Polytetrafluoroethylene as a spacer graft for the correction of lower eyelid retraction.
(17/49)
PURPOSE: To evaluate the efficacy of porous expanded polytetrafluoroethylene (e-PTFE, Goretex) containing large pores made with a 21-gauge needle as a graft for the correction of lower lid retraction. METHODS: e-PTFE grafts were implanted between the tarsus and lower lid retractor via a transconjunctival approach with/without amniotic membrane transplantation, or via a transcutaneous approach. Rabbits were examined and assessed for comeal and conjunctival complications and for e-PTFE graft status. Rabbits were sacrificed for a histological study at 8 weeks postoperatively. RESULTS: e-PTFE grafts were uniformly extruded 3 weeks postoperatively in eyelids operated on via the transconjunctival approach. However, rabbits operated on via the transcutaneous approach demonstrated e-PTFE graft retention; in addition, dense fibrovascular ingrowths into the large pores of e-PTFE were observed histologically. CONCLUSIONS: e-PTFE is a good substitute for other graft materials as a spacer in lower lid retraction operations, especially as an interpositional graft using a transcutaneous approach. (+info)
Eyelid malposition: lower lid entropion and ectropion.
(18/49)
Correcting entropion and ectropion successfully requires knowledge of the eyelid problems, because understanding of these abnormalities is a key to planning a successful surgical procedure. Entropion is a condition in which the eyelid margin turns inwards against the globe. It is divided into following categories: congenital and acquired, which may be involutional or cicatricial. Ectropion is a malposition in which the lid falls away or is pulled away from its normal apposition to the globe. The condition is classified as congenital and acquired, which is divided into following categories: involutional, cicatricial, paralytic, and mechanical. Therefore, there are some common anatomic changes for both entropion and ectropion as well as specific changes that are unique to each eyelid malposition. Typically, instability of the eyelid is caused by either horizontal laxity or disinsertion or attenuation of the lower eyelid retractors to the inferior tarsal border, so surgical procedures should be directed at correcting the horizontal and vertical instability of the lid. Classification, etiology, underlying anatomic changes in the lid, principles of surgical treatment of entropion and ectropion are reviewed in this article. (+info)
The role of botulinum toxin in correcting frontalis-induced eyelid pseudo-retraction post ptosis surgery.
(19/49)
We report a case of a 52-year-old female patient who developed overcorrection, due to brow overuse, post surgery for bilateral aponeurotic ptosis. The patient had undergone levator palpebrae superioris plication bilaterally. Due to brow overuse habituated by long standing ptosis, the patient presented with superior scleral show, post ptosis surgery. The lid contour was normal in both eyes and when brow overaction was blocked mechanically, the palpebral fissure heights were normal, comparable, with no scleral show bilaterally. Despite repeated instructions, when the patient continued brow overuse subconsciously, an injection of botulinum toxin was given just above both brows. This led to elimination of brow overuse within a month, with elimination of superior scleral show. The patient maintained lid and brow symmetry with no overaction, eight months post injection. (+info)
The graded levator hinge procedure for the correction of upper eyelid retraction (an American Ophthalmological Society thesis).
(20/49)
PURPOSE: Many surgical techniques have been developed to address eyelid retraction with varying results. Identifying and evaluating the anatomical and pathophysiological factors involved will assist in its surgical treatment. This prospective study evaluated the graded levator hinge procedure, in combination with a Mullerectomy and/or lateral canthoplasty when indicated, in an attempt to precisely and selectively target the pathophysiology responsible for the various causes of eyelid retraction in only one surgical session. METHODS: This is a clinical, prospective study of patients with moderate to severe eyelid retraction due to various causes who underwent the graded levator hinge procedure, in combination with a Mullerectomy and/or lateral canthoplasty when indicated. The exact amount of hinging of the levator aponeurosis, and combination with a Mullerectomy and/or lateral canthoplasty, was determined by the clinical operative findings with active cooperation from the conscious patient. RESULTS: Thirty-two consecutive patients (48 eyelids) with varying degrees of upper eyelid retraction underwent the graded levator hinge procedure in combination with a Mullerectomy and or lateral canthoplasty when indicated. The mean (+/- standard deviation) preoperative palpebral vertical fissure height was 12.4 mm (+/- 0.45 mm), and the mean postoperative palpebral fissure height was 9.0 mm (+/-0.20 mm). The mean preoperative asymmetry in the palpebral fissure height was 2.41 (+/- 0.29) mm, and the mean postoperative asymmetry was 0.59 mm (+/- 0.09), and this difference was statistically significant (P <.001). The mean reduction in the palpebral fissure height was 4.6 mm (+/- 0.29 mm) (range, 1-10 mm). The graded levator hinge procedure in combination with a Mullerectomy and or lateral canthoplasty when indicated, led to a statistically significant (P <.001) reduction in mean palpebral fissure height for all patients, the bilateral subset of patients, the unilateral subset of patients, and the thyroid-related orbitopathy subgroup. The graded levator hinge procedure in combination with a Mullerectomy and/or lateral canthoplasty when indicated led to a statistically significant reduction in palpebral fissure height, asymmetry between the eyes in the total set of patients, the unilateral set of patients, and the thyroid-related orbitopathy subset, but not in the bilaterally operated subset of patients, which were already relatively symmetric preoperatively. Postoperatively 90.6 % of all eyelids were within 1 mm of the desired postoperative level (25% were equal, 68.8% were within 0.5 mm, and 6.2% greater than 1 mm from the desired level). CONCLUSIONS: The graded levator hinge procedure, alone or in combination with a Mullerectomy and/or lateral canthoplasty, is a safe and highly effective surgical approach for the treatment of various causes of upper eyelid retraction. Through consideration of the various anatomical and pathophysiological causes of eyelid retraction, excellent functional and cosmetic results are achieved with a graded procedure tapered to the needs of each individual. (+info)
Results of long-term follow-up observations of blepharoptosis correction using the palmaris longus tendon.
(21/49)
Improved visual acuity after frontalis sling surgery for simple congenital ptosis.
(24/49)
INTRODUCTION: Congenital ptosis is malpositioning of the eyelids that, when moderate or severe, can negatively affect visual development during its critical period, resulting in amblyopia: diminished visual acuity with no apparent organic cause. Early diagnosis and timely treatment are essential for preventing amblyopia. Congenital ptosis is uncommon but poses a challenge to any ophthalmologist; the only treatment is surgical. Among these patients in Cuba, those with the most complex clinical characteristics are generally referred to the Ramon Pando Ferrer Ophthalmology Institute in Havana. OBJECTIVE: Characterize visual acuity outcomes obtained in patients seen at this Institute who received surgery for simple congenital ptosis using the frontalis sling procedure. METHOD: A descriptive prospective longitudinal study was conducted to describe visual acuity outcomes in 11 patients with a diagnosis of isolated congenital ptosis seen in the Oculoplastic Service of the Ramon Pando Ferrer Ophthalmology Institute between January and July 2009 and operated on using the frontalis sling procedure. The majority exhibited severe visual acuity impairment (0.1-0.5) prior to surgery. Variables employed were age, sex, degree of ptosis, degree of ptosis correction, visual acuity, and complications during surgery and postoperatively. RESULTS: Male patients aged 1-4 years predominated. Visual acuity improved in 100% of patients, to varying degrees. Prior to surgery, 72% had visual acuity of 0.1-0.5. Six months post-surgery, with visual rehabilitation, 90.9% exhibited visual acuity of >0.5. In 81.8% of patients, palpebral ptosis was fully corrected. Complications were minimal: injury to the palpebral tarsus and undercorrection were the most common and did not affect final surgical outcome or interfere with rehabilitation. CONCLUSIONS: Correction of congenital ptosis using the frontalis sling technique yielded satisfactory visual acuity outcomes, contributing to visual rehabilitation of the affected patients. (+info)