TY - JOUR
T1 - Supramaximal levator resection for unilateral congenital ptosis
T2 - Cosmetic and functional results
AU - Cruz, Antonio A.V.
AU - Akaishi, Patricia M.S.
AU - Mendonça, Ana K.T.S.
AU - Bernadini, Francesco
AU - Devoto, Martin
AU - Garcia, Denny M.
PY - 2014/1/1
Y1 - 2014/1/1
N2 - Conclusions: In unilateral congenital ptosis, SMLPSr effectively reduces the positional asymmetry between eyelids. Mild contour abnormalities and lash ptosis are the main complications of the surgery. Postoperatively, spontaneous blinks and downward saccades were reduced in most eyelids. The reduced postoperative eyelid kinetics indicates that only patients with normal upward Bell signs are good candidates for this procedure.Purpose: To analyze the cosmetic and functional results of a large series of patients with unilateral congenital ptosis without spontaneous compensatory ipsilateral frontalis hyperaction who underwent supramaximal levator resection (SMLPSr).Methods: A multicenter retrospective review of 35 children (14 girls and 21 boys) of mean age 5.5 ± 3.6 SD years with unilateral congenital ptosis who underwent surgery in 3 different countries: Italy, n = 8; Argentina, n = 11; and Brazil, n = 16. Preoperative evaluation included measurements of upper eyelid margin reflex distance (MRD1) and levator palpebrae superioris muscle excursion, assessment of frontalis hyperaction, and ocular motility examination. At least 6 months postoperatively, photographs were used to measure the upper eyelid contour of OU. The spontaneous blinking amplitude and downward eyelid saccades of OU were quantified in a subset of 14 patients. Quantitative comparison among the 3 centers was performed with nonparametric 1-way analysis of variance (Kruskal-Wallis). Paired t tests were used to compare the pre- and postoperative measurements, and p value < 0.05 was statistically significant.Results: The mean preoperative MRD1 of the operated eyes increased from 0.5 ± 1.1 SD mm to 3.4 ± 0.84 SD mm (t = 15.9; p < 0.000001), consequently the eyelid positional asymmetry decreased from 3.1 ± 1.21 mm to 0.1 ± 0.86 SD mm (t = 16.5; p ≤ 0.000001). Twenty-nine percent of eyelids had mild contour abnormalities and 31.4% showed some degree of lash ptosis. Spontaneous blinks were abnormal in 93% of the cases (eyelids). The amplitude of the abnormal blinks ranged from 12.9% to 65.4% (mean = 37.1%) of the contralateral eyelids. Downward eyelid saccades were reduced in 79% of the eyelids. The amplitudes the saccades ranged from 2.2% to 84.6% (mean = 54.8%).
AB - Conclusions: In unilateral congenital ptosis, SMLPSr effectively reduces the positional asymmetry between eyelids. Mild contour abnormalities and lash ptosis are the main complications of the surgery. Postoperatively, spontaneous blinks and downward saccades were reduced in most eyelids. The reduced postoperative eyelid kinetics indicates that only patients with normal upward Bell signs are good candidates for this procedure.Purpose: To analyze the cosmetic and functional results of a large series of patients with unilateral congenital ptosis without spontaneous compensatory ipsilateral frontalis hyperaction who underwent supramaximal levator resection (SMLPSr).Methods: A multicenter retrospective review of 35 children (14 girls and 21 boys) of mean age 5.5 ± 3.6 SD years with unilateral congenital ptosis who underwent surgery in 3 different countries: Italy, n = 8; Argentina, n = 11; and Brazil, n = 16. Preoperative evaluation included measurements of upper eyelid margin reflex distance (MRD1) and levator palpebrae superioris muscle excursion, assessment of frontalis hyperaction, and ocular motility examination. At least 6 months postoperatively, photographs were used to measure the upper eyelid contour of OU. The spontaneous blinking amplitude and downward eyelid saccades of OU were quantified in a subset of 14 patients. Quantitative comparison among the 3 centers was performed with nonparametric 1-way analysis of variance (Kruskal-Wallis). Paired t tests were used to compare the pre- and postoperative measurements, and p value < 0.05 was statistically significant.Results: The mean preoperative MRD1 of the operated eyes increased from 0.5 ± 1.1 SD mm to 3.4 ± 0.84 SD mm (t = 15.9; p < 0.000001), consequently the eyelid positional asymmetry decreased from 3.1 ± 1.21 mm to 0.1 ± 0.86 SD mm (t = 16.5; p ≤ 0.000001). Twenty-nine percent of eyelids had mild contour abnormalities and 31.4% showed some degree of lash ptosis. Spontaneous blinks were abnormal in 93% of the cases (eyelids). The amplitude of the abnormal blinks ranged from 12.9% to 65.4% (mean = 37.1%) of the contralateral eyelids. Downward eyelid saccades were reduced in 79% of the eyelids. The amplitudes the saccades ranged from 2.2% to 84.6% (mean = 54.8%).
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U2 - 10.1097/IOP.0000000000000105
DO - 10.1097/IOP.0000000000000105
M3 - Article
C2 - 24759292
AN - SCOPUS:84914154702
SN - 0740-9303
VL - 30
SP - 366
EP - 371
JO - Ophthalmic plastic and reconstructive surgery
JF - Ophthalmic plastic and reconstructive surgery
IS - 5
ER -