Multistage Correction of Blepharophimosis: Our Rationale for 18 Cases

Li, Yong; Li, Dongmei; Jie, Ying; Yin, Qinye

doi:10.1007/s00266-009-9313-4

Cited by 12 publications

(13 citation statements)

References 15 publications

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“…It was used to correct epicanthic folds in Asian patients with satisfactory results [21] . Li et al reported better results with the Y to V procedure especially in patients older than 10 years [5] . The Y to V medial canthoplasty was used in this study and yielded good satisfactory results.…”

Section: Resultsmentioning

confidence: 99%

“…This creates the most natural anatomical reconstruction possible. The use of this procedure by a broader surgical practitioner base with less experience may not be the most appropriate [5,8,10,12,25] . As regards ptosis correction, frontalis suspension is preferred in patients with no or minimal levator function, which is the case in patients with BPES.…”

Section: Resultsmentioning

confidence: 99%

“…It is traditionally recommended to perform it between 3 and 5 years of age. Before 3 years of age the face is not sufficiently developed, and late surgery may result in more prominent scarring [5,8,18] . The age of the patients in this study ranged between 3 and 5 years with a mean 3.7±0.8 years.…”

Section: Resultsmentioning

confidence: 99%

“…Some believe that the geometric basis of these flaps is too complicated, and the design is confusing. The transposition of various flaps may be challenging and a significant amount of flap trimming may be required before suturing [5,7,20] . Sebastia et al reported the use of Z-epicanthoplasty which is simpler to perform and yielded results similar to Mustarde flaps [9] .…”

Section: Resultsmentioning

confidence: 99%

“…Surgical treatment for BPES is one of the most complex in the field of eyelid surgery due to the presence of multiple deformities. Many surgical techniques have been described to address the epicanthus inversus and accompanying telecanthus including Y to V flaps, the Mustarde technique, the 5-flap technique, medial canthal tendon shortening or plication, and transnasal wiring, and none of them is free from criticism [5][6][7][8][9] . Some authors recommended that medial canthoplasty should be performed first followed by ptosis correction, while others recommended one stage.…”

Section: Blepharophimosis-ptosis-epicanthus Inversus Syndrome (Bpes)mentioning

confidence: 99%

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Outcome of Y to V Medial Canthoplasty With Medial Canthal Tendon Plication for the Correction of Blepharophimosis- Ptosis-Epicanthus Inversus Syndrome

Elbakary

2015

International Journal of Ophthalmic Research

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CONCLUSION:The two stages management using simple procedures as Y to V medial canthoplasty with MCT plication followed by frontalis suspension or maximum levator resection yielded satisfactory results in the correction of complicated deformity as BPES. INTRODUCTIONBlepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is an uncommon congenital disorder characterized by a narrowed horizontal palpebral aperture, ptosis, epicanthus inversus, and telecanthus. It typically has bilateral features, although not always symmetrical [1,2] . This syndrome is inherited as an autosomal disease, but also can be manifested as a result of new genetic mutations and sporadic cases without family history of the disease can occur. Several studies confirmed the presence of mutations such as deletion or translocation of the FOXL2 gene, which maps to chromosome 3q21-24 [3,4] . Surgical treatment for BPES is one of the most complex in the field of eyelid surgery due to the presence of multiple deformities. Many surgical techniques have been described to address the epicanthus inversus and accompanying telecanthus including Y to V flaps, the Mustarde technique, the 5-flap technique, medial canthal tendon shortening or plication, and transnasal wiring, and none of them is free from criticism [5][6][7][8][9] . Some authors recommended that medial canthoplasty should be performed first followed by ptosis correction, while others recommended one stage. Therefore, there is no unanimous consensus on BPES correction with respect to either MATERIALS AND METHODS:Prospective interventional case series which included 15 cases of BPES. Two stages management was used in all cases. The first stage was Y to V medial canthoplasty with MCT plication. 3 months later, ptosis was corrected by bilateral frontalis suspension or maximum levator resection in the more ptotic eyelid in patients with asymmetric ptosis. Data regarding margin reflex distance 1 (MRD1), horizontal palpebral fissure length (HPFL), inner intercanthal distance (IICD), and the ratio of IICD to HPFL were recorded before and after surgery and were statistically analyzed. Post operative IICD/HPFL ratio of 1.5 or less was considered successful outcome. RESULTS: The mean age of patients was 3.7±0.8 years. According to the postoperative IICD/HPFL, 12 patients (80%) had successful outcome. The preoperative IICD had a mean of 37.6±1.5 mm, which was reduced post operative to a mean of 33.0±2.3 mm. The HPFL improved from preoperative mean 21±1.2 mm to postoperative mean 24.2±1.4 mm. The mean preoperative IICD/HPFL ratio was 1.8±0.2 which was reduced post operative to a mean of 1.37±0.2. The MRD1 improved from preoperative mean of 1±0.4 mm to 3.6±0.3 mm post operative. The main complication recorded was undercorrection which was observed in 3 patients (20%).

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Section: Resultsmentioning

confidence: 99%