (ATR), or oblique astigmatism (OA) pre- and postoperatively. SIA was calculated by vector analysis using the Cravy and Jaffe methods. The correlation between SIA and margin reflex distance (MRD) was calculated. One hundred and eight eyes from 58 patients (AP group: 85 eyes from 45 patients, CLP group: 23 eyes from 13 patients) were included. The AP group (73.8±7.6 years) was significantly older than the CLP group (47.7±6.6 years). The MRD increased significantly after treatment in both groups. The proportions of WTR, ATR, and OA were 52%, 22%, and 25%, and 86%, 9%, and 4% in the AP and CLP groups, respectively. A shift in astigmatism type was observed in 41% and 13% of patients in the AP and CLP groups, respectively. The average SIA measured using the Cravy method was 0.11±1.22 D in the AP group and -0.28±1.07 D in the CLP group (WTR astigmatism). The SIA calculated using the Jaffe method was 0.78±0.70 D in the AP group and 0.82±0.88 D in the CLP group. There was no significant correlation between SIA calculated using the Cravy and Jaffe methods and MRD. ATR was most common in age-related ptosis and WTR was most common in contact lens-related ptosis. Upper eyelid re-positioning may affect visual functions due to astigmatic changes in the short term postoperatively.


Assuntos
Astigmatismo/patologia , Blefaroptose/cirurgia , Lentes de Contato/efeitos adversos , Complicações Pós-Operatórias/patologia , Idoso , Astigmatismo/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Acuidade Visual
3.
Arch Soc Esp Oftalmol (Engl Ed) ; 96(10): 545-548, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34620484

RESUMO

Monocular elevation deficiency (MED) is characterized by unilateral limitation of supraductions, similar in adduction and abduction, in addition to hypotropia and ptosis. We describe a case of a 62-year-old woman with long-standing left ptosis who was initially operated with a frontal suspension technique. On subsequent examinations, a MED of that eye was found. The passive duction test was positive, so the inferior rectus was recessed. In addition, a modified Nishida technique was performed, consisting of the scleral anchorage of the superior edges of the rectus, medial and lateral, 12mm from the corneal limbus in the superonasal and superotemporal quadrants, respectively. Postoperatively, the left eye presented a minimal hypotropia of 3 PD. This modified technnique used here on the horizontal rectus muscles, turned out to be effective and safe for the correction of MED.


Assuntos
Blefaroptose , Estrabismo , Blefaroptose/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Esclera , Estrabismo/cirurgia
4.
Ann Plast Surg ; 87(5): 523-527, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34469913

RESUMO

OBJECTIVE: This study aims to evaluate the clinical effect of modified maximal levator palpebrae superioris shortening method for severe congenital ptosis. METHODS: A retrospective case series was performed including 66 eyes from 62 patients who underwent modified maximal levator palpebrae superioris shortening surgery to treat severe congenital ptosis between February 2015 and November 2018. Preoperative and postoperative margin reflex distance 1 and levator muscle function were recorded. The surgical results were graded as good, satisfied, and poor for functional and cosmetic improvement of the eyelids, and the incidence of complications was also documented. RESULTS: The mean patient age at the time of surgery was 4.6 ± 1.8 years (2-9 years), and the mean follow-up time was 36.3 ± 14.1 (12-55 months). A mean significant improvement in margin reflex distance 1 and levator function after operation was noted (P < 0.01). The eyelid height and symmetry were satisfied in 59 patients, with success rate of 95.2%. For the patients in the levator function (≤2 mm) group, the success rate was 87.5%. Moreover, the levator function (≤2 mm) group had a higher rate of poor results than levator function (2-4 mm) group (12.5% vs 2.2%). Overcorrection (6.5%) and eyelid fold deformity (11.3%) were the most frequent postoperative complications. CONCLUSION: Modified maximal levator palpebrae superioris shortening was effective and endurable in the treatment of severe congenital ptosis with poor levator function, including in patients whose levator function was less than 2 mm.


Assuntos
Blefaroplastia , Blefaroptose , Blefaroptose/cirurgia , Criança , Pálpebras/cirurgia , Humanos , Músculos Oculomotores/cirurgia , Estudos Retrospectivos
5.
Indian J Ophthalmol ; 69(10): 2771-2775, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34571632

RESUMO

Purpose: : To report the frequency of periorbital aesthetic abnormalities in patients undergoing refractive surgery and to report the ability of the patient and the refractive surgeon in picking up these findings compared to the oculoplastic surgeon. Methods: Single-center, prospective observational case series. All patients underwent standard pre-operative work-up for refractive surgery, answered a study questionnaire, and underwent face photographs (with and without glasses). The patient, the refractive, and the oculoplastic surgeons evaluated the photographs to categorize the concerns as none, presence of ptosis, tear trough deformity, scleral show, and others. The findings of the oculoplastic surgeon were taken as the standard of reference. Results: The photographs of 121 patients were analyzed. The mean age was 25.76 ± 3.75 years and 72% were males. The main indication for surgery was to eliminate dependency on glasses in a majority (76%) followed by cosmesis in 23%. The oculoplastic surgeon noted tear trough deformity in 14 (11.5%) cases, scleral show in 51 (42.1%), ptosis in 35 (28.9%), and other findings in 45 (37.1%). When the symmetrical scleral show was excluded, the patient picked up aesthetic concerns in only 8.26%, the refractive surgeon in 14% as compared to 39% by the oculoplastic surgeon (P < 0.01). Conclusion: Periorbital aesthetic significant findings were noted in 39% of the patients undergoing corneal refractive surgery when assessed by an oculoplastic surgeon. The refractive surgeon was able to pick up less than 50% of these. We recommend a basic aesthetic initial evaluation prior to refractive surgery and photographic documentation, especially in cosmetically aware patients.


Assuntos
Blefaroptose , Procedimentos Cirúrgicos Refrativos , Adulto , Blefaroptose/cirurgia , Estética , Humanos , Masculino , Procedimentos Cirúrgicos Oftalmológicos , Inquéritos e Questionários , Adulto Jovem
6.
BMC Ophthalmol ; 21(1): 313, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454463

RESUMO

BACKGROUND: Blepharochalasis is a rare eyelid disorder but eventually leading to destructive eyelid deformation. Until now the clinical and epidemiological data are unavailable. This study aimed to report the manifestations, epidemiological characteristics and surgical strategy of a large series of blepharochalasis patients with long-term follow-up. The prognosis of different clinical deformities was also investigated. METHODS: This was a retrospective cohort study, including consecutive patients diagnosed with blepharochalasis in a single center. Blepharoplasty and other surgical approaches were performed according to manifestations, after a 2-year quiescent period with no recurrent attacks and exacerbation of lesions. Prognosis after surgery was recorded. RESULTS: A total of 93 patients, with a mean age of 30.77 ± 14.04 (range: 9.00-70.00) years were included. Of all those 93 patients, 72.04% were females (67, P = 0.02). The mean follow-up was 5.29 ± 2.07 (range: 3-10) years before surgery, and 2.07 (range:1.54-4.22)years follow-up after surgery. The mean age of onset of blepharochalasis symptoms was 10.09 ± 3.32 (range: 5-16) years, and 83.87% patients got symptoms in puberty. With an average of 5 times per year, the mean duration of each acute attack was 28.12 ± 1.01 (rang: 2-192) hours. The mean duration from the onset of acute attack to the quiescent stage lasted for 7.33 ± 2.05 (range: 4-10) years. Most of the cases (88, 94.62%) had more than one manifestation at the end of the last follow-up before surgery. Ptosis (48.39%) was the most common deformity. Followed by lacrimal gland prolapse (44.09%), canthal angle deformity (29.04%), lower eyelid retraction (17.20%). After surgery, the functional and cosmetically acceptable results were achieved in all patients except for overcorrection in 5 (11.90%) patients with ptosis. The lacrimal gland prolapse recurred in two (4.00%) patients at 29 and 36 months after surgery. CONCLUSIONS: Blepharochalasis is rare but mostly occurred in adolescent females. The process from the onset to the stable stage usually lasted for about 7 years, which might be associated with the onset of puberty. Surgical management of clinical manifestations after at least 2-year follow-up period of quiescence would be appropriate in order to observe a great plastic effect, low overcorrection and recurrence rate.


Assuntos
Blefaroplastia , Blefaroptose , Doenças Palpebrais , Adolescente , Adulto , Idoso , Blefaroptose/epidemiologia , Blefaroptose/cirurgia , Criança , Pré-Escolar , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/epidemiologia , Doenças Palpebrais/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
7.
Medicine (Baltimore) ; 100(29): e26688, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398040

RESUMO

RATIONALE: Fungal keratitis (FK) is a severe vision-threatening disease that can lead to corneal perforation or endophthalmitis despite proper treatment. It is important to diagnose the disease promptly due to its indolent nature and disproportionate disease symptoms. Trichosporon asahii is reported rarely as the causative organism of FK. We report a case of highly unusual bilateral T asahii keratitis following ptosis surgery. PATIENT CONCERNS: An 86-year-old female underwent bilateral levator resection surgery for ptosis. Postoperatively, the patient complained of gradually worsening bilateral ocular pain and a decrease in visual acuity associated with a chronic non-healing epithelial defect. DIAGNOSES: Both eyes of the patient were evaluated using best-corrected visual acuity, intraocular pressure, slit-lamp examination, fundus examination, and corneal culture. Multifocal deep stromal infiltrates were found in both corneas. Cultures from both corneal ulcers revealed growth of T asahii. Optical coherence tomographic examination showed bilateral macular edema. INTERVENTIONS: The patient was treated with revisional ptosis surgery, an antifungal agent for the corneal ulcer, and intravitreal injection of steroid for macular edema. OUTCOMES: Both eyes recovered well. Her best-corrected visual acuity improved from 20/200 to 20/40 in the right eye and from 20/100 to 20/40 in the left eye. LESSONS: FK can develop in the cornea when certain risk factors are present, including recent lid surgery, chronic keratitis, and steroid eye drop use. Identification and correction of risk factors can be beneficial in the treatment of FK.


Assuntos
Basidiomycota/isolamento & purificação , Blefaroptose/cirurgia , Infecções Oculares Fúngicas/diagnóstico , Idoso de 80 Anos ou mais , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Diagnóstico Diferencial , Infecções Oculares Fúngicas/tratamento farmacológico , Feminino , Humanos , Soluções Oftálmicas , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico
8.
Plast Reconstr Surg ; 148(2): 195e-199e, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398084

RESUMO

SUMMARY: Patients with aponeurotic blepharoptosis who are treated with external levator advancement may experience complications such as upper eyelid height asymmetry and often require revision surgery. The authors assessed the efficacy of Müller muscle-conjunctival resection in cases with upper eyelid height asymmetry following bilateral external levator advancement. The authors used retrospective analysis of 11 cases between September of 2016 and October of 2018 with eyelid asymmetry following bilateral external levator advancement. Following a positive phenylephrine test, these patients underwent unilateral Müller muscle-conjunctival resection revision surgery to treat the undercorrected eyelid. Preoperative and postoperative marginal reflex distance 1, symmetry outcomes, and clinical outcomes of patients were evaluated after the Müller muscle-conjunctival resection. The average patient age was 54.81 ± 3.95 years (range, 37 to 69 years; median, 56 years); seven patients (63.6 percent) were women. Hering dependency was seen in all patients before the external levator advancement. A total of three patients underwent bilateral external levator advancement simultaneously, and eight patients underwent bilateral external levator advancement sequentially. The phenylephrine test was positive in all patients before the Müller muscle-conjunctival resection. Symmetry outcomes were assessed after the revision surgery as perfect (<0.5 mm), good (≥0.5 to <1 mm), or fair (≥1 mm) in four patients, six patients, and one patient, respectively. An optimal correction was noted in 13 of the 22 eyelids after the revision surgery, whereas eight of the 22 eyelids had minimal undercorrection, and one eyelid had minimal overcorrection. Müller muscle-conjunctival resection revision surgery for treatment of the ptotic eyelid following bilateral external levator advancement is viable and may represent a new alternative among the limited revision techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Blefaroplastia/métodos , Blefaroptose/cirurgia , Reoperação/métodos , Adulto , Idoso , Blefaroplastia/estatística & dados numéricos , Túnica Conjuntiva/cirurgia , Pálpebras/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
9.
Korean J Ophthalmol ; 35(5): 383-390, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34344132

RESUMO

PURPOSE: Even though it is stated that external levator advancement (ELA) has a much longer learning curve than Müller muscle-conjunctival resection (MMCR) in the treatment of aponeurotic ptosis, there is no study in the literature regarding the learning curves of these two surgical techniques. We aimed to objectively determine the length of the learning curves of ELA and MMCR using cumulative sum (CUSUM) analysis. METHODS: The first 30 unilateral ELA and the first 30 unilateral MMCR consecutively performed by a single surgeon were retrospectively reviewed. The CUSUM method was used to analyze the learning curves of ELA and MMCR based on operation times of consecutive surgeries and the clinical outcomes were compared. RESULTS: CUSUM analyses revealed that the operation time stabilized after around 11 ELA surgeries and 12 MMCR surgeries and R2 value for ELA and MMCR were 0.93 and 0.91, respectively. There was no significant difference in these stratified analyses. Mean operation time was 45.7 minutes in the ELA group and 34.1 minutes in the MMCR group (p = 0.002). Total number of intraoperative complications was 37 in the ELA group and 16 in the MMCR group (p = 0.015). Symmetry success rate was significantly higher (p < 0.0001) and reoperation rate was significantly lower in the MMCR group (p = 0.045). CONCLUSIONS: Even though ELA is more challenging than MMCR, comparable learning curves indicate that surgeons in training need to be encouraged to perform both techniques. The challenges and obstacles that the surgeons in training face in these two techniques need to be analyzed in detail.


Assuntos
Blefaroplastia , Blefaroptose , Blefaroptose/cirurgia , Pálpebras/cirurgia , Humanos , Curva de Aprendizado , Músculos Oculomotores/cirurgia , Estudos Retrospectivos
11.
Traffic Inj Prev ; 22(6): 473-477, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34133254

RESUMO

OBJECTIVE: To evaluate the impact of visually significant blepharoptosis and dermatochalasis on driving safety and performance. Patients with visually significant blepharoptosis often complain of difficulty with driving, but the impact of blepharoptosis on driving has not been evaluated in a real-world setting. METHODS: Retrospective cohort study of 610 consecutive adult patients undergoing bilateral functional blepharoplasty or ptosis repair surgery at a single, University-based practice between 2014 and 2017. This cohort had a median age of 65 and was predominantly female. Pre-operative rates of motor vehicle collisions (MVCs) and moving violations (MVs) extracted from state Department of Transportation (DOT) records were compared with post-operative rates, using each patient as their own control. Poisson models were used for analysis. RESULTS: Subjects were included in the study for a median of 730 days before eyelid surgery (IQR 346 - 730) and 783 days after surgery (IQR 449 - 1176). There were 30 total MVCs before surgery (0.024 per subject, per year) and 48 after surgery (0.036 per subject, per year) (p = 0.08). There were 81 MVs before surgery (0.065 per subject, per year) and 66 after (0.049 per subject, per year) (p = 0.11). The multivariable model comparing MVCs pre- versus post-surgery adjusting for age, ptosis severity, gender, and comorbidities yields a rate ratio of 0.63 (p = 0.05). The multivariable model comparing MVs pre- versus post-surgery demonstrates a rate-ratio of 1.2 (p = 0.20). Older age was associated with lower rates of moving violations (coefficient of -0.03, p < 0.01). None of the other variables included in the final models had a significant association with MVCs or MVs. CONCLUSIONS: In this cohort, visually significant blepharoptosis and dermatochalasis were not associated with rates of MVCs or MVs. Further work is needed to study the impact of these common conditions on driving, for example adjusting MVC and MV rates by miles driven, which may influence decisions about when to operate on ptotic eyelids.


Assuntos
Acidentes de Trânsito , Condução de Veículo , Blefaroplastia , Blefaroptose , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Idoso , Condução de Veículo/legislação & jurisprudência , Blefaroplastia/estatística & dados numéricos , Blefaroptose/epidemiologia , Blefaroptose/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Segurança
12.
J Craniofac Surg ; 32(8): e698-e701, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34172687

RESUMO

OBJECTIVE: To explore the ocular surface changes after ptosis surgery in patients with severe congenital blepharoptosis. METHODS: The patients were divided into group A and group B, Group A received conjoint fascial sheath suspension, and group B received frontal muscle flap suspension. The ocular surface changes were followed upon the 7th day and in the 1st and 3rd month after operation, which included Schirmer test (ST), break-up time (BUT), tear meniscus height (TMH). For normal distribution variables, t test was used before and after operation, and the Wilcoxon test was used for variables with abnormal distribution. RESULTS: Compared to preoperative status, the ST and TMH were not significantly changed after surgery (P > 0.05), but BUT higher on the 7th day and in the 1st and 3rd month after operation (P < 0.05). The fluorescence staining (FL) score was higher in the 3rd month than that in the 1st month (P < 0.05), but was not significantly different between the 7th and in the 1st month after operation (P > 0.05). The ST, TMH, and BUT after surgery were not significantly different between groups of A and B (P > 0.05), but the FL score lower in the 3rd month than on the 7th day and in the 1st month after operation (P < 0.05). CONCLUSIONS: The ST, BUT, and TMH were not significantly changed after surgery between groups of A and B, but the FL score was lower in group A than that in group B in early postoperative time.


Assuntos
Blefaroptose , Blefaroptose/cirurgia , Olho , Fáscia , Humanos , Músculos , Retalhos Cirúrgicos
13.
J Plast Reconstr Aesthet Surg ; 74(11): 3094-3100, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33994326

RESUMO

Treatment options for acquired blepharoptosis include levator resection, levator aponeurosis advancement (LAA), Müller's muscle-conjunctival resection (MMCR), and frontalis suspension. Previously, we reported a technique called external Müller's muscle tucking (EMMT) using the Müller's muscle as a power source. In this study, we compare LAA with EMMT and evaluate the recurrence and reoperation rates. LAA was performed on 96 eyelids in 51 patients. The average follow-up period was 12.2 months, recurrence occurred in four eyelids (4.2%) of three patients, and reoperation was required in one eyelid of one patient (2.0%). EMMT was performed on 94 eyelids in 51 patients, the mean follow-up period was 10.5 months, recurrence occurred in 14 eyelids (15%) of 10 patients, and reoperation was required in three eyelids of two patients (3.9%). A comparison of LAA and EMMT recurrence showed that EMMT was associated with a significantly higher recurrence rate (P = 0.0021). The causes of EMMT recurrence included thinning and fatty degeneration of Müller's muscles, necrosis of ligated Müller's muscles, and less postoperative scar formation. There was no correlation between EMMT recurrence and the severity of the blepharoptosis.


Assuntos
Aponeurose/cirurgia , Blefaroptose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos
16.
Orv Hetil ; 162(18): 705-711, 2021 05 02.
Artigo em Húngaro | MEDLINE | ID: mdl-33934085

RESUMO

Összefoglaló. Bevezetés: Szemhéjcsüngésnek (ptosis vagy blepharoptosis) nevezzük azt az állapotot, amikor a felso szemhéj abnormálisan alacsony pozícióban van. A szemhéjcsüngésnek lehetnek veleszületett és szerzett formái. Célkituzés: Célunk volt bemutatni a szemhéjemelo izom (levator) - veleszületett szemhéjcsüngés korrekciója céljából végzett - kötohártya feloli redozésének eredményeit retrospektív módszerrel. Módszer: 20 beteg 22 szemhéján végeztük el a mutétet (átlagéletkor: 19,4 ± 9,9 év, férfi: 12 [60%], no: 8 [40%]). Beválasztási kritérium volt a közepes (5-8 mm) vagy jó (9 mm felett) levatorfunkció. Kizártuk a korábban szemhéjkorrekciós mutéten átesett és a 3 hónapnál rövidebb követési idovel rendelkezo betegeket. A mutét elott megmértük a levatorfunkciót és a margó-reflex-távolságot. A mutét után megmértük a margó-reflex-távolságot, a szemhéjak magassága közti aszimmetria mértékét, és elemeztük a szemhéj posztoperatív kontúrját. Eredmények: A preoperatív levatorfunkció 10,6 ± 3,0 mm, a preoperatív margó-reflex-távolság 1,8 ± 0,8 mm volt. A 7,8 ± 7,2 hónap átlagos követési ido alatt a posztoperatív margó-reflex-távolság 3,2 ± 0,8 mm volt. A preoperatív és a posztoperatív margó-reflex-távolság különbsége nem tért el szignifikánsan a sikeres és a sikertelen mutétek között (p = 0,523). A szemhéjak magassága közti aszimmetria mértéke 3 betegnél haladta meg az 1 mm-t. A szemhéj posztoperatív kontúrja minden esetben megfelelo volt. A mutét összességében 86,4%-ban (19/22) volt sikeres. A helyi érzéstelenítésben és altatásban végzett mutétek közt nem találtunk szignifikáns különbséget a sikeresség tekintetében (p = 0,227). Következtetés: Tanulmányunk alapján az elvégzett mutéteink eredményessége a nemzetközi irodalomban közöltekhez hasonló volt. A veleszületett szemhéjcsüngés korrekciójára a kötohártya feloli levatorredozés megfelelo kezelési mód közepes vagy annál jobb levatorfunkció esetén. Orv Hetil. 2021; 162(18): 705-711. INTRODUCTION: Droopy eyelid (ptosis or blepharoptosis) is defined through abnormally low upper eyelid position. Ptosis can be classified as congenital or acquired. OBJECTIVE: Our purpose was to report the results of posterior approach levator plication for congenital ptosis in a retrospective review. METHOD: 22 eyelids of 20 patients were included in this study (age: 19.4 ± 9.9 years, male: 12 [60%], female: 8 [40%]). The inclusion criteria were moderate (5-8 mm) or good (more than 9 mm) levator function. Patients with postoperative follow-up time shorter than 3 months and those who underwent previous eyelid surgery were excluded. The data collected included preoperative levator function and margin reflex distance, postoperative margin reflex distance, inter-eyelid height asymmetry and postoperative eyelid contour. RESULTS: Preoperative levator function was 10.6 ± 3.0 mm, preoperative margin reflex distance was 1.8 ± 0.8 mm. During 7.8 ± 7.2 months postoperative follow-up, postoperative margin reflex distance was 3.2 ± 0.8 mm. The difference between preoperative and postoperative margin reflex distance was not significant (p = 0.523) in the group of successful operations compared with unsuccessful operations. Inter-eyelid height asymmetry was more than 1 mm in 3 cases. Satisfactory postoperative eyelid contour was achieved in all cases. Overall success rate was 86.4% (19/22). Surgical success did not differ significantly between surgeries in local or general anaesthesia (p = 0.227). CONCLUSION: Our study shows an overall success rate of the procedures comparable to those in international publications. Posterior approach levator plication for congenital ptosis with moderate or better levator function seems to be a suitable treatment method. Orv Hetil. 2021; 162(18): 705-711.


Assuntos
Blefaroptose , Adolescente , Adulto , Blefaroptose/cirurgia , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
17.
J Craniofac Surg ; 32(7): 2358-2361, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34054081

RESUMO

BACKGROUND: Frontalis flap advancement is an alternative means of congenital ptosis repair from frontalis suspension utilizing autologous fascia or allogenic implants. Variations in technique, including flap division, location and number of skin incisions, and dissection planes, are described in the literature. MATERIALS AND METHODS: A retrospective case series of patients with congenital myogenic ptosis treated with simplified, minimal dissection frontalis flap advancement involving a single upper eyelid crease incision with dissection in the preseptal and subcutaneous planes without division to mobilize the frontalis flap. Inclusion criteria: pediatric patients age < 18 years with either primary or recurrent congenital ptosis following previous surgical repair. Exclusion criteria: ptosis of neurogenic etiology or postoperative follow-up < 3 months. Primary outcome measures were postoperative margin-reflex distance 1 (MRD1), the difference in MRD1 between surgical and nonsurgical eyelids in unilateral ptosis, and lagophthalmos. Secondary outcome measures included recurrence and complications. RESULTS: Twenty-six patients met inclusion criteria, 24 males and 2 females. Mean postoperative MRD1 at last follow-up was 2.9 ±â€Š1.2 mm and the mean difference in MRD1 between surgical and nonsurgical eyelids at last follow-up was 1.1 ±â€Š1.0 mm. Average lagophthalmos at postoperative month 2 to 5 was 0.6 ±â€Š0.7 mm. One patient demonstrated postoperative lid retraction that required re-operation. Four of 31 eyelids (12.9%) demonstrated ptosis recurrence at 5, 12, or 24 months. CONCLUSIONS: In this retrospective series, the authors report clinically and statistically significant surgical eyelid height improvement and symmetry between nonsurgical and surgical eyelids in congenital ptosis patients treated with minimal dissection direct frontalis flap advancement.


Assuntos
Blefaroplastia , Blefaroptose , Implantes Dentários , Adolescente , Blefaroptose/cirurgia , Criança , Dissecação , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Músculos Oculomotores/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
18.
Graefes Arch Clin Exp Ophthalmol ; 259(10): 3119-3125, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33963919

RESUMO

PURPOSE: To evaluate the postoperative changes with a computer vision algorithm for anterior full-face photographs of patients who have undergone upper eyelid blepharoplasty surgery with, or without, a Müller's muscle-conjunctival resection (MMCR). METHODS: All patients who underwent upper eyelid blepharoplasty surgery (Group I), or upper eyelid blepharoplasty with MMCR (Group II) were included. Both preoperative and 6-month postoperative anterior full-face photographs of 55 patients were analyzed. Computer vision and image processing technologies were used to measure the palpebral distance (PD), eye-opening area (EA), and average eyebrow height (AEBH) for both eyes. Preoperative and postoperative measurements were calculated and compared between the two groups. RESULTS: In Group II, change in postoperative Right PD, Left PD, Right EA, Left EA was significantly higher than in Group I (p = 0.004 for REPD; p = 0.001 for LEPD; p = 0.004 for REA; p = 0.002 for LEA, p < 0.05). In Group II, the postoperative change in Right AEBH, Left AEBH was significantly higher than in Group I (p = 0.001 for RABH and LABH, p < 0.05). CONCLUSION: Eyelid surgery for esthetic purposes requires artistic judgment and objective evaluation. Because of the slight differences in photograph sizes and dynamic factors of the face due to head movements and facial expressions, it is hard to compare and make a truly objective evaluation of the eyelid operations. With a computer vision algorithm, using the face and facial landmark detection system, the photographs are normalized and calibrated. This system offers a simple, standardized, objective, and repeatable method of patient assessment. This can be the first step of Artificial Intelligence algorithm to evaluate the patients who had undergone eyelid operations.


Assuntos
Blefaroplastia , Blefaroptose , Inteligência Artificial , Blefaroptose/diagnóstico , Blefaroptose/cirurgia , Computadores , Pálpebras/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
19.
Ann Palliat Med ; 10(3): 3185-3193, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33849104

RESUMO

BACKGROUND: Perioperative negative emotion of surgical patients has a greater impact on surgical efficacy and prognosis. The study aimed to analyze the effect of psychological intervention on perioperative anxiety and depression of patients with severe blepharoptosis undergoing autologous fascia lata frontal muscle suspension, and provide a reference for improving and optimizing patient care plans. METHODS: Ninety-two patients with severe blepharoptosis who underwent autologous fascia lata frontal muscle suspension in our hospital from February 2018 to January 2020 were selected as the research subjects. Patients were numbered according to the order of operation, and were divided into a control group (46 cases) and an observation group (46 cases) using a numerical random table method. Patients in both groups received routine nursing intervention during the perioperative period, and patients in the observation group also received psychological intervention during this period. The two groups of patients were evaluated using the Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D). Numerical rating scale (NRS) results for surgical site pain were evaluated and compared between the groups. The perioperative compliance rate and nursing satisfaction rate of the two groups of patients were investigated and compared. Intraoperative and postoperative complications were collected, sorted, and compared between the two groups of patients. RESULTS: (I) The HAM-A and HAM-D scores of the observation group before and after surgery were significantly lower than those of the control group (P<0.05). (II) The NRS scores of patients in the observation group were markedly lower than those in the control group at 6 h and 24 h postoperatively (P<0.05). (III) The intra- and post-operative complication rate of the observation group was lower than that of the control group (P<0.05). (IV) The compliance rate and the total satisfaction rate of patients with the perioperative care in the observation group was considerably higher compared to that of patients in the control group (P<0.05). CONCLUSIONS: Our results showed that psychological intervention can effectively alleviate the negative emotions in patients with severe blepharoptosis who underwent autologous fascia lata frontal muscle suspension, improve their compliance with medical care, reduce their pain, and increase their satisfaction rate. Therefore, psychological intervention has high clinical value.


Assuntos
Blefaroplastia , Blefaroptose , Ansiedade , Blefaroptose/cirurgia , Fascia Lata/cirurgia , Humanos , Músculos , Intervenção Psicossocial , Resultado do Tratamento
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