BACKGROUND Morbihan disease is a rare skin condition with diagnostic and therapeutic challenges.Facial nonpitting erythematous edema is usually considered to be a characteristic manifestation and diagnostic clue for t...BACKGROUND Morbihan disease is a rare skin condition with diagnostic and therapeutic challenges.Facial nonpitting erythematous edema is usually considered to be a characteristic manifestation and diagnostic clue for the Morbihan disease.Treatment of Morbihan disease remains a dilemma due to its long course,poor response,and high recurrence rate.CASE SUMMARY We report the case of a 69-year-old man with Morbihan disease.The patient presented ptosis as the first and main symptom.There was no obvious edema or other skin lesions.The patient was misdiagnosed with senile blepharoptosis based on eyelid performance and no treatment was administered to him.After continuous progressive asthenia of eye-opening and ptosis for more than one year,a skin biopsy was recommended.Histopathological analysis showed edema in the dermis,lymphatic hyperplasia and dilatation,and perivascular lymphocytic infiltration.An obvious increase in toluidine blue-stained mast cells was observed.The patient was finally diagnosed with Morbihan disease.Minocycline and ketotifen were prescribed based on the increase of mast cells in skin tissue slices.The patient experienced rapid relief seven days later and complete remission after 40 d from the commencement of the treatment.CONCLUSION Ptosis without obvious swelling could be the only or main clinical manifestation of Morbihan disease in rare conditions.An increase of mast cells was an important therapeutic clue to the rapid and remarkable efficiency of the combination therapy of minocycline and antihistamine.展开更多
Background:To correct mild and moderate congenital ptosis,traditional surgical techniques usually include dissection of the Müller’s muscle.Meanwhile,both the levator palpebrae superioris and the Müller’s ...Background:To correct mild and moderate congenital ptosis,traditional surgical techniques usually include dissection of the Müller’s muscle.Meanwhile,both the levator palpebrae superioris and the Müller’s muscle play a synergistic role to elevate the upper eyelid.Thus,to protect the Müller muscle and minimize injury,we developed and applied a levator imbrication technique in patients with mild and moderate congenital ptosis and followed it up to evaluate its clinical efficacy.Methods:This retrospective case series included 53 patients with mild and moderate congenital ptosis,all of whom had undergone ptosis correction using the levator imbrication technique at the Plastic and Aesthetic Department of the Second Affiliated Hospital of Zhengzhou University between June 2018 and June 2020.The outcomes of correction,upper eyelid appearance,and operative complications were observed and analyzed.The postoperative follow-up was 3–12 months.Results:Fifty cases of ptosis were fully corrected,and the bilateral double eyelids were smooth and natural.The eyelids of 20 patients were incompletely closed immediately after the operation but were able to close spontaneously within 2 weeks.No serious complications such as exposure keratitis were reported.Three patients with undercorrection underwent reoperation 3 months after the first operation,and ptosis was corrected.Conclusion:The levator imbrication technique for mild and moderate congenital ptosis is simple to perform and shortens the operation time with less damage,stable postoperative outcomes,and no long-term complications.展开更多
·AIM:To characterize the phenylephrine test in aponeurotic and congenital eyelid ptosis,to determine the appropriate timing of the phenylephrine test,and to assess the responses of the upper and lower eyelids....·AIM:To characterize the phenylephrine test in aponeurotic and congenital eyelid ptosis,to determine the appropriate timing of the phenylephrine test,and to assess the responses of the upper and lower eyelids.·METHODS:This was a retrospective analysis of 140 eyes of 87 patients(mean age 52.29±16.45 y;22 males,65 females)with upper eyelid ptosis.Totally 88.6%had aponeurotic and 11.4%had congenital ptosis.For the evaluation of the responses of the upper and lower eyelids to topical 2.5%phenylephrine,the scleral show height,the marginal reflex distance(MRD)between the inferior margin of the upper eyelid and pupillary light reflex(MRD1),and between the central portion of the lower eyelid and pupillary light reflex(MRD2)were measured at the 2^(nd),5^(th),and15^(th)minutes.The changes of MRD1 and MRD2 with time(ΔMRD1 andΔMRD2)were evaluated.·RESULTS:The mean MRD1,MRD2.and scleral show heights increased within 5 min after testing,remaining largely stable between the 5^(th)-15^(th)minutes.The percentage of eyes with a greater response in MRD1 increased with increased severity of ptosis(P<0.05).Eyes with aponeurotic ptosis were more responsive to phenylephrine testing than congenital ptosis.The mild ptosis group had lower scleral show measurements and higherΔMRD2 values.TheΔMRD1 andΔMRD2 values were poorly correlated in all measurement times.·CONCLUSION:Performing the phenylephrine test 5 min after instilling the reagent is adequate to assess the maximum response of the upper and lower eyelids.The upper and lower eyelid responses in phenylephrine testing are poorly correlated.However,theΔMRD2 is related with baseline scleral show degree that may be a postoperative predictive factor.Further studies are necessary to determine the relationship between the responses of the lower eyelids to phenylephrine testing.展开更多
Congenital ptosis is an abnormally low position of the upper eyelid,with respect to the visual axis in the primary gaze.It can be present at birth or manifest itself during the first year of life and can be bilateral ...Congenital ptosis is an abnormally low position of the upper eyelid,with respect to the visual axis in the primary gaze.It can be present at birth or manifest itself during the first year of life and can be bilateral or unilateral.Additionally,it may be an isolated finding or part of a constellation of signs of a specific syndrome or systemic associations.Depending on how much it interferes with the visual axis,it may be considered as a functional or a cosmetic condition.In childhood,functional ptosis can lead to deprivation amblyopia and astigmatism and needs to be treated.However,even mild ptosis with normal vision can lead to psychosocial problems and correction is also advised,albeit on a less urgent basis.Although,patching and glasses can be prescribed to treat the amblyopia,the mainstay of management is surgical.There are several types of surgical procedure available depending on the severity and etiology of the droopy eyelid.The first part of this paper will review the different categories of congenital ptosis,including more common associated syndromes.The latter part will briefly cover the different surgical approaches,with emphasis on how to choose the correct condition.In spite of many complex factors inherent to the treatment of congenital ptosis,the overall outcomes are quite satisfactory,and most surgeons feel that ptosis management can be both challenging and rewarding at the same time.展开更多
AIM:To investigate the influence of unilateral congenital ptosis on the development of the eye and vision in children.METHODS:In this prospective observational study,41 patients with unilateral congenital ptosis were ...AIM:To investigate the influence of unilateral congenital ptosis on the development of the eye and vision in children.METHODS:In this prospective observational study,41 patients with unilateral congenital ptosis were enrolled(age range 3-15y).The blepharoptosis was divided into 3 subgroups according to the margin reflex distance-1(MRD-1),including mild group(MRD-1>2 mm),moderate group(0<MRD-1<2 mm),and severe group(MRD-1<0 mm).The fellow eyes served as controls.All subjects underwent ocular examinations,including axial length,keratometry,and refractive error.RESULTS:The incidence of astigmatism(ptotic eyes:58.5%vs fellow eyes:24.4%,P=0.002)and magnitude of cylindrical power(ptotic eyes:-0.86±0.79 D vs fellow eyes:-0.43±0.63 D,P=0.003)differed significantly between the ptotic eyes and the fellow eyes.The spherical equivalent refraction(P=0.006),spherical power(P=0.01),cylindrical power(P=0.011),axial length-corneal radius(AL/CR)ratio(P=0.009),frequency of hyperopia(P=0.002)and astigmatism(P=0.004)were significantly different among the ptotic eye subgroups and the fellow eye group.In addition,in patients with congenital ptosis,the incidence of amblyopia is 43.9%and the incidence of anisometropia is 24.4%.More importantly,the ratio of AL/CR showed significantly positive correlation with the severity of ptosis(P=0.002).CONCLUSION:Congenital ptosis may lead to a delayed eyeball development in the aspect of AL/CR.The risk of amblyopia is also increased due to visual deprivation and aggravated anisometropia,particularly in severe ptosis case.展开更多
AIM: To con duct a systematic review and Meta-analysis of the published literature to evaluate the pooled prevalence rate of amblyopia in patients with congenital ptosis.METHODS: We searched the PubMed, Embase, the Co...AIM: To con duct a systematic review and Meta-analysis of the published literature to evaluate the pooled prevalence rate of amblyopia in patients with congenital ptosis.METHODS: We searched the PubMed, Embase, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Data, and Chongqing VIP databases for studies reporting the prevalence of amblyopia in patients with congenital ptosis. The reference lists of relevant studies were scanned. Heterogeneity of effect sizes across studies was tested. We calculated prevalence ratios to compare prevale nee estimates for different causes of amblyopia in patients with congenital ptosis, as well as for different geographical regions, year of publication and sample size in subgroup analyses. A systematic review and Meta-analysis were performed.RESULTS: We identified 29 eligible surveys with a total population of 2436. Prevalence rates of amblyopia ranged from 13.8% to 69%. We noted substantial heterogeneity in prevalence estimates for amblyopia in congenital ptosis (Cochran's χ2 significant at P<0.0001;I^2=90%). The pooled prevalence using random-effects models of 29 studies was 32.8%(95%CI: 27.3%-38.4%) in the overall population. Compared to the overall pooled prevalence, amblyopia prevalence was higher in studies in which only subjects with blepharophimosis syndrome were included. CONCLUSION: We con firm that nearly on e-third of congenital ptosis patients are suffering from or at risk for amblyopia. Patients with blepharophimosis syndrome are more likely to develop amblyopia. The identification and management of amblyopia should be integral to the treatment of congenital ptosis.展开更多
AIM:To compare frontalis sling and tarsoconjunctival mullerectomy plus levator resection(TCMLR)in subjects with severe unilateral congenital ptosis with poor levator function(LF).METHODS:A prospective non-randomized n...AIM:To compare frontalis sling and tarsoconjunctival mullerectomy plus levator resection(TCMLR)in subjects with severe unilateral congenital ptosis with poor levator function(LF).METHODS:A prospective non-randomized nonblinded single center clinical trial.Fifty patients with severe unilateral congenital ptosis with poor LF were recruited.The frontalis sling and TCMLR were performed and the functional,cosmetic outcomes,complications,and success rate were evaluated at 1,3,and 6mo postoperatively.The t-test,Chi-square,Fishers exact,and nonparametric MannWhitney tests were used by SPSS software.RESULTS:Frontalis sling and TCMLR procedures were performed on 26 and 24 patients respectively.The mean age was 10.97±10.67y.LF was significantly better in the TCMLR group at months 1,3,and 6(P=0.002).Lagophthalmos was more common in the TCMLR group(no significant difference).At month 3,mild punctate epithelial erosions were observed more in the frontalis sling group(P=0.002).Significant complete success rate of 1st and 6th month for the frontalis sling vs TCMLR groups were 50%vs 20.8%(P=0.02),and 38.4%vs 50%(P=0.03)respectively.CONCLUSION:Complete success rate of TCMLR is higher in long-term follow-up in contrast with the frontalis sling in the short-term.Transient complications are more detected in mid-term follow-ups in both groups.展开更多
BACKGROUND Intracranial tuberculoma is a rare and serious type of tuberculosis,which mostly occurs in the frontoparietal and cerebellar hemispheres,with predominance in the gray-white matter junction area,while tuberc...BACKGROUND Intracranial tuberculoma is a rare and serious type of tuberculosis,which mostly occurs in the frontoparietal and cerebellar hemispheres,with predominance in the gray-white matter junction area,while tuberculomas only in the cistern are extremely rare with only a few reported cases in the literature.We describe a unique case of isolated tuberculoma in the suprasellar cistern,with only right ocular motility disorder and upper eyelid ptosis.CASE SUMMARY A 5-year-old boy without any medical history presented with right ocular motility disorder and upper eyelid ptosis one month ago.He had no history of fever,headache,vomiting,convulsions,or limb weakness.Neurological examination showed right third cranial nerve palsy with restrictions of eye movements and ptosis,pupil dilation and negative light reflex.Imaging suggested a spaceoccupying lesion in the suprasellar cistern with calcification and ring-enhancement.Moreover,no Mycobacterium tuberculosis was found in cerebrospinal fluid by polymerase chain reaction(PCR).The lesion was initially diagnosed as a tumor,while postoperative pathology combined with PCR indicated tuberculoma.The patient continued postoperative anti-tuberculosis treatment.At present,the patient's condition is stable and the symptoms are partially relieved compared with those before surgery.CONCLUSION This case confirmed that isolated intracranial tuberculoma can occur in the suprasellar cistern.Therefore,for space-occupying lesions in the suprasellar cistern,tuberculoma should be included in the differential diagnosis even if there is no history or indication of tuberculosis infection.展开更多
Dear Editor,Evidence of oculomotor nerve(ON)synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of sy...Dear Editor,Evidence of oculomotor nerve(ON)synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy,following intracranial aneurysm,trauma,compressive neoplasms,cavernous sinus展开更多
AIM: To evaluate the predictive factors of postoperative corneal astigmatism change in ptosis patients who underwent ptosis surgical repair.METHODS: Patients who underwent levator resection at Oculoplastic service of ...AIM: To evaluate the predictive factors of postoperative corneal astigmatism change in ptosis patients who underwent ptosis surgical repair.METHODS: Patients who underwent levator resection at Oculoplastic service of the Department of Ophthalmology, Naresuan University Hospital, Thailand between September 2017 and August 2019 were retrospectively evaluated. Changes in degree and axis of corneal astigmatism after ptosis surgery were compared based on patient factors consisting of age at operation, sex, preoperative marginreflex distance(MRD) 1, and preoperative degree and axis of corneal astigmatism.RESULTS: Forty-two eyes of 28 patients were included in the study. Wilcoxon signed ranks test showed a significant postoperative corneal astigmatism change only in a subgroup of eyes with preoperative astigmatism of ≥1.5 diopters(D;P=0.006). Furthermore, 72.2%(13/18) of the eyes with preoperative astigmatism of ≥1.5 D showed a reduction of astigmatism after eyelid surgery, with the mean astigmatic change of 0.65 D. Majority of preoperative eyes demonstrated with-the-rule astigmatism pattern(45.2%), of which 57.9% showed a reduced degree of astigmatism.CONCLUSION: In patients undergoing ptosis surgery, the data demonstrate for the first time the association between postoperative corneal astigmatism change and a preoperative corneal astigmatism of ≥1.5 D. Thus, we encourage considering severity of corneal astigmatism prior to cataract or refractive surgery planning in ptosis patients, especially with toric-intraocular lens, to avoid the possibility of calculation error.展开更多
Introduction: The ptosis is a fall of the upper eyelid in relation to a deficit of the levator device of this one. In practice, it poses two major problems, the first one is the eminent risk of amblyopia during severe...Introduction: The ptosis is a fall of the upper eyelid in relation to a deficit of the levator device of this one. In practice, it poses two major problems, the first one is the eminent risk of amblyopia during severe congenital ptosis, and the second is of an aesthetic nature, representing the main reason for consultation. The aim of this work is to evaluate the interest of the levator palpebrae superioris muscle plication in the ptosis surgery. Materials and Methods: We collected 12 patients who received a correction of their ptosis by plication of the levator palpebrae superioris muscle over a period of 3 years from January 2012 to December 2014. Result: The mean age at treatment was 22 years;the ptosis was congenital in 8 cases, and acquired in 4. The ptosis was major in 67% and moderate in 33% of the cases. Muscle plication was the basic surgical technique in all patients in our series. The function and aesthetic results were satisfying in 6 cases (50%), good in 4 cases (34%), acceptable in 1 case and bad in 1 case (8%). Discussion: The comparative study has shown that the plication of the levator palpebrae superioris muscle is a possible alternative for the correction of ptosis whatever the type of ptosis with results comparable to the reference technique compared to the degree of correction, whereas the operative follow-up is simpler and more minor complications. Conclusion: The surgical treatment of ptosis should be done after a systematic clinical examination and after very precise indications. However, the plication of the levator muscle of the upper eyelid has shown its functional and aesthetic efficiency in congenital ptosis and in the ptosis of the adult.展开更多
Blepharoptosis (ptosis) is defined as the abnormal drooping of the upper eyelid and is a feature of many conditions. It can be in isolated or syndromic form, bilateral or unilateral and congenital or acquired. Previou...Blepharoptosis (ptosis) is defined as the abnormal drooping of the upper eyelid and is a feature of many conditions. It can be in isolated or syndromic form, bilateral or unilateral and congenital or acquired. Previously we have carried out linkage analysis on a family with dominantly inherited congenital bilateral isolated ptosis and found the condition to be linked to a region of approximately 20 megabases of chromosome Xq24-Xq27.1 with a cumulative LOD score of 5.89. We now describe further analysis using array comparative genomic hybridisation (array CGH), fluorescence in situ hybridisation (FISH), long range PCR and sequencing. This has enabled us to identify and characterise at the level of DNA sequence an insertional duplication and rearrangement involving chromosomes 1p21.3 and a small quasipalindromic sequence in Xq27.1, disruption of which has been associated with other phenotypes but which is cosegregating with X-linked congenital bilateral isolated ptosis in this family. This work highlights the significance of the small quasipalindromic sequence in genomic rearrangements involving Xq27.1 and the importance of comprehensive molecular and molecular cytogenetic investigations to fully characterise genomic structural complexity.展开更多
Vincristine is a chemotherapy drug belonging to the group of Vinca alkaloids which also includes vinblastine and vindesine. It is used in hematological malignancies and solid tumors. The Vinca alkaloids are neurotoxic...Vincristine is a chemotherapy drug belonging to the group of Vinca alkaloids which also includes vinblastine and vindesine. It is used in hematological malignancies and solid tumors. The Vinca alkaloids are neurotoxic, usually causing peripheral neuropathy, and rarely cranial neuropathies. We report a case of a 33-month-old male child diagnosed with Wilms’ tumor, who had an isolated unilateral right ptosis following vincristine, with a good improvement after stopping it.展开更多
Objective:To investigate the effect of vault on conjunctiva combined with fascia sheath suspension on the mobility and aesthetics of eyelid in patients with ptosis.Methods:A total of 80 patients with ptosis who were a...Objective:To investigate the effect of vault on conjunctiva combined with fascia sheath suspension on the mobility and aesthetics of eyelid in patients with ptosis.Methods:A total of 80 patients with ptosis who were admitted to our hospital from January 2017 to January 2019 were selected as the subjects.They were divided into 2 groups with random number table method,40 cases each.The control group was treated with modified single-incision frontalis fascia flap suspension,and the observation group was treated with vault on conjunctiva combined with fascia sheath suspension.The eyelid margin activity,aesthetics and complications were compared between the two groups.Results:The eyelid margin activity of the observation group after treatment was higher than that of the control group,the difference was statistically significant(P<0.05);the aesthetic satisfaction of the observation group after treatment was 95.00%(38/40)higher than that of the control group 70.00%(28/40)The difference was statistically significant(P<0.05);the incidence of complications in the observation group was 2.50%(1/40)lower than that in the control group 20.00%(8/40),and the difference was statistically significant(P<0.05).Conclusion:Patients with ptosis are treated with superior conjunctival fornix combined with fascia sheath suspension,which can improve the mobility of eyelid margin,and it is more beautiful and has less complications.展开更多
Objective To evaluate a knitted polypropylene mesh used for mammapexy in correcting the breast ptosis. Methods Twenty-one patients with the mild or moderate breast ptosis were undergoing the mammapexy with a knitted p...Objective To evaluate a knitted polypropylene mesh used for mammapexy in correcting the breast ptosis. Methods Twenty-one patients with the mild or moderate breast ptosis were undergoing the mammapexy with a knitted polypropylene mesh. The operation was performed through the periareolar incision and a monofilament knitted polypropylene mesh was subcutaneously implanted on the surface of the gland and fixed up-ward. Results All of the patients were satisfactory of the appearance with the follow-ups from 2 to 16 months. No secondary ptosis, hypemophic scars and foreign body reactions were found. Conclusion The above-mentioned technique could be a good, safe and reliable method for correcting breast ptosis. 13 refs,3 figs.展开更多
Background Accurate preoperative evaluation of the levator palpebrae superioris(LPS)strength is required for specific calculation of anterior migration or shortening.This information serves as a surgical reference for...Background Accurate preoperative evaluation of the levator palpebrae superioris(LPS)strength is required for specific calculation of anterior migration or shortening.This information serves as a surgical reference for more accurate correction of ptosis.Methods Between June 2017 and June 2019,155 eyes of 97 patients were studied.Patients were divided into the following 3 groups based on the ptosis degree:mild(28 cases),moderate(53 cases),and severe(16 cases).The LPS strength was evaluated preoperatively and used to calculate LPS anterior migration and shortening.The LPS aponeurosis and Müller’s muscle(L-M)complex was separated from the upper margin of the tarsal plate to the calculated height according to the levator muscle suspension system retention approach.The complex was subsequently fixed to the planned tarsal plate location.The upper eyelid margin(UEM)height,eyelid morphology,eyelid closure,eye symmetry,exposure keratitis status,and patient satisfaction were evaluated at 1 week and at 1 and 6 months postoperatively.Results In all cases,the UEM positions were normal,and only patients with severe ptosis exhibited lagophthalmos in the early posterative period.Six months postoperatively,13%of eyes in the severe group had residual ptosis;all mild and moderate cases exhibited good surgical outcomes.The eyelids closed well with no exposure keratitis.All patients were satisfied with the eyelid contour.Conclusions Accurate LPS anterior migration and aponeurosis shortening can eliminate various factors affecting surgical blepharoptosis treatment.These procedures not only reduce operation time but also enhance the stability of postoperative correction.展开更多
Ptosis is a common ophthalmologic condition,and the diagnosis is primarily based on ocular appearance.Thediagnosis of such conditions can be improved using emerging technology such as artificial intelligence-basedmeth...Ptosis is a common ophthalmologic condition,and the diagnosis is primarily based on ocular appearance.Thediagnosis of such conditions can be improved using emerging technology such as artificial intelligence-basedmethods.However,unified data collection and labeling standards have not yet been established.This directlyimpacts the accuracy of ptosis diagnosis based on appearance alone.Therefore,in the present study,we aimedto establish a procedure to obtain and label images to devise a recommendation system for optimal recognitionof ptosis based on ocular appearances.This would help to standardize and facilitate data sharing and serve as aguideline for the development and improvisation of algorithms in artificial intelligence for ptosis.展开更多
Periorbital rejuvenation is a common aesthetic goal sought by patients presenting to the plastic or oculoplastic surgeon.For this reason,it is critical that the surgeon understand the functional considerations,such as...Periorbital rejuvenation is a common aesthetic goal sought by patients presenting to the plastic or oculoplastic surgeon.For this reason,it is critical that the surgeon understand the functional considerations,such as preexisting blepharoptosis,which will contribute to the ultimate aesthetic outcome.This article will review the anatomy of the normal and ptotic lid and will discuss the approach to diagnosing and characterizing the type and degree of lid ptosis.High-yield surgical techniques for ptosis correction will then be described,including the indications for and steps of each procedure.Finally,the diagnosis and management of common complications that follow ptosis surgery will be discussed.Our main objective is to arm the surgeon with the preoperative and operative planning tools to successfully manage comorbid ptosis and thereby improve blepharoplasty outcomes.展开更多
Aim:Augmentation mammoplasty is a commonly performed procedure with a high satisfaction rate.Multiplane pocket was described for simultaneous internal mastopexy and augmentation using inframammary crease incision for ...Aim:Augmentation mammoplasty is a commonly performed procedure with a high satisfaction rate.Multiplane pocket was described for simultaneous internal mastopexy and augmentation using inframammary crease incision for selected primary and secondary mammoplasties.The use of the technique is presented with a larger experience for correction of ptosis in a patient presenting for revision surgery following subglandular augmentation mammoplasty.Methods:A retrospectively collected data were analyzed using the Excel Spread Sheet.A total of 25 patients had multiplane augmentation with the internal mastopexy following augmentation mammoplasty in subglandular pocket.Data of 25 patients who had their revision surgery in multiplane were analyzed.Results:The group included 25 patients with a mean age of 36.6 years(range:25-54 years)with mean implant duration of 6.4 years(range:1.5-13 years).Twenty-three of the patients were nonsmokers,1 smoker and 1 patient’s smoking status was not mentioned.Eighteen patients presented with grade I capsular contracture,3 patients with grade II contracture and 4 patients had a combination of grade I and II capsular contracture.Pseudoptosis was present in 6,class B ptosis in 6,A/B ptosis in 3,water-down deformity in 5 and rippling in 5 patients.Average preoperative size of implant used initially was 334.4 mL(range:250-340 mL)and the mean implant size selected for revision surgery was 416 mL(range:260-525 mL).Mean follow-up time was 18 months(range:6-48 months).Of 25 patients,21 had a bilateral procedure whereas the technique was used unilaterally in 4 patients for the correction of asymmetry.All patients had a single dose of intravenous antibiotics and followed by an oral course for 5 days,there was no infection noted in the series.In the current series,no patient required revision surgery following the multiplane internal mastopexy.Conclusion:Multiplane internal mastopexy can be useful in selected cases of revisionary augmentation mammoplasty.展开更多
Aim:Eyelid contour is a key component to satisfactory lid position and appearance following ptosis repair,the components of which have been highly debated and remain difficult to objectively measure.We sought to minim...Aim:Eyelid contour is a key component to satisfactory lid position and appearance following ptosis repair,the components of which have been highly debated and remain difficult to objectively measure.We sought to minimize the number of intraoperative adjustments required and reduce reoperation rates by addressing only the central 6 mm of tarsus when reapproximating levator to the anterior surface of tarsus,thereby eliminating contour as an adjustable variable.Methods:All patients who underwent external levator resection with blepharoplasty for correction of involutional ptosis between 2012 and 2019 by a single surgeon at one center were retrospectively reviewed.Patients who underwent concomitant brow lifting surgery were excluded.The same technique was used for each eyelid with uniform suture placement.One 6-0 silk horizontal mattress suture was placed partial thickness through the superior third of tarsus 3 mm lateral to the center of tarsus;another was passed 3 mm medial to the center of tarsus.No sutures were placed outside of this central 6-mm zone.Patient fixation was used to determine lid height and symmetry.Once satisfactory,the sutures were tied down in a permanent fashion and the eyelid position again verified.In total,153 eyelids in 85 patients were evaluated.Data obtained included preoperative and postoperative margin-to-reflex distance(MRD1),intraoperative and postoperative complications,reoperation rates,and patient satisfaction with appearance of lid contour and symmetry.Results:The mean follow up time was 3.41 months.The mean preoperative MRD1 was 1.05 mm.The mean post-operative was 3.18 mm.All patients had recovery of an anatomically normal temporal peak height.Two of 153 ;eyelids(1.31%)required reoperation due to residual ptosis or overcorrection.No patients had postoperative lagophthalmos.Ninety-one percent of patients who underwent bilateral surgery had satisfactory symmetry defined as less than or equal to 1-mm difference between right and left MRD1.Eighty-two of the 85 patients were satisfied with their postoperative appearance.Conclusion:This simple and standardized technique for suture placement gives reliable and effective results for external elevator advancement for ptosis repair by eliminating contour as an adjustable variable.Addressing the central 6 mm of tarsus is not only paramount but also in and of itself satisfactory in achieving optimal contour during external levator resection,without regard to more medial or lateral lid anatomy.展开更多
文摘BACKGROUND Morbihan disease is a rare skin condition with diagnostic and therapeutic challenges.Facial nonpitting erythematous edema is usually considered to be a characteristic manifestation and diagnostic clue for the Morbihan disease.Treatment of Morbihan disease remains a dilemma due to its long course,poor response,and high recurrence rate.CASE SUMMARY We report the case of a 69-year-old man with Morbihan disease.The patient presented ptosis as the first and main symptom.There was no obvious edema or other skin lesions.The patient was misdiagnosed with senile blepharoptosis based on eyelid performance and no treatment was administered to him.After continuous progressive asthenia of eye-opening and ptosis for more than one year,a skin biopsy was recommended.Histopathological analysis showed edema in the dermis,lymphatic hyperplasia and dilatation,and perivascular lymphocytic infiltration.An obvious increase in toluidine blue-stained mast cells was observed.The patient was finally diagnosed with Morbihan disease.Minocycline and ketotifen were prescribed based on the increase of mast cells in skin tissue slices.The patient experienced rapid relief seven days later and complete remission after 40 d from the commencement of the treatment.CONCLUSION Ptosis without obvious swelling could be the only or main clinical manifestation of Morbihan disease in rare conditions.An increase of mast cells was an important therapeutic clue to the rapid and remarkable efficiency of the combination therapy of minocycline and antihistamine.
文摘Background:To correct mild and moderate congenital ptosis,traditional surgical techniques usually include dissection of the Müller’s muscle.Meanwhile,both the levator palpebrae superioris and the Müller’s muscle play a synergistic role to elevate the upper eyelid.Thus,to protect the Müller muscle and minimize injury,we developed and applied a levator imbrication technique in patients with mild and moderate congenital ptosis and followed it up to evaluate its clinical efficacy.Methods:This retrospective case series included 53 patients with mild and moderate congenital ptosis,all of whom had undergone ptosis correction using the levator imbrication technique at the Plastic and Aesthetic Department of the Second Affiliated Hospital of Zhengzhou University between June 2018 and June 2020.The outcomes of correction,upper eyelid appearance,and operative complications were observed and analyzed.The postoperative follow-up was 3–12 months.Results:Fifty cases of ptosis were fully corrected,and the bilateral double eyelids were smooth and natural.The eyelids of 20 patients were incompletely closed immediately after the operation but were able to close spontaneously within 2 weeks.No serious complications such as exposure keratitis were reported.Three patients with undercorrection underwent reoperation 3 months after the first operation,and ptosis was corrected.Conclusion:The levator imbrication technique for mild and moderate congenital ptosis is simple to perform and shortens the operation time with less damage,stable postoperative outcomes,and no long-term complications.
文摘·AIM:To characterize the phenylephrine test in aponeurotic and congenital eyelid ptosis,to determine the appropriate timing of the phenylephrine test,and to assess the responses of the upper and lower eyelids.·METHODS:This was a retrospective analysis of 140 eyes of 87 patients(mean age 52.29±16.45 y;22 males,65 females)with upper eyelid ptosis.Totally 88.6%had aponeurotic and 11.4%had congenital ptosis.For the evaluation of the responses of the upper and lower eyelids to topical 2.5%phenylephrine,the scleral show height,the marginal reflex distance(MRD)between the inferior margin of the upper eyelid and pupillary light reflex(MRD1),and between the central portion of the lower eyelid and pupillary light reflex(MRD2)were measured at the 2^(nd),5^(th),and15^(th)minutes.The changes of MRD1 and MRD2 with time(ΔMRD1 andΔMRD2)were evaluated.·RESULTS:The mean MRD1,MRD2.and scleral show heights increased within 5 min after testing,remaining largely stable between the 5^(th)-15^(th)minutes.The percentage of eyes with a greater response in MRD1 increased with increased severity of ptosis(P<0.05).Eyes with aponeurotic ptosis were more responsive to phenylephrine testing than congenital ptosis.The mild ptosis group had lower scleral show measurements and higherΔMRD2 values.TheΔMRD1 andΔMRD2 values were poorly correlated in all measurement times.·CONCLUSION:Performing the phenylephrine test 5 min after instilling the reagent is adequate to assess the maximum response of the upper and lower eyelids.The upper and lower eyelid responses in phenylephrine testing are poorly correlated.However,theΔMRD2 is related with baseline scleral show degree that may be a postoperative predictive factor.Further studies are necessary to determine the relationship between the responses of the lower eyelids to phenylephrine testing.
文摘Congenital ptosis is an abnormally low position of the upper eyelid,with respect to the visual axis in the primary gaze.It can be present at birth or manifest itself during the first year of life and can be bilateral or unilateral.Additionally,it may be an isolated finding or part of a constellation of signs of a specific syndrome or systemic associations.Depending on how much it interferes with the visual axis,it may be considered as a functional or a cosmetic condition.In childhood,functional ptosis can lead to deprivation amblyopia and astigmatism and needs to be treated.However,even mild ptosis with normal vision can lead to psychosocial problems and correction is also advised,albeit on a less urgent basis.Although,patching and glasses can be prescribed to treat the amblyopia,the mainstay of management is surgical.There are several types of surgical procedure available depending on the severity and etiology of the droopy eyelid.The first part of this paper will review the different categories of congenital ptosis,including more common associated syndromes.The latter part will briefly cover the different surgical approaches,with emphasis on how to choose the correct condition.In spite of many complex factors inherent to the treatment of congenital ptosis,the overall outcomes are quite satisfactory,and most surgeons feel that ptosis management can be both challenging and rewarding at the same time.
基金Supported by the Project of Science and Technology of Tianjin(No.17ZXHLSY00030).
文摘AIM:To investigate the influence of unilateral congenital ptosis on the development of the eye and vision in children.METHODS:In this prospective observational study,41 patients with unilateral congenital ptosis were enrolled(age range 3-15y).The blepharoptosis was divided into 3 subgroups according to the margin reflex distance-1(MRD-1),including mild group(MRD-1>2 mm),moderate group(0<MRD-1<2 mm),and severe group(MRD-1<0 mm).The fellow eyes served as controls.All subjects underwent ocular examinations,including axial length,keratometry,and refractive error.RESULTS:The incidence of astigmatism(ptotic eyes:58.5%vs fellow eyes:24.4%,P=0.002)and magnitude of cylindrical power(ptotic eyes:-0.86±0.79 D vs fellow eyes:-0.43±0.63 D,P=0.003)differed significantly between the ptotic eyes and the fellow eyes.The spherical equivalent refraction(P=0.006),spherical power(P=0.01),cylindrical power(P=0.011),axial length-corneal radius(AL/CR)ratio(P=0.009),frequency of hyperopia(P=0.002)and astigmatism(P=0.004)were significantly different among the ptotic eye subgroups and the fellow eye group.In addition,in patients with congenital ptosis,the incidence of amblyopia is 43.9%and the incidence of anisometropia is 24.4%.More importantly,the ratio of AL/CR showed significantly positive correlation with the severity of ptosis(P=0.002).CONCLUSION:Congenital ptosis may lead to a delayed eyeball development in the aspect of AL/CR.The risk of amblyopia is also increased due to visual deprivation and aggravated anisometropia,particularly in severe ptosis case.
基金Supported by the National Natural Science Foundation of China(No.81870688)Shanghai Science and Technology Commission Natural Science Foundation(No.16ZR1419600)the Science and Technology Commission of Shanghai(No.17DZ2260100)
文摘AIM: To con duct a systematic review and Meta-analysis of the published literature to evaluate the pooled prevalence rate of amblyopia in patients with congenital ptosis.METHODS: We searched the PubMed, Embase, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Data, and Chongqing VIP databases for studies reporting the prevalence of amblyopia in patients with congenital ptosis. The reference lists of relevant studies were scanned. Heterogeneity of effect sizes across studies was tested. We calculated prevalence ratios to compare prevale nee estimates for different causes of amblyopia in patients with congenital ptosis, as well as for different geographical regions, year of publication and sample size in subgroup analyses. A systematic review and Meta-analysis were performed.RESULTS: We identified 29 eligible surveys with a total population of 2436. Prevalence rates of amblyopia ranged from 13.8% to 69%. We noted substantial heterogeneity in prevalence estimates for amblyopia in congenital ptosis (Cochran's χ2 significant at P<0.0001;I^2=90%). The pooled prevalence using random-effects models of 29 studies was 32.8%(95%CI: 27.3%-38.4%) in the overall population. Compared to the overall pooled prevalence, amblyopia prevalence was higher in studies in which only subjects with blepharophimosis syndrome were included. CONCLUSION: We con firm that nearly on e-third of congenital ptosis patients are suffering from or at risk for amblyopia. Patients with blepharophimosis syndrome are more likely to develop amblyopia. The identification and management of amblyopia should be integral to the treatment of congenital ptosis.
基金Supported by Tehran University of Medical Sciences(No.9511257008)。
文摘AIM:To compare frontalis sling and tarsoconjunctival mullerectomy plus levator resection(TCMLR)in subjects with severe unilateral congenital ptosis with poor levator function(LF).METHODS:A prospective non-randomized nonblinded single center clinical trial.Fifty patients with severe unilateral congenital ptosis with poor LF were recruited.The frontalis sling and TCMLR were performed and the functional,cosmetic outcomes,complications,and success rate were evaluated at 1,3,and 6mo postoperatively.The t-test,Chi-square,Fishers exact,and nonparametric MannWhitney tests were used by SPSS software.RESULTS:Frontalis sling and TCMLR procedures were performed on 26 and 24 patients respectively.The mean age was 10.97±10.67y.LF was significantly better in the TCMLR group at months 1,3,and 6(P=0.002).Lagophthalmos was more common in the TCMLR group(no significant difference).At month 3,mild punctate epithelial erosions were observed more in the frontalis sling group(P=0.002).Significant complete success rate of 1st and 6th month for the frontalis sling vs TCMLR groups were 50%vs 20.8%(P=0.02),and 38.4%vs 50%(P=0.03)respectively.CONCLUSION:Complete success rate of TCMLR is higher in long-term follow-up in contrast with the frontalis sling in the short-term.Transient complications are more detected in mid-term follow-ups in both groups.
文摘BACKGROUND Intracranial tuberculoma is a rare and serious type of tuberculosis,which mostly occurs in the frontoparietal and cerebellar hemispheres,with predominance in the gray-white matter junction area,while tuberculomas only in the cistern are extremely rare with only a few reported cases in the literature.We describe a unique case of isolated tuberculoma in the suprasellar cistern,with only right ocular motility disorder and upper eyelid ptosis.CASE SUMMARY A 5-year-old boy without any medical history presented with right ocular motility disorder and upper eyelid ptosis one month ago.He had no history of fever,headache,vomiting,convulsions,or limb weakness.Neurological examination showed right third cranial nerve palsy with restrictions of eye movements and ptosis,pupil dilation and negative light reflex.Imaging suggested a spaceoccupying lesion in the suprasellar cistern with calcification and ring-enhancement.Moreover,no Mycobacterium tuberculosis was found in cerebrospinal fluid by polymerase chain reaction(PCR).The lesion was initially diagnosed as a tumor,while postoperative pathology combined with PCR indicated tuberculoma.The patient continued postoperative anti-tuberculosis treatment.At present,the patient's condition is stable and the symptoms are partially relieved compared with those before surgery.CONCLUSION This case confirmed that isolated intracranial tuberculoma can occur in the suprasellar cistern.Therefore,for space-occupying lesions in the suprasellar cistern,tuberculoma should be included in the differential diagnosis even if there is no history or indication of tuberculosis infection.
文摘Dear Editor,Evidence of oculomotor nerve(ON)synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy,following intracranial aneurysm,trauma,compressive neoplasms,cavernous sinus
文摘AIM: To evaluate the predictive factors of postoperative corneal astigmatism change in ptosis patients who underwent ptosis surgical repair.METHODS: Patients who underwent levator resection at Oculoplastic service of the Department of Ophthalmology, Naresuan University Hospital, Thailand between September 2017 and August 2019 were retrospectively evaluated. Changes in degree and axis of corneal astigmatism after ptosis surgery were compared based on patient factors consisting of age at operation, sex, preoperative marginreflex distance(MRD) 1, and preoperative degree and axis of corneal astigmatism.RESULTS: Forty-two eyes of 28 patients were included in the study. Wilcoxon signed ranks test showed a significant postoperative corneal astigmatism change only in a subgroup of eyes with preoperative astigmatism of ≥1.5 diopters(D;P=0.006). Furthermore, 72.2%(13/18) of the eyes with preoperative astigmatism of ≥1.5 D showed a reduction of astigmatism after eyelid surgery, with the mean astigmatic change of 0.65 D. Majority of preoperative eyes demonstrated with-the-rule astigmatism pattern(45.2%), of which 57.9% showed a reduced degree of astigmatism.CONCLUSION: In patients undergoing ptosis surgery, the data demonstrate for the first time the association between postoperative corneal astigmatism change and a preoperative corneal astigmatism of ≥1.5 D. Thus, we encourage considering severity of corneal astigmatism prior to cataract or refractive surgery planning in ptosis patients, especially with toric-intraocular lens, to avoid the possibility of calculation error.
文摘Introduction: The ptosis is a fall of the upper eyelid in relation to a deficit of the levator device of this one. In practice, it poses two major problems, the first one is the eminent risk of amblyopia during severe congenital ptosis, and the second is of an aesthetic nature, representing the main reason for consultation. The aim of this work is to evaluate the interest of the levator palpebrae superioris muscle plication in the ptosis surgery. Materials and Methods: We collected 12 patients who received a correction of their ptosis by plication of the levator palpebrae superioris muscle over a period of 3 years from January 2012 to December 2014. Result: The mean age at treatment was 22 years;the ptosis was congenital in 8 cases, and acquired in 4. The ptosis was major in 67% and moderate in 33% of the cases. Muscle plication was the basic surgical technique in all patients in our series. The function and aesthetic results were satisfying in 6 cases (50%), good in 4 cases (34%), acceptable in 1 case and bad in 1 case (8%). Discussion: The comparative study has shown that the plication of the levator palpebrae superioris muscle is a possible alternative for the correction of ptosis whatever the type of ptosis with results comparable to the reference technique compared to the degree of correction, whereas the operative follow-up is simpler and more minor complications. Conclusion: The surgical treatment of ptosis should be done after a systematic clinical examination and after very precise indications. However, the plication of the levator muscle of the upper eyelid has shown its functional and aesthetic efficiency in congenital ptosis and in the ptosis of the adult.
文摘Blepharoptosis (ptosis) is defined as the abnormal drooping of the upper eyelid and is a feature of many conditions. It can be in isolated or syndromic form, bilateral or unilateral and congenital or acquired. Previously we have carried out linkage analysis on a family with dominantly inherited congenital bilateral isolated ptosis and found the condition to be linked to a region of approximately 20 megabases of chromosome Xq24-Xq27.1 with a cumulative LOD score of 5.89. We now describe further analysis using array comparative genomic hybridisation (array CGH), fluorescence in situ hybridisation (FISH), long range PCR and sequencing. This has enabled us to identify and characterise at the level of DNA sequence an insertional duplication and rearrangement involving chromosomes 1p21.3 and a small quasipalindromic sequence in Xq27.1, disruption of which has been associated with other phenotypes but which is cosegregating with X-linked congenital bilateral isolated ptosis in this family. This work highlights the significance of the small quasipalindromic sequence in genomic rearrangements involving Xq27.1 and the importance of comprehensive molecular and molecular cytogenetic investigations to fully characterise genomic structural complexity.
文摘Vincristine is a chemotherapy drug belonging to the group of Vinca alkaloids which also includes vinblastine and vindesine. It is used in hematological malignancies and solid tumors. The Vinca alkaloids are neurotoxic, usually causing peripheral neuropathy, and rarely cranial neuropathies. We report a case of a 33-month-old male child diagnosed with Wilms’ tumor, who had an isolated unilateral right ptosis following vincristine, with a good improvement after stopping it.
文摘Objective:To investigate the effect of vault on conjunctiva combined with fascia sheath suspension on the mobility and aesthetics of eyelid in patients with ptosis.Methods:A total of 80 patients with ptosis who were admitted to our hospital from January 2017 to January 2019 were selected as the subjects.They were divided into 2 groups with random number table method,40 cases each.The control group was treated with modified single-incision frontalis fascia flap suspension,and the observation group was treated with vault on conjunctiva combined with fascia sheath suspension.The eyelid margin activity,aesthetics and complications were compared between the two groups.Results:The eyelid margin activity of the observation group after treatment was higher than that of the control group,the difference was statistically significant(P<0.05);the aesthetic satisfaction of the observation group after treatment was 95.00%(38/40)higher than that of the control group 70.00%(28/40)The difference was statistically significant(P<0.05);the incidence of complications in the observation group was 2.50%(1/40)lower than that in the control group 20.00%(8/40),and the difference was statistically significant(P<0.05).Conclusion:Patients with ptosis are treated with superior conjunctival fornix combined with fascia sheath suspension,which can improve the mobility of eyelid margin,and it is more beautiful and has less complications.
文摘Objective To evaluate a knitted polypropylene mesh used for mammapexy in correcting the breast ptosis. Methods Twenty-one patients with the mild or moderate breast ptosis were undergoing the mammapexy with a knitted polypropylene mesh. The operation was performed through the periareolar incision and a monofilament knitted polypropylene mesh was subcutaneously implanted on the surface of the gland and fixed up-ward. Results All of the patients were satisfactory of the appearance with the follow-ups from 2 to 16 months. No secondary ptosis, hypemophic scars and foreign body reactions were found. Conclusion The above-mentioned technique could be a good, safe and reliable method for correcting breast ptosis. 13 refs,3 figs.
文摘Background Accurate preoperative evaluation of the levator palpebrae superioris(LPS)strength is required for specific calculation of anterior migration or shortening.This information serves as a surgical reference for more accurate correction of ptosis.Methods Between June 2017 and June 2019,155 eyes of 97 patients were studied.Patients were divided into the following 3 groups based on the ptosis degree:mild(28 cases),moderate(53 cases),and severe(16 cases).The LPS strength was evaluated preoperatively and used to calculate LPS anterior migration and shortening.The LPS aponeurosis and Müller’s muscle(L-M)complex was separated from the upper margin of the tarsal plate to the calculated height according to the levator muscle suspension system retention approach.The complex was subsequently fixed to the planned tarsal plate location.The upper eyelid margin(UEM)height,eyelid morphology,eyelid closure,eye symmetry,exposure keratitis status,and patient satisfaction were evaluated at 1 week and at 1 and 6 months postoperatively.Results In all cases,the UEM positions were normal,and only patients with severe ptosis exhibited lagophthalmos in the early posterative period.Six months postoperatively,13%of eyes in the severe group had residual ptosis;all mild and moderate cases exhibited good surgical outcomes.The eyelids closed well with no exposure keratitis.All patients were satisfied with the eyelid contour.Conclusions Accurate LPS anterior migration and aponeurosis shortening can eliminate various factors affecting surgical blepharoptosis treatment.These procedures not only reduce operation time but also enhance the stability of postoperative correction.
基金The study was supported by Science and Technology PlanningProjects of Guangdong Province(Grant No.2018B010109008)National Key R&D Program of China(Grant No.2018YFC0116500).
文摘Ptosis is a common ophthalmologic condition,and the diagnosis is primarily based on ocular appearance.Thediagnosis of such conditions can be improved using emerging technology such as artificial intelligence-basedmethods.However,unified data collection and labeling standards have not yet been established.This directlyimpacts the accuracy of ptosis diagnosis based on appearance alone.Therefore,in the present study,we aimedto establish a procedure to obtain and label images to devise a recommendation system for optimal recognitionof ptosis based on ocular appearances.This would help to standardize and facilitate data sharing and serve as aguideline for the development and improvisation of algorithms in artificial intelligence for ptosis.
文摘Periorbital rejuvenation is a common aesthetic goal sought by patients presenting to the plastic or oculoplastic surgeon.For this reason,it is critical that the surgeon understand the functional considerations,such as preexisting blepharoptosis,which will contribute to the ultimate aesthetic outcome.This article will review the anatomy of the normal and ptotic lid and will discuss the approach to diagnosing and characterizing the type and degree of lid ptosis.High-yield surgical techniques for ptosis correction will then be described,including the indications for and steps of each procedure.Finally,the diagnosis and management of common complications that follow ptosis surgery will be discussed.Our main objective is to arm the surgeon with the preoperative and operative planning tools to successfully manage comorbid ptosis and thereby improve blepharoplasty outcomes.
文摘Aim:Augmentation mammoplasty is a commonly performed procedure with a high satisfaction rate.Multiplane pocket was described for simultaneous internal mastopexy and augmentation using inframammary crease incision for selected primary and secondary mammoplasties.The use of the technique is presented with a larger experience for correction of ptosis in a patient presenting for revision surgery following subglandular augmentation mammoplasty.Methods:A retrospectively collected data were analyzed using the Excel Spread Sheet.A total of 25 patients had multiplane augmentation with the internal mastopexy following augmentation mammoplasty in subglandular pocket.Data of 25 patients who had their revision surgery in multiplane were analyzed.Results:The group included 25 patients with a mean age of 36.6 years(range:25-54 years)with mean implant duration of 6.4 years(range:1.5-13 years).Twenty-three of the patients were nonsmokers,1 smoker and 1 patient’s smoking status was not mentioned.Eighteen patients presented with grade I capsular contracture,3 patients with grade II contracture and 4 patients had a combination of grade I and II capsular contracture.Pseudoptosis was present in 6,class B ptosis in 6,A/B ptosis in 3,water-down deformity in 5 and rippling in 5 patients.Average preoperative size of implant used initially was 334.4 mL(range:250-340 mL)and the mean implant size selected for revision surgery was 416 mL(range:260-525 mL).Mean follow-up time was 18 months(range:6-48 months).Of 25 patients,21 had a bilateral procedure whereas the technique was used unilaterally in 4 patients for the correction of asymmetry.All patients had a single dose of intravenous antibiotics and followed by an oral course for 5 days,there was no infection noted in the series.In the current series,no patient required revision surgery following the multiplane internal mastopexy.Conclusion:Multiplane internal mastopexy can be useful in selected cases of revisionary augmentation mammoplasty.
文摘Aim:Eyelid contour is a key component to satisfactory lid position and appearance following ptosis repair,the components of which have been highly debated and remain difficult to objectively measure.We sought to minimize the number of intraoperative adjustments required and reduce reoperation rates by addressing only the central 6 mm of tarsus when reapproximating levator to the anterior surface of tarsus,thereby eliminating contour as an adjustable variable.Methods:All patients who underwent external levator resection with blepharoplasty for correction of involutional ptosis between 2012 and 2019 by a single surgeon at one center were retrospectively reviewed.Patients who underwent concomitant brow lifting surgery were excluded.The same technique was used for each eyelid with uniform suture placement.One 6-0 silk horizontal mattress suture was placed partial thickness through the superior third of tarsus 3 mm lateral to the center of tarsus;another was passed 3 mm medial to the center of tarsus.No sutures were placed outside of this central 6-mm zone.Patient fixation was used to determine lid height and symmetry.Once satisfactory,the sutures were tied down in a permanent fashion and the eyelid position again verified.In total,153 eyelids in 85 patients were evaluated.Data obtained included preoperative and postoperative margin-to-reflex distance(MRD1),intraoperative and postoperative complications,reoperation rates,and patient satisfaction with appearance of lid contour and symmetry.Results:The mean follow up time was 3.41 months.The mean preoperative MRD1 was 1.05 mm.The mean post-operative was 3.18 mm.All patients had recovery of an anatomically normal temporal peak height.Two of 153 ;eyelids(1.31%)required reoperation due to residual ptosis or overcorrection.No patients had postoperative lagophthalmos.Ninety-one percent of patients who underwent bilateral surgery had satisfactory symmetry defined as less than or equal to 1-mm difference between right and left MRD1.Eighty-two of the 85 patients were satisfied with their postoperative appearance.Conclusion:This simple and standardized technique for suture placement gives reliable and effective results for external elevator advancement for ptosis repair by eliminating contour as an adjustable variable.Addressing the central 6 mm of tarsus is not only paramount but also in and of itself satisfactory in achieving optimal contour during external levator resection,without regard to more medial or lateral lid anatomy.
