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 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
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 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
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 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.
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.
