Functional centre of the upper eyelid: the optimal point for eyelid lifting in ptosis surgery

Kim, Chang Yeom; Son, Byeong Jae; Lee, Sang Yeul

doi:10.1136/bjophthalmol-2014-305101

Cited by 11 publications

(4 citation statements)

References 12 publications

(11 reference statements)

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“…It has been reported that the marginal peak point in ptotic eyelids moves temporally by the main hanging suture in ELA (8,(19)(20)(21) . Due to the unilateral ptosis design of our study, we noticed that the peak point of the ptotic eyelid shifted nasally in the ELA Group achieving peak point symmetry with the contralateral eyelid.…”

Section: Discussionmentioning

confidence: 99%

Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller's muscle conjunctival resection

Bilici,

Harbigil-Sever,

Ugurbas

2024

ABO

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Evaluation of lid contour and marginal peak point changes to compare outcomes of external levator advancement and Müller's muscle conjunctival resection surgery in unilateral ptosis. Methods: We reviewed the charts of unilateral ptosis patients who underwent external levator advancement or Müller'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 Müller'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 Müller'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.

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Section: Discussionmentioning

confidence: 99%

Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller's muscle conjunctival resection

Bilici,

Harbigil-Sever,

Ugurbas

2024

ABO

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“…Recent studies have reported a more temporal peak of the upper lid than previously reported [ 15 ], both in healthy subjects [ 16 , 17 ] and patients with thyroid ophthalmopathy [ 18 ]. In addition, multiple studies have reported a slight temporalization of the peak after ptosis correction [ 7 , 17 , 19 , 20 ]. In our study, while the mean peak of the contralateral eye was found to be 1.25 ± 1.55 mm temporal to the center of the pupil, the preoperative mean peak of the ptotic eye was located 0.03 ± 1.57 mm nasal and the postoperative mean peak of the ptotic eye was located 1.87 ± 1.41 mm temporal to the center of the pupil.…”

Section: Discussionmentioning

confidence: 99%

Comparing the symmetry of upper eyelid following unilateral ptosis correction

Aytoğan

Ayıntap

2021

BMC Ophthalmol

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Background Margin Reflex Distance 1(MRD 1) only describes the central height of upper eyelid and relies on the examiner’s experience and disregards eyelid contour abnormalities. Therefore MRD 1 may not be sufficient for an acceptable result to evaluate the outcomes of ptosis surgery. The primary purpose of this study was to assess outcomes of unilateral ptosis correction based on parameters including degree of symmetry, MRD 1, peak height of the upper lid, temporal and nasal ocular surface area, and temporal/nasal area ratio with an objective, quantitative, and repeatable method. Methods This study was designed as a retrospective non-randomized case-control study. Medical records of the patients with unilateral ptosis between October 2015 and December 2020 were reviewed. Patients with unilateral ptosis who underwent surgical correction and levator function of 5 mm or greater were included in the study. Two groups were defined; ptotic eye was case group and contralateral eye was control group. Data analysis was performed Image J and Matlab softwares. Results Thirty-four patients were included in the study. Mean age of patients was 58.8 ± 12.7 years (range 15–75 years). Mean follow-up time was 19.5 ± 7.3 months (range 8–40 months). Four patients were diagnosed with congenital ptosis and 30 patients aponeurotic ptosis. Mean preoperative degree of symmetry for overall eyelid contour was 36.6 ± 27.5% (range 1–92%). Mean postoperative degree of symmetry for overall eyelid contour was 72.4 ± 16.5% (range 55–92%). Temporal/Nasal (T/N) area ratios for contralateral normal eye was 1.19 pre-postoperative, and it was 1.11 preoperatively, 1.15 postoperatively for operated ptotic eye. Conclusions This study primarily demonstrated a quantitative, objective, and repeatable method to investigate the degree of symmetry after eyelid surgeries. Secondly, this study suggested that T/N ratio may not be a reliable parameter to evaluate the eyelid symmetry.

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“…In recent studies, 27,28 supratarsal fixation of the silicone rods at two points resulted in good patient outcomes in frontalis suspension surgery. Kim et al 27 reported the functional centre of the upper eyelid, suggesting its clinical significance when performing ptosis surgery. They demonstrated that the outcome of silicone-rod surgery was excellent when the rod was fixed 4.4 mm nasal and 3.9 mm temporal from the functional eyelid centre.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two- and three-point sutures for advancing the levator aponeurosis in Asian eyelids

Kim

Yoon

Jang

2015

Eye

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Purpose To compare the functional and cosmetic outcomes of two-and three-point sutures for advancing the levator aponeurosis in blepharoptosis surgery on Asians.Patients and methods This retrospective study examined 60 Asian patients with blepharoptosis who had undergone advancement of the levator aponeurosis: 34 patients (46 eyelids) had ptosis correction using the two-point suture technique and 26 patients (41 eyelids) had ptosis correction using the three-point suture technique. The postoperative marginal reflex distance (MRD1), lid height difference, and eyelid contour were evaluated. Results Twenty-seven (79.4%) of the 34 patients in the two-point group and 19 (73.1%) of 26 patients in the three-point group had a postoperative MRD1 of 2-4 mm, lids within 0.5 mm of each other, and a satisfactory eyelid contour; this difference was not significant. The rate of reoperation did not differ significantly between the two groups. Conclusion Two-and three-point sutures for advancing the levator aponeurosis were equally effective for correcting blepharoptosis in Asians.

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Functional centre of the upper eyelid: the optimal point for eyelid lifting in ptosis surgery

Abstract: The functional eyelid centre was located slightly temporal to the mid-pupillary line. A better eyelid contour in ptosis surgery is produced when eyelid lifting is centred around the functional eyelid centre.

Cited by 11 publications

References 12 publications

Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller's muscle conjunctival resection

Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller's muscle conjunctival resection

Comparing the symmetry of upper eyelid following unilateral ptosis correction

Comparison of two- and three-point sutures for advancing the levator aponeurosis in Asian eyelids

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