Background: Congenital ptosis with poor levator function are very difficult to make good results of functional and cosmetic side. Surgical methods for the correction of congenital ptosis with poor levator function, including frontalis suspension or maximal levator resection, remain controversial. We evaluated the postoperative surgical and cosmetic long-term outcomes after frontalis sling operation with preserved fascia lata for congenital ptosis with poor levator function. Objective: To evaluate the long-term outcome of asymmetric ptosis with frontalis sling operation preserved fascia lata by modified direct tarsal fixation in congenital ptosis patients. Methods: A retrospective case series was performed. From January 2000 to December 2018, 53 patients (30 unilateral and 23 bilateral asymmetric ptosis) with 70 eyelids who underwent frontalis sling with preserved fascia lata were included. Six patients underwent levator resection at opposite eye. The surgical results were graded as excellent, good and poor. Results: The mean age at the time of surgery was 5.2±3.2 years (range, 1-43 years) with a mean follow-up time of 106.6±29.1 months (range, 60-196 months). Satisfactory results (excellent or good result) were obtained in 94.2% of the patients. Patients were divided into two groups based on levator function as follows: 0 to 2 mm (24 cases) and 2.5 to 4.0 mm (46 cases). Preoperative levator function, margin reflex distance-1 and levator dehiscence were not correlated with postoperative surgical outcomes. Complications were exposure keratopathy (8.6%), lidcrease asymmetry (7.1%), overcorrection (5.7%), entropion (5.7%), and eyelash ptosis (2.9%). Conclusion: Frontalis sling operation by preserved fascia lata with modified direct tarsal fixation is a simple but effective treatment for severe congenital ptosis with poor levator function. And it has good long-term results.
Purpose We sought to investigate the temporal changes of eyelid height after phenylephrine instillation in Korean patients with and without ptosis to determine the time points of the first and maximum reactions. Methods The phenylephrine test was performed on 16 eyes of 12 ptotic patients (group I) and 24 eyes of 12 normal control subjects (group II) in our hospital between September 2017 and March 2018. One drop of 2.5% phenylephrine was instilled and the marginal reflex distance 1 (MRD1) was measured at 15 seconds before instillation and the following time points after instillation: at 15-second intervals for the initial 5 minutes and at 5-minute intervals until a total of 20 minutes was reached (i.e., at 10, 15, and 20 minutes). Results In group I patients, the first reaction appeared at 5 minutes ( p = 0.034), while the maximum eyelid height after the first reaction was reached at 15 minutes ( p = 0.025) and was maintained until 20 minutes. In group II subjects, the first reaction appeared at 5 minutes ( p = 0.034), while the maximum eyelid height was reached at 10 minutes ( p = 0.015) and was maintained until 20 minutes. There was no significant difference in the response of eyelid height based on time ( p = 0.122) between the two groups. Conclusions Our analysis of phenylephrine test results in Korean ptotic patients revealed a significant increase occurred in the eyelid height after 5 minutes; meanwhile, the maximum eyelid height was reached at 15 minutes and was maintained until 20 minutes after instillation.
Purpose: To evaluate the effect of a ptosis correction operation on eyebrow position of senile upper lid ptosis patients. Methods: A retrospective study of 140 eyes of 70 patients who had a ptosis correction operation between June 2011 and July 2018 was conducted. Marginal reflex distance 1 and brow height were measured preoperatively and at 1 month and 3 months postoperatively. Patients were divided into two groups, according to whether brow height asymmetry was symmetrized (≤1 mm) or not after the operation. Results: The average brow height decreased after the operation (19.3-18.3 mm, p = 0.00), as did the brow height symmetricity (2.7-2.3 mm, p = 0.01). The symmetric group were older and had a higher female ratio than the asymmetric group, as well as a smaller preoperative brow symmetricity. Conclusions: Brow height and brow asymmetry were reduced by ptosis correction of senile upper lid ptosis patients. The symmetrization rate was higher in patients who were older, female, and who had smaller preoperative brow symmetricity.
Purpose: In patient with intraocular lens dislocation, surgery was performed to fix the existing intraocular lens to the sclera by flanged fixation using 5-0 polypropylene without replacing the existing intraocular lens, and this is to be introduced.Case summary: One mm incisions were made in the cornea at 11 and 2 o'clock and the prolapsed vitreous was removed. Through the incised cornea, the 5-0 polypropylene is inserted through one hole of the intraocular lens and drawn out of the eye, and the other end of the 5-0 polypropylene is also drawn out of the eye through the vitreous. The ends of the 5-0 polypropylene were melted with a Low-Temperature Cautery to form a flanged shape and fixed to the sclera. No significant complications occurred after the operation.Conclusions: It can be seen that the flanged type of scleral fixation using 5-0 polypropylene is a useful alternative to the conventional classic scleral fixation.
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