Meticulous objective examination of a patient with blepharoptosis allows determining the tactics of surgical treatment. It depends on many factors, but main ones are blepharoptosis etiology, upper eyelids levator function, and ptosis degree. The estimation algorithm of objective examination of a patient with blepharoptosis is presented in this article.
Background. Transconjunctival techniques for blepharoptosis correction are popular because of ease of implementation and good predictability. For a long time, the phenylephrine test remained the main factor influencing the choice of blepharoptosis correction method. Recently, more and more researches indicate the possibility of the superior tarsal muscle resection in patients with negative responses to the phenylephrine test. Authors have proposed and described a new modified technique for resection of the superior tarsal muscle, which can be used to correct blepharoptosis in patients with different responses to phenylephrine test. Materials and methods. The study included 2 groups of patients with mild to moderate blepharoptosis with levator muscle function 8 mm or more. The main group (75 patients, 103 eyelids) underwent a modified resection of the superior tarsal muscle, and in the comparison group (26 patients, 35 eyelids) an open sky resection of the superior tarsal muscle was performed. Surgery in the main group was planned according to the following algorithm. In positive and sufficient response to the test, 2/3 of the superior tarsal muscle was resected. In case of positive but insufficient response to the phenylephrine test, subtotal superior tarsal muscle resection was performed. In case of negative or slightly positive result of phenylephrine test, an assessment of the white line motility was additionally performed intraoperatively. If the motility of the white line (in mm) was equal to the amount of ptosis, subtotal superior tarsal muscle resection was performed without resection of the superior tarsal plate. If the motility of the white line was less than desired amount of correction, then subtotal superior tarsal muscle resection was combined with tarsal plate resection to reach the desired amount of correction. The residual height of the tarsal plate was always left 5 mm or more. If superior tarsal plate was compromised or not high enough to perform desired amount of resection then white line was advanced to the tarsal plate. Results. The degree of ptosis, the result, the width of the palpebral fissure in the center, lateral and medial limbus, MRD 1 and MRD 2 did not significantly differ between the groups (p 0.05). However, the frequency of hypo- and hypercorrections was significantly lower in the main group (p 0.05). Conclusion. New algorithm of planning modified superior tarsal muscle resection gives an opportunity to use transconjuctival methods of blepharoptosis correction in cases of weak and negative phenylephrine test and to reduce the amount of hypo- and hypercorrections
Introduction. It is common knowledge that positive response to phenylephrine (PE) test remains the main indication for superior tarsal muscle (STM) resection for mild and moderate blepharoptosis. However, in recent times, there have been reports about possibility of STM resection in patients with weakly positive and negative responses to the PE test. However, the question remains open what a surgeon should focus on when planning STM resection in these cases? Authors have developed a test for assessing motility of the white line that could help to answer this question. Materials and methods. 75 patients (103 eyelids) operated for blepharoptosis with STM resection in Saint Petersburg City Hospital No. 2 from November 2017 until august 2019 were enrolled in the study. Results. We found no significant correlation between the result of white line motility test in patients with positive response to PE test and the effect of surgery, while in patients with week and negative PE test results there was a strong correlation. Conclusion. The white line motility test could help to assess the desired amount of STM resection in patients with week and negative phenylephrine test results.
In this article, using a clinical case as example we report clinical features of keratopathy associated with pseudoexfoliation syndrome, as well as pathological changes found by confocal microscopy.
In this article, a clinical case of astrocytoma of optic nerve head in patient with neurofibromatosis type 1 is presented. The main feature of this clinical case is a difficulty in differential diagnosis with amelanotic choroidal melanoma.
Purpose. To evaluate the changes in the quality of life of patients with thyroid eye disease after different methods of orbital decompression. Materials and methods. The study included 24 patients (37 orbits) with thyroid eye disease, aged 41.6 20.6 (from 20 to 79 years), 18 women and 6 men. The patients were divided into two groups. The first group included 12 patients (19 orbits) who underwent orbital fat decompression. The second group included 12 patients (18 orbits) who underwent endoscopic endonasal bony orbital decompression. The Graves ophthalmopathy quality of life questionnaire (GO-QOL) was completed before surgery, and 3 and 6 months after it. Outcome analysis included also the assessment of visual acuity, proptosis, eyelid retraction, and palpebral fissure height. Results. The GO-QOL visual function scores in both groups did not change significantly in 3 and in 6 months after orbital decompression (p 0.05): in the first group, before and after 6 months, scores were 69.27 20.02 and 68.96 18.44, in the second group 53.13 29.13 and 57.81 23.56, respectively. An improvement in the GO-QOL visual function estimation was observed in those patients whose visual acuity improved after surgery. The GO-QOL facial appearance scores significantly improved 3 months after surgery, and continued to increase up to 6 months: in the first group, facial appearance scores improved from 23.96 23.01 to 48.42 25.56 (p = 0.004), in the second group from 47.92 21.04 to 66.15 23.15 (p = 0.037). Conclusions. Orbital decompression significantly improves the quality of life of patients with thyroid eye disease, this is primarily associated with an improvement in facial appearance.
Transconjunctival methods of ptosis correction gain popularity nowadays. The wide use of the technique is limited because of the lack of clear recommendations regarding the volume of the resection, especially in patients with negative phenylephrine test. Purpose. To assess the influence of main predictive factors on superior tarsal muscle (STM) resection result. Materials and methods. Patients were divided into two groups according to the result of phenylephrine test (PE). Patients with positive results were included in the first group, with negative and weak results in the second group. All patients underwent STM resection according our new algorithm. Results. The result of STM resection was influenced by PE test and intraoperative white line motility test (WLM), but not by levator function and the amount of superior tarsal muscle resection. Conclusions. PE and WLM tests play main role in choosing a method for blepharoptosis correcting.
The search for new techniques of fixation intraocular lenses (IOL) cases of its dislocation or inadequate capsular support continues to be an actual problem. The most physiological is the IOL position in the posterior chamber. In this article, a new method for scleral IOL fixation using limbal mini-pockets proposed by the authors will be presented.
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