Modified Combined Fascia Sheath and Levator Muscle Complex Suspension With Müller Muscle Preservation on Treating Severe Congenital Ptosis

Abstract

Background This study aims to evaluate the effect of a modified approach on severe congenital ptosis treatment. Methods Through anterior approach, Müller muscle was preserved, meanwhile the upper tarsus was suspended to combined fascia sheath (CFS) and levator muscle (LM) complex. The main outcome measures included marginal reflex distance1 (MRD1), palpebral fissure height (PFH), MRD1 regression, MRD1 improvement, and patient self-satisfaction. Results There were 70 patients (90 eyelids) with severe congenital ptosis received treatment of modified operation, including 20 bilateral and 50 unilateral ptosis. The average LF was 2.53 ± 1.06 mm. The preoperative MRD1 and PFH was −0.06 ± 0.76 mm and 4.25 ± 0.85 mm, respectively. The follow-up was at least 6 months with average of 12.67 ± 4.92 months. The immediate postoperative MRD1 and PFH average was 4.52 ± 0.39 mm and 9.24 ± 0.26, respectively. The last follow-up MRD1 and PFH average was 2.43 ± 0.57 mm and 7.16 ± 0.69 mm, respectively, which was improved significantly (P < 0.01). There were variety degrees of MRD1 regression especially in the first month after operation, and the last follow-up MRD1 regression was 2.09 ± 0.67 mm. The lagophthalmos was obvious immediately after operation and regularly released after 6 months. Objective curative effect assessment showed 78 (86.7%) satisfactory eyes, 4 (4.4%) improved eyes, and 8 (8.9%) noneffective eyes. Two noneffective eyes required reoperation of frontalis suspension. Self-satisfaction rate was 93.3%. Parameters analysis showed that LF had positive correlation with last follow-up MRD1 and negative correlation with MRD1 improvement (P < 0.01). Five eyes had levator shorten history, which was associated remarkably with CFS + LM curative effect (P < 0.01). Mean swelling time was 0.53 ± 0.41 months, and no complications were observed until the last visit. Conclusions This modified method gives powerful correction and vivid eyelid contour, featured with simple surgical procedures, few complications, and satisfactory effect, which is worth to wide application.

Research on the expression of elastin in the conjoint fascial sheath for the correction of severe unilateral congenital blepharoptosis

“…This disease can result in narrowing of the palpebral fissure and visual field [ 9 ], and may seriously affect aesthetics and mental health. At present, traditional corrective methods for blepharoptosis can be categorized into 3 classifications [ 4 ], such as levator resection, Müller muscle conjunctival resection [ 10 ] and frontalis suspension. However, these surgeries are associated with many complications, such as lagophthalmos, corneal exposure, forehead wrinkle aggravation and eyebrow raising [ 11 ].…”

“…In the past decade, CFS has attracted a great deal of attention as a cure for congenital blepharoptosis [ 4 , 12 ]. Much earlier, in 1805, Tenon discovered and described the existence of the CFS, believing it to be the tendinous fascia of the superior rectus muscle; functionally, this connective structure was reported to assist the function of the rectus muscle and promote the movement of the upper eyelid [ 13 ].…”

“…In 2008, Hwang proposed that this structure is a piece of fibrous connective tissue formed by the fusion and proliferation of the LM and superior rectus fascia, naming it the conjoint fascial sheath, or CFS [ 19 ]. In recent years, many studies have applied CFS suspension or CFS + LM complex suspension to correct severe congenital blepharoptosis; these procedures have been found to have many advantages [ 4 , 12 , 20 ], such as a lack of obvious separation of the eyelid from the eyeball, a lack of severe postoperative discomfort, a natural double eyelid, swift postoperative recovery and intact eyebrow and forehead tissues. The mechanism of CFS + LM suspension is to suture the CFS + LM complex to the tarsal plate through a double eyelid incision, which lifts the upper eyelid.…”

“…Since 2002, CFS suspension has been applied to correct blepharoptosis; this procedure has a satisfactory curative effect and produces fewer complications than other procedures for blepharoptosis correction [ 3 ]. Recently, CFS + LM complex suspension has achieved better clinical effects than CFS suspension in the correction of severe blepharoptosis [ 4 , 5 ]. Additionally, researchers have gradually begun to conduct anatomical and histological research on the CFS.…”

Modified conjoint fascial sheath suspension for the correction of severe congenital blepharoptosis in pediatric patients at different ages

“…Since 2002, conjoint fascial sheath suspension (CFS) has been applied to correct congenital blepharoptosis (6). This procedure has a satisfactory curative effect in mild or moderate blepharoptosis, however, the effect of the surgery on severe ptosis was not ideal (6,7). Over the past few years, CFS + LM complex suspension, a modified CFS-based surgery, has shown good results for the treatment of severe blepharoptosis (7)(8)(9).…”