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1.
Medicine (Baltimore) ; 103(24): e38547, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38875429

RESUMO

INTRODUCTION: Oculomotor nerve palsy (ONP) is often discovered in the ophthalmology department, manifested as ptosis with the same side, eyeball in the fixed external booth, or accompanied by limited inward, upward, and downward movements. The present case report described the effect of electroacupuncture (EA) on a breast cancer patient with ONP after chemotherapy. PATIENT CONCERNS: A 56-year-old breast cancer patient presented with severe ptosis and fixed right eye exotropia. Besides, it is challenging to perform the movement inward, upward, and downward, and with obvious diplopia. DIAGNOSES: The breast cancer patient was diagnosed with ONP, chemotherapy history. INTERVENTIONS: The patient was introduced to acupuncture department to receiving EA treatment. OUTCOMES: After 12 times of EA treatments, the symptom of ptosis was significantly improved, and the right upper eyelid can lift autonomously as same as the left eye. Besides, the patient's right lateral eye could move freely, and the symptoms of double vision disappeared. CONCLUSION: The case suggests that EA may be an effective alternative treatment for ONP.


Assuntos
Blefaroptose , Neoplasias da Mama , Eletroacupuntura , Doenças do Nervo Oculomotor , Humanos , Feminino , Pessoa de Meia-Idade , Eletroacupuntura/métodos , Doenças do Nervo Oculomotor/terapia , Doenças do Nervo Oculomotor/etiologia , Neoplasias da Mama/tratamento farmacológico , Blefaroptose/etiologia , Blefaroptose/induzido quimicamente , Blefaroptose/terapia , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico
2.
BMC Ophthalmol ; 24(1): 232, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38822301

RESUMO

BACKGROUND: Blepharoptosis is a common symptom in ophthalmology clinic, but eyelid retraction when smiling in a ptosis eye is a rare manifestation. Here we report a novel manifestation that eyelid retraction during smiling in a patient with monocular congenital ptosis. CASE DESCRIPTION: A 10-year-old girl with isolated and mild unilateral congenital ptosis showed eyelid retraction in ptotsis eye when smiling together with a lid lag on downgaze. She didn't have any systematic and ocular diseases other than myopia and astigmatism.Eyelid retraction during smiling is 5 mm, resulting in a significant difference in the height of bilateral palpebral fissures.As for ptosis, is mild.The margin to reflex distance 1 is 1.0 mm on the right eye(ptosis eye) and 3.0 mm on the left eye. A lid lag of 1.0 mm on downward gaze was noted on the right, she could close her eyes fully while sleeping.The ice pack test, laboratory test for thyroid function, whole-exome sequencing (WES) and magnetic resonance imaging(MRI) of the orbital and ocular motor nerves showed normal results.Her symptoms alleviated after 6 months, with the retraction of the right upper eyelid when smiling was approximately 3 mm, thus the difference in the palpebral fissure height when smiling was smaller than that at the initial presentation. CONCLUSION: Blepharoptosis may accompanied with abnormal innervation like eyelid retraction, this phenomenon can be alleviated with age.The results of the levator muscle function test should be carefully examined to determine whether it is ptosis in an impaired innervation eyelid.


Assuntos
Blefaroptose , Pálpebras , Humanos , Feminino , Blefaroptose/congênito , Blefaroptose/fisiopatologia , Criança , Pálpebras/fisiopatologia , Sorriso/fisiologia , Músculos Oculomotores/fisiopatologia
3.
J Plast Reconstr Aesthet Surg ; 93: 203-209, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38703712

RESUMO

BACKGROUND: Direct browlift is useful but leaves a scar above the brow. We proposed a dual-plane browlift to avoid facial scarring while effectively resolving brow ptosis in young and young adult patients. METHODS: Seven patients with facial palsy underwent dual-plane browlift between July 2018 and June 2022. The mean postoperative follow-up period was 31.9 months. Skin resection at the hairline was combined with subcutaneous dissection down to the inferior margin of the brow to "lift" the brow. Fascia lata strips were fixed to the dermis just inferior to the eyebrow to "hold" the brow, and the strips were suspended upward through the subperiosteal tunnel and fixed to the periosteum. Brow height was compared before and after the procedure and with the contralateral side. RESULTS: The reported complications included slight hematoma at the recipient site, temporary difficulty in closing the eye, and seroma at the fascia donor site. The paralyzed side showed significant differences between the preoperative period and postoperative months (POM) 3, 6, and 12, but differences were not shown in the intervals between POM 3 and 6, 6 and 12, or 3 and 12. The difference in eyebrow height between the paralyzed and nonparalyzed sides was significant preoperatively but not at POM 3, 6, or 12. All scars matured well, and the fascia silhouette was not visible in the forehead region. CONCLUSIONS: Dual-plane browlift enables rigid suspension using the fascia lata and excises flaccid skin without leaving facial scars, yielding excellent cosmetic quality and stable long-term outcomes.


Assuntos
Blefaroptose , Sobrancelhas , Paralisia Facial , Ritidoplastia , Humanos , Feminino , Paralisia Facial/cirurgia , Masculino , Blefaroptose/cirurgia , Ritidoplastia/métodos , Adulto , Adulto Jovem , Fascia Lata/transplante , Testa/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Blefaroplastia/métodos
4.
Ophthalmic Plast Reconstr Surg ; 40(3): e95-e97, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38738723

RESUMO

We describe the first case reported in ophthalmological literature of the surgical management of a 17-month-old boy with bilateral vision-threatening ptosis, tarsomegaly, ectropion, and euryblepharon secondary to suspected overgrowth syndrome. We elaborate on the major challenges associated with surgical management including the natural and asymmetric growth of oversized tissue, the high likelihood of scarring and formation of disorganized tissue, and risks of frequent intubation in these patients who may have lesions that compromise critical structures such as the airway. Ultimately, surgical intervention is encouraged primarily if vision or ocular health is threatened and secondarily to achieve good cosmesis.


Assuntos
Blefaroptose , Humanos , Masculino , Blefaroptose/cirurgia , Blefaroptose/diagnóstico , Blefaroptose/etiologia , Lactente , Procedimentos Cirúrgicos Oftalmológicos/métodos , Pálpebras/cirurgia , Pálpebras/anormalidades , Síndrome , Músculos Oculomotores/cirurgia
5.
J AAPOS ; 28(3): 103919, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38631482

RESUMO

Lamb-Shaffer syndrome (LSS) is a rare neurodevelopmental disorder, genetically diagnosed in fewer than 100 individuals worldwide. We present a case series of 6 pediatric patients with LSS and describe its ophthalmic manifestations. Strabismus was present in 5 patients, with exotropia being most common. All subjects had significant refractive errors; 5 had astigmatism of at least 2 D. All patients had optic nerve abnormalities, including pallor (4), hypoplasia (2), and anomalous appearance (1), with retinal nerve fiber layer thinning demonstrated in a single subject. Other ophthalmic disorders detected were ptosis (1), nasolacrimal duct obstruction (1), and nystagmus (2).


Assuntos
Estrabismo , Humanos , Masculino , Feminino , Pré-Escolar , Criança , Lactente , Estrabismo/diagnóstico , Nervo Óptico/anormalidades , Nervo Óptico/diagnóstico por imagem , Blefaroptose/diagnóstico , Obstrução dos Ductos Lacrimais/diagnóstico , Obstrução dos Ductos Lacrimais/congênito , Erros de Refração/diagnóstico , Erros de Refração/fisiopatologia , Astigmatismo/diagnóstico , Astigmatismo/fisiopatologia , Adolescente , Nistagmo Patológico/diagnóstico , Exotropia/diagnóstico , Exotropia/fisiopatologia , Exotropia/genética
6.
Ophthalmic Plast Reconstr Surg ; 40(3): 331-335, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38624153

RESUMO

PURPOSE: Pilot studies suggest that waiting 15 minutes after a subcutaneous tranexamic acid injection is associated with decreased intraoperative bleeding and postoperative ecchymosis in eyelid surgery. The outcomes of commencing eyelid surgery immediately after injection without a waiting period remain unexplored. METHODS: This prospective, randomized, multicenter, double-masked, controlled study examined bilateral symmetric upper and/or lower lid blepharoplasty or ptosis repair. Patients received tranexamic acid in 1 eyelid and control in the contralateral eyelid. The surgeon recorded the side with more intraoperative bleeding. Two masked graders evaluated periocular ecchymosis at postoperative day 0 and postoperative week 1 (POW 1) with a 5-point scale. At POW 1, patients reported subjective grading of bruising as increased on 1 side or similar on both sides. Results were analyzed with Wilcoxon signed-rank and sign tests. RESULTS: Of 130 patients, there was less eyelid ecchymosis on the tranexamic side at postoperative day 0 ( p = 0.001) and POW 1 ( p < 0.001). By surgery type, the 69 levator advancement surgeries had significantly less ecchymosis at postoperative day 0 ( p < 0.001) and POW 1 ( p = 0.001), while upper eyelid blepharoplasty, combined upper and lower lid blepharoplasty, and conjunctivomullerectomy trended toward significance. Of 68 patients reporting a POW 1 grading, 69% reported less bruising on the tranexamic side ( p < 0.001). Intraoperative bleeding was not significantly different between sides ( p = 0.930). CONCLUSIONS: Without a postinjection waiting period, subcutaneous tranexamic acid for eyelid surgery significantly decreased postoperative ecchymosis on postoperative day 0 and POW 1 but did not affect intraoperative bleeding. Subcutaneous tranexamic acid was not associated with any complications.


Assuntos
Antifibrinolíticos , Blefaroplastia , Blefaroptose , Equimose , Pálpebras , Hemorragia Pós-Operatória , Ácido Tranexâmico , Humanos , Ácido Tranexâmico/administração & dosagem , Antifibrinolíticos/administração & dosagem , Estudos Prospectivos , Método Duplo-Cego , Blefaroplastia/métodos , Blefaroplastia/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Idoso , Pálpebras/cirurgia , Equimose/etiologia , Equimose/prevenção & controle , Equimose/diagnóstico , Blefaroptose/cirurgia , Adulto , Perda Sanguínea Cirúrgica/prevenção & controle
7.
Aesthetic Plast Surg ; 48(11): 2050-2056, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38578308

RESUMO

BACKGROUND: Levator aponeurectomy is a common operation for mild to moderate blepharoptosis. The accuracy of ptosis correction relied on intraoperative judgement when patients were under local anesthesia. For patients who must receive the operation under general anesthesia, it would be an issue to determine how much length of levator aponeurosis to shorten. To solve this issue, we collected data from patients who underwent the operation under local anesthesia and concluded an algorithm. METHODS: This single-center, prospective bivariate regression study allocated patients of mild to moderate congenital blepharoptosis who received levator aponeurectomy under local anesthesia. Preoperative MRD1 and levator function, intraoperative amount of levator aponeurotic shortening, and postoperative MRD1 were measured. The follow-up period was right after the operation. RESULTS: Twenty-nine patients were included in this trial. Two subjects exited because of not receiving allocated operation and data of the other 27 subjects (including 34 eyelids) were analyzed. A scatter diagram was drawn where x axis referred to levator function and y axis referred to the ratio of the amount of shortening of levator aponeurosis over the height of MRD1 correction. Linear regression showed y = - 0.2717*x + 5.026, R2 = 0.8553. CONCLUSION: A modified algorithm to predict the amount of shortening of levator aponeurosis based on levator function and height of ptosis correction was concluded with better accuracy and clinical feasibility. 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 .


Assuntos
Algoritmos , Aponeurose , Blefaroplastia , Blefaroptose , Humanos , Blefaroptose/cirurgia , Blefaroptose/congênito , Feminino , Masculino , Estudos Prospectivos , Aponeurose/cirurgia , Blefaroplastia/métodos , Músculos Oculomotores/cirurgia , Criança , Adolescente , Adulto Jovem , Índice de Gravidade de Doença , Pálpebras/cirurgia , Adulto , Pré-Escolar , Resultado do Tratamento
8.
Aesthetic Plast Surg ; 48(11): 2057-2063, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38589561

RESUMO

BACKGROUND: Chat generative pre-trained transformer (ChatGPT) is a publicly available extensive artificial intelligence (AI) language model that leverages deep learning to generate text that mimics human conversations. In this study, the performance of ChatGPT was assessed by offering insightful and precise answers to a series of fictional questions and emulating a preliminary consultation on blepharoplasty. METHODS: ChatGPT was posed with questions derived from a blepharoplasty checklist provided by the American Society of Plastic Surgeons. Board-certified plastic surgeons and non-medical staff members evaluated the responses for accuracy, informativeness, and accessibility. RESULTS: Nine questions were used in this study. Regarding informativeness, the average score given by board-certified plastic surgeons was significantly lower than that given by non-medical staff members (2.89 ± 0.72 vs 4.41 ± 0.71; p = 0.042). No statistically significant differences were observed in accuracy (p = 0.56) or accessibility (p = 0.11). CONCLUSIONS: Our results emphasize the effectiveness of ChatGPT in simulating doctor-patient conversations during blepharoplasty. Non-medical individuals found its responses more informative compared with the surgeons. Although limited in terms of specialized guidance, ChatGPT offers foundational surgical information. Further exploration is warranted to elucidate the broader role of AI in esthetic surgical consultations. LEVEL OF EVIDENCE V: Observational study under respected authorities. 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 .


Assuntos
Inteligência Artificial , Blefaroplastia , Blefaroptose , Humanos , Blefaroplastia/métodos , Blefaroptose/cirurgia , Feminino , Encaminhamento e Consulta , Aconselhamento/métodos , Masculino , Cirurgia Plástica , Relações Médico-Paciente , Adulto
9.
BMJ Case Rep ; 17(4)2024 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-38684350

RESUMO

The POLG mutation, a leading cause of mitochondrial diseases, exhibits a wide-ranging age of onset and a complex clinical presentation. We encountered an atypical clinical profile in an elderly man with a POLG mutation, characterised by a stroke-like episode, chronic insomnia and transient oculomasticatory rhythmic movement. History revealed chronic constipation since his 50s and progressive bilateral ophthalmoplegia since his early 60s. Subsequently, he had experienced acute encephalopathy and later developed chronic insomnia. The present neurological examination showed bilateral complete ophthalmoplegia, ptosis, and rhythmic ocular and jaw movements. Imaging indicated findings suggestive of a stroke-like episode and eventual genetic analysis revealed a homozygous missense mutation in the POLG gene. This case expands the clinical spectrum of POLG mutations in individuals over 60 years, showcasing the rare combination of a stroke-like episode, chronic insomnia and oculomasticatory rhythmic movement.


Assuntos
DNA Polimerase gama , Distúrbios do Início e da Manutenção do Sono , Humanos , Masculino , DNA Polimerase gama/genética , Distúrbios do Início e da Manutenção do Sono/genética , Acidente Vascular Cerebral/genética , Acidente Vascular Cerebral/complicações , Mutação de Sentido Incorreto , Doenças Mitocondriais/genética , Doenças Mitocondriais/complicações , Doenças Mitocondriais/diagnóstico , Idoso , Pessoa de Meia-Idade , Oftalmoplegia/genética , Oftalmoplegia/diagnóstico , Blefaroptose/genética , Mutação
10.
BMJ Open Ophthalmol ; 9(1)2024 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-38575344

RESUMO

PURPOSE: Effective visual perceptual processing is one of the many components of surgical competence. Human face identification is most efficient when viewed upright. However, it is not yet clear how this perception sensitivity impacts eyelid symmetry. This study investigates surgeons' and laypeople's accuracy and efficiency in perceiving eyelid asymmetry from different spatial perspectives. METHODS: A prospective psychometric experiment was conducted where oculoplastic surgeons were recruited from the American Society of Ophthalmic Plastic and Reconstructive Surgery and the Brazilian Oculoplastic Surgery Society, and control participants were recruited via crowdsourcing (Amazon's Mechanical Turk). Standard illustrations of the human face with varying degrees of eyelid abnormality, laterality, gender and rotation were presented to participants who were asked to judge whether the eyelids were symmetric or asymmetric. RESULTS: The survey was completed by 75 oculoplastic surgeons (49.33% male; mean age of 46.9±10.7) and 192 lay individuals (54.6% male; mean age 34.6±11.3 years). Among oculoplastic surgeons, deviation from upright was significantly associated with increased reaction time and decreased proportion correct (OR per 45° for peak 0.68, 95% CI 0.60 to 0.77, p<0.001; OR per 45° for ptosis 0.52, 95% CI 0.32 to 0.87, p=0.012; OR per 180° for aggregate responses 0.56, 95% CI 0.51 to 0.61, p<0.001). Oculoplastic surgeons demonstrated increasing accuracy and decreasing reaction time with additional trials for both peak and ptosis. CONCLUSION: Oculoplastic surgeons perceive eyelid asymmetries more accurately and can better compensate for inverted sensory information. However, accuracy increases and reaction time decreases with additional trials, suggesting trainability and potential for improvement in inversion disability.


Assuntos
Blefaroptose , Doenças Palpebrais , Humanos , Masculino , Estados Unidos , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Feminino , Estudos Prospectivos , Pálpebras/cirurgia , Blefaroptose/cirurgia , Doenças Palpebrais/cirurgia , Percepção
11.
Digit J Ophthalmol ; 30(1): 15-18, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38601901

RESUMO

We report 2 cases of pediatric ocular myasthenia gravis. The first case was a 7-year-old girl who presented with bilateral ophthalmoplegia and ptosis that correlated with the onset of upper respiratory symptoms. Neuroimaging and acetylcholine receptor antibody testing were unremarkable. The ice pack test was positive. Symptoms greatly improved with pyridostigmine, with full resolution of ophthalmoplegia achieved by 8-month follow-up. The second case was a 4-year-old girl who presented emergently with ptosis and bilateral ophthalmoplegia. Acetylcholine receptor antibodies testing was positive. The patient was started on pyridostigmine and intravenous immunoglobulin and is scheduled to follow-up with pediatric ophthalmology in the outpatient setting.


Assuntos
Blefaroptose , Miastenia Gravis , Oftalmoplegia , Feminino , Criança , Humanos , Pré-Escolar , Brometo de Piridostigmina/uso terapêutico , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Blefaroptose/diagnóstico , Blefaroptose/etiologia , Oftalmoplegia/diagnóstico , Oftalmoplegia/etiologia , Receptores Colinérgicos , Autoanticorpos
12.
BMC Med Imaging ; 24(1): 97, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38671380

RESUMO

BACKGROUND: The aim of this study was to evaluate the ability of two novel eyelid curvature measurements to distinguish between normal eyes and different severities of blepharoptosis. METHODS: A comparative cross-sectional analysis of upper eyelid curvature was performed for different severities of patients with unilateral blepharoptosis (congenital and aponeurotic) and normal controls. Mean upper lid contour index (ULCI) and area circularity index (ACI) were calculated for each group by dividing the intercanthal distance by upper eyelid margin length (ULCI) and dividing the interpalpebral area by the area of a circle enclosing the eye (ACI). The ratio of each index for the study and fellow normal eye of each patient was also calculated and compared between groups. RESULTS: A total of 106 eyes including 30 eyes in the control group and 25, 27, and 24 eyes in the mild, moderate, and severe ptosis groups were enrolled in the study. ULCI and ACI showed a statistically significant difference between the groups (p < 0.001, p < 0.001). The inter-eye ratio (ULCI-ratio and ACI-ratio) of indices was also significantly different between groups (p = 0.002, p < 0.001). Pairwise comparisons revealed that ACI and ACI-ratio were significantly different between all pairs of study groups. CONCLUSION: The results of our study showed that ACI based on area measurements may distinguish blepharoptosis patients from normal controls and from each other. Including the data from the fellow normal eyes in the form of ratio indices may improve the differentiating power. These results can be useful in designing the optimal eyelid curvature measurements.


Assuntos
Blefaroptose , Pálpebras , Humanos , Blefaroptose/diagnóstico por imagem , Pálpebras/diagnóstico por imagem , Pálpebras/anormalidades , Pálpebras/patologia , Pálpebras/anatomia & histologia , Feminino , Masculino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Adolescente , Idoso , Estudos de Casos e Controles , Adulto Jovem , Criança
14.
BMC Ophthalmol ; 24(1): 164, 2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38622551

RESUMO

PURPOSE: To analyze the clinicopathological characteristics and surgical outcomes of patients with Wolfring gland ductal cysts (WGDCs). METHODS: A retrospective, consecutive, interventional comparative case series was performed over a period of 7 years. Data on demographic and clinical characteristics, pathological findings and outcomes of surgically excised cysts were collected. A comparison between the transconjunctival and transcutaneous approaches was also assessed. RESULTS: Forty-eight patients (48 eyelids) were included in the final analysis. The most common presenting symptom was painless eyelid swelling (81.3%). The median symptom duration was 11.5 months (IQR, 18.25). The upper eyelid was involved in 31 (64.6%) patients, 29/31 of whom had cysts in a medial or centromedial location. Forty-five (93.8%) cysts were bluish gray and transilluminable with clear contents on lid eversion and a median largest dimension of 22 mm (IQR, 8). A transverse conjunctival fibrotic band was observed along the proximal tarsal border in the cyst area in all patients. Signs of chronic trachoma were noted in 38 (79.2%) patients. Preoperative significant ptosis was present in 28/31 (90.3%) of the upper eyelid cysts. Thirty cysts (62.5%) were excised through the skin, and 18 cysts (37.5%) were excised transconjunctivally. Intraoperative cyst rupture, the need for conjunctival grafting and postoperative residual upper lid ptosis were significantly greater in the transconjunctival group (p = 0.009, p < 0.001, and p = 0.016, respectively). CONCLUSION: The present study highlights the clinicopathological characteristics of a relatively large series of surgically excised WGDCs. Transcutaneous excision of WGDCs has proven to be an effective treatment with fewer adverse sequelae than the transconjunctival approach.


Assuntos
Blefaroptose , Cistos , Humanos , Estudos Retrospectivos , Pálpebras/cirurgia , Pálpebras/patologia , Resultado do Tratamento , Cistos/cirurgia , Cistos/patologia
15.
Neurology ; 102(10): e209395, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38669629

RESUMO

BACKGROUND AND OBJECTIVES: We developed repetitive ocular vestibular-evoked myogenic potentials (roVEMP) as an electrophysiologic test that allows us to elicit the characteristic decrement of extraocular muscles in patients with ocular myasthenia gravis (OMG). Case-control studies demonstrated that roVEMP reliably differentiates patients with OMG from healthy controls. We now aimed to evaluate the diagnostic accuracy of roVEMP for OMG diagnosis in patients with ptosis and/or diplopia. METHODS: In this blinded prospective diagnostic accuracy trial, we compared roVEMP in 89 consecutive patients presenting with ptosis and/or diplopia suspicious of OMG with a multimodal diagnostic approach, including clinical examination, antibodies, edrophonium testing, repetitive nerve stimulation of accessory and facial nerves, and single-fiber EMG (SFEMG). We calculated the roVEMP decrement as the ratio between the mean of the first 2 responses compared with the mean of the sixth-ninth responses in the train and used cutoff of >9% (unilateral decrement) in a 30 Hz stimulation paradigm. RESULTS: Following a complete diagnostic work-up, 39 patients (44%) were diagnosed with ocular MG, while 50 patients (56%) had various other neuro-ophthalmologic conditions, but not MG (non-MG). roVEMP yielded 88.2% sensitivity, 30.2% specificity, 50% positive predictive value (PPV), and 76.5% negative predictive value (NPV). For comparison, SFEMG resulted in 75% sensitivity, 56% specificity, 55.1% PPV, and 75.7% NPV. All other diagnostic tests (except for the ice pack test) also yielded significantly higher positive results in patients with MG compared with non-MG. DISCUSSION: The study revealed a high sensitivity of 88.2% for roVEMP in OMG, but specificity and PPV were too low to allow for the OMG diagnosis as a single test. Thus, differentiating ocular MG from other neuro-ophthalmologic conditions remains challenging, and the highest diagnostic accuracy is still obtained by a multimodal approach. In this study, roVEMP can complement the diagnostic armamentarium for the diagnosis of MG. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that in patients with diplopia and ptosis, roVEMP alone does not accurately distinguish MG from non-MG disorders. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov: NCT03049956.


Assuntos
Blefaroptose , Diplopia , Miastenia Gravis , Potenciais Evocados Miogênicos Vestibulares , Humanos , Miastenia Gravis/diagnóstico , Miastenia Gravis/fisiopatologia , Miastenia Gravis/complicações , Masculino , Feminino , Diplopia/diagnóstico , Diplopia/fisiopatologia , Diplopia/etiologia , Pessoa de Meia-Idade , Potenciais Evocados Miogênicos Vestibulares/fisiologia , Adulto , Blefaroptose/diagnóstico , Blefaroptose/fisiopatologia , Blefaroptose/etiologia , Idoso , Estudos Prospectivos , Eletromiografia/métodos , Sensibilidade e Especificidade , Músculos Oculomotores/fisiopatologia , Adulto Jovem
16.
Intern Med ; 63(8): 1163-1166, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38616117

RESUMO

Neuronal intranuclear inclusion disease (NIID) exhibits diverse clinical manifestations. Our patient was a 64-year-old woman with bilateral ptosis as the chief complaint. She had bilateral miosis, and the pupil was only slightly dilated 60 min after 1% phenylephrine administration, suggesting autonomic dysfunction secondary to preganglionic sympathetic impairment. A head-up tilt test revealed asymptomatic orthostatic hypotension. She was diagnosed with NIID based on a skin biopsy and genetic testing. This study suggests that blepharoptosis is an early manifestation of NIID. Furthermore, patients with suspected NIID should be examined carefully for autonomic dysfunction.


Assuntos
Doenças do Sistema Nervoso Autônomo , Blefaroptose , Doenças Neurodegenerativas , Feminino , Humanos , Pessoa de Meia-Idade , Blefaroptose/diagnóstico , Blefaroptose/etiologia , Biópsia , Testes Genéticos , Corpos de Inclusão Intranuclear
17.
Arq Bras Oftalmol ; 87(3): e20230028, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38537045

RESUMO

PURPOSE: Evaluation of lid contour and marginal peak point changes to compare outcomes of external levator advancement and Miiller's muscle conjunctival resection surgery in unilateral ptosis. METHODS: We reviewed the charts of unilateral ptosis patients who underwent external levator advancement or Miiller's muscle conjunctival resection. Eyelid contour analysis was conducted on preoperative and 6-month postoperative digital images. This was performed with the multiple margin reflex distances technique, measuring the vertical distance from a line intersecting the center of the pupil to the eyelid margin at 10 positions at 2 mm intervals. The marginal peak point changes were analyzed digitally using the coordinates of the peak point according to the pupil center. Each position's mean distance was compared preoperatively, postoperatively, and with the fellow eyelid. RESULTS: Sixteen patients underwent external levator advancement and 16 patients had Miiller's muscle conjunctival resection. The mean margin reflex distance was improved by both techniques (1.46 vs. 2.43 mm and 1.12 vs. 2.25 mm, p=0.008 and p=0.0001 respectively) and approached that of the fellow eyelid (2.43 vs. 2.88 and 2.25 vs. 2.58 mm, p=0.23 and p=0.19, respectively). However, statistically significant lid margin elevation was limited to between the N6 and T6 points in the external levator advancement group. Whereas, significant elevation was achieved along the whole lid margin in the Miiller's muscle conjunctival resection group. The marginal peak point was shifted slightly laterally in the external levator advancement group (p=0.11). CONCLUSIONS: Both techniques provide effective lid elevation, however, the external levator advancement's effect lessens toward the canthi while Müller's muscle conjunctival resection provides more uniform elevation across the lid margin. The margin reflex distance alone is not sufficient to reflect contour changes.


Assuntos
Blefaroplastia , Blefaroptose , Humanos , Pálpebras/cirurgia , Blefaroptose/cirurgia , Blefaroplastia/métodos , Túnica Conjuntiva/cirurgia , Músculos Oculomotores/cirurgia , Estudos Retrospectivos
18.
Int Ophthalmol ; 44(1): 123, 2024 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-38429587

RESUMO

PURPOSE: Levator muscle dystrophy has been commonly accused being the main pathology of congenital ptosis, nevertheless, few reports drew attention to the existence of congenital aponeurotic defects. This study aims at highlighting the detailed clinical and surgical features of aponeurotic maldevelopment together with the efficacy of simple aponeurosis repair. METHODS: This is a retrospective nonrandomised study including patients with congenital ptosis who underwent levator muscle surgery throughout 4 years. Patients' records were reviewed for the preoperative clinical assessment and photographs, intraoperative recorded data, and videos as well as postoperative data and photographs. RESULTS: Twenty-seven eyes of 22 patients (9.4%) out of 287 eyes were recorded to have absent levator muscle at its typical anatomical insertion site intraoperatively. The mean preoperative MRD1 was (0.44 ± 1.17 mm). The mean levator function was 8.56 ± 3.89 mm, with higher-than-normal crease position (mean value 10.07 ± 1.62 mm). 25 eyes of included cases (92.6%) showed total absence of the levator aponeurosis edge which only was revealed after cutting through the orbital septal covering of the preaponeurotic fat. CONCLUSION: Congenital aponeurotic defect is an established yet under reported entity of congenital ptosis with reproducible characteristic intraoperative findings. Simple aponeurosis repair could achieve ptosis correction in such cases.


Assuntos
Aponeurose , Blefaroptose , Humanos , Estudos Retrospectivos , Músculos Oculomotores/cirurgia , Blefaroptose/cirurgia , Blefaroptose/congênito , Pálpebras/cirurgia
19.
J Fr Ophtalmol ; 47(4): 104108, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38437775

RESUMO

We report a patient with isolated ptosis secondary to orbital metastasis but no evidence of a neoplastic process on magnetic resonance imaging (MRI). A 69-year-old male was referred to our hospital with ptosis of the right upper eyelid and secondary frontalis muscle overaction on the left side for six months. The palpebral fissure was 3mm on the right and 16mm on the left, and levator function was 6mm and 19mm respectively. Three years previously, he had undergone surgical resection of the left lower lobe of the lung due to a T1 N0 M0 adenocarcinoma, and no recurrence had since been observed. An MRI was performed to rule out ptosis secondary to metastasis. Thyroid dysfunction and myasthenia were also ruled out. The ptosis was attributed to an isolated microvascular third nerve palsy. A standard external levator advancement was performed. Six months after the surgery, the patient presented with intense pain, minimal ptosis, edema and diplopia. A new MRI revealed an orbital metastasis measuring 2.4×1.0×1.6cm in the superior orbit, exerting mass effect on the superior rectus and the levator palpebrae superioris muscle. A positron emission tomography scan revealed a recurrence of the lung cancer with multiple bony metastases. The patient underwent chemotherapy consisting of the taxol-carboplatin protocol. Our report highlights the importance of a high index of suspicion of a neoplastic etiology in patients with mild symptoms and a history of cancer even if imaging does not initially reveal a mass or infiltration.


Assuntos
Blefaroptose , Idoso , Humanos , Masculino , Blefaroptose/diagnóstico , Pálpebras , Imageamento por Ressonância Magnética , Músculos Oculomotores/diagnóstico por imagem , Músculos Oculomotores/cirurgia , Órbita
20.
Int Ophthalmol Clin ; 64(2): 1-9, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38525978
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