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Agarwal A, Joseph J, Naik MN. Delayed infections following polybutylate-coated polyester (Ethibond) suture frontalis suspension surgery for severe blepharoptosis. Orbit 2024:1-7. [PMID: 38687955 DOI: 10.1080/01676830.2024.2338789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/27/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE To describe the incidence and management of delayed infections following frontalis sling suspension with polybutylate-coated polyester suture (Ethibond). METHODS Retrospective, interventional case series of 177 eyes of 150 patients, who underwent frontalis suspension surgery with Ethibond (Johnson and Johnson, USA), at L V Prasad Eye Institute, Hyderabad, India, between January 2016 and February 2022. Patients were assessed for chronic secondary sling infection, defined as infection/suture granuloma occurring beyond 6 weeks post-surgery. All patients received postoperative oral antibiotics. The clinical profile, microbiological evaluation, antibiotic sensitivity patterns, and management outcomes were analyzed. RESULTS Delayed infection following Ethibond sling suspension was noted in 14 eyes of 13 patients (7.9%). Of these, eight cases (61.5%) were females. The average time interval from surgery to presentation was 7.5 months (range: 2.5 months to 2.5 years). Eleven eyes underwent sling removal. Of the three who received initial antibiotic course, two eventually needed sling removal. Microbiological evaluation was available in seven eyes (50%), with Staphylococcus aureus as the most common organism. Of the six positive cultures, five (83.3%) were resistant to fluoroquinolones (FQs). CONCLUSION Frontalis suspension with Ethibond has an 8% incidence of delayed infections, with Staphylococcus aureus as the most common organism. The authors recommend early sling removal in all patients with infection and recommend consideration of an alternative material in the event of future revision surgery.
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Affiliation(s)
- Ayushi Agarwal
- Hariram Motumal Nasta & Renu Hariram Nasta Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, L.V. Prasad Eye Institute, Hyderabad, India
| | - Milind N Naik
- Hariram Motumal Nasta & Renu Hariram Nasta Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India
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Fogel Tempelhof O, Bachar Zipori A, Mezad-Koursh D, Tomashpolski E, Abumanhal M, Leibovitch I, Ben Cnaan R. Congenital ptosis repair in children: comparison of frontalis muscle suspension surgery and levator muscle surgery. Graefes Arch Clin Exp Ophthalmol 2023; 261:2979-2986. [PMID: 37195337 DOI: 10.1007/s00417-023-06105-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/11/2023] [Accepted: 05/06/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Comparing the surgical and refractive outcomes of congenital ptosis repair by different surgical techniques. METHODS This longitudinal cohort study reviewed medical records of 101 patients who underwent congenital ptosis repair, from 2006 to 2022 in a single center. Analysis was performed for demographic background, co-morbidities, pre-operative and post-operative ocular examinations and refraction, complications, reoperations, and success rates. RESULTS Following exclusion criteria, we remained with 80 patients (103 eyes) who underwent either frontalis muscle suspension surgery (FMS) (55 eyes) or levator muscle surgery (LM) (48 eyes). Patients in the FMS group were younger (mean age of 3.1 vs. 6.0 years, p < 0.001) and had worse pre-operative ocular assessments including prevalence of visual axis involvement, chin-up head position, ptosis severity, and levator muscle function (LF) (p < 0.001). Both groups had a 25% rate of reoperation, however while in the LM group reoperation was required solely due to undercorrection, in the FMS group various indications prompted reoperation. Success rate was higher in the FMS group (87.3% vs. 60.4%, p = 0.002). While pre-operative astigmatism was higher in the LM group (p = 0.019), no significant differences were observed post-operatively. Spherical and spherical equivalent changes over time were significant only in the FMS group (p = 0.010 and p = 0.004, respectively). CONCLUSIONS Within our cohort, a higher success rate of congenital ptosis repair was observed among patients who underwent FMS compared to LM, despite similar reoperation rates. In cases of severe ptosis and moderate LF, LM demonstrated a lower-than-anticipated success rate. Astigmatic changes following ptosis repair were not consistent in either group.
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Affiliation(s)
- Ortal Fogel Tempelhof
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel.
| | - Anat Bachar Zipori
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Daphna Mezad-Koursh
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Elena Tomashpolski
- Department of Radiology, Shamir, Assaf Harofeh Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, Be'er Ya'akov, Israel
| | - Muhammad Abumanhal
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Igal Leibovitch
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Ran Ben Cnaan
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 6423906, Tel Aviv, Israel
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Ortega-Evangelio L, Araújo-Miranda R, Raga-Cervera J, Romo López Á, Díaz-Céspedes RA, Peris-Martínez C. Evolution of the «frontal flap advancement» in congenital ptosis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:572-582. [PMID: 35637109 DOI: 10.1016/j.oftale.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/02/2021] [Indexed: 06/15/2023]
Abstract
The treatment of congenital ptosis with poor levator activity is often based upon the union of the superior eyelid to the frontalis muscle by using different materials as potential grafts. Nevertheless, theses grafts may lead some complications. In order to avoid them, a new technic has been described using an advancement flap of the frontalis muscle, that is tided to the upper tarsus, eliminating the need of a graft. Although, it is not yet a standard procedure, reason why many variants has been recently described with the objective of improve the aesthetical and functional results. The goal of this systematic review is to conscientiously evaluate these variants with the propose of determine which one gives the best results in terms of safety, functional and aesthetical outcomes. From the review of the published procedures, we conclude that the best technique in terms of functional and aesthetical results is: sub-orbicularis dissection via lid crease incision reaching the orbital margin, followed by blunt dissection of the frontalis muscle and creation of a "U" shaped flap (that might be associated to a levator advancement in severe cases), finally, the frontalis flap is stitched to the upper end of the tarsus taking care to maintain a symmetrical contour when compared to the contralateral eye. The final eyelid margin height should be 1.5 mm above the sclero-corneal limbus.
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Affiliation(s)
- L Ortega-Evangelio
- Fisabio-Oftalmología Médica (FOM), Valencia, Spain; Clínica Baviera, Valencia, Spain.
| | | | | | | | | | - C Peris-Martínez
- Fisabio-Oftalmología Médica (FOM), Valencia, Spain; Clínica oftalmológica Aviñó Peris, Valencia, Spain; Facultad de Medicina, Departamento de Cirugía, Universitat de València, Valencia, Spain
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4
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Combined levator and frontalis muscle advancement flaps for recurrent severe congenital ptosis. Eye (Lond) 2022; 37:1100-1106. [PMID: 35469061 PMCID: PMC10102021 DOI: 10.1038/s41433-022-02071-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To evaluate the outcomes of combined levator resection and frontalis muscle advancement for surgical management of recurrent severe congenital ptosis. DESIGN Retrospective, nonrandomized interventional case series. METHODS A retrospective review was performed of patients who underwent combined levator resection and frontalis muscle advancement for recurrent congenital ptosis between 2017 and 2020. Inclusion criteria were levator function of 4 mm or less and margin reflex distance 1 (MRD1) of 0 mm or less. Main outcome measures were postoperative MRD 1, lagophthalmos, lash angle, and grades of eyelid contour and crease. The outcomes were assessed by reviewing medical charts and photographs. RESULTS Thirty-one patients (35 eyelids) met the inclusion criteria. The mean preoperative MRD1 was -1.14 ± 1.56 mm, which improved to 3.93 ± 0.52 mm with an average lagophthalmos of 0.91 ± 0.74 mm at the last follow-up. A total of 91.4% of eyelids had excellent eyelid contour, crease, and eyelash angle at the final follow-up. One eyelid required revision surgery. There were no other significant complications. CONCLUSIONS For poor function recurrent congenital ptosis, combining levator resection and frontalis muscle advancement is an effective method that results in long-term correction with cosmetically pleasing outcomes and minimal complications.
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Lim HK, Lau AZ, Charles WN, Khajuria A. Efficacy and Complications of External and Internal Pediatric Blepharoptosis Repair Techniques: A Systematic Review. Ophthalmic Plast Reconstr Surg 2022; 38:1-7. [PMID: 33782331 DOI: 10.1097/iop.0000000000001974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review and evaluate the efficacy and complication rates of external and internal blepharoptosis repair techniques in pediatric patients. METHODS The systematic review protocol was published on PROSPERO (CRD42020197343). Embase, MEDLINE, CENTRAL, and ClinicalTrials.gov were searched without date limitations. Two independent reviewers evaluated the articles for inclusion. Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS-I tool, respectively. RESULTS Of 2,228 articles screened, 23 studies involving 730 patients were included. There were 20 case series and 3 retrospective cohort studies, but no randomized controlled studies. Overall study quality was low with serious risk of bias according to the GRADE and ROBINS-I criteria, respectively. External levator resection was the most studied procedure, evaluated in 18 studies. Seven studies investigated internal approaches including the Fasanella-Servat procedure. There was no standardized evaluation of surgical efficacy. Reoperation rates were 16.6% (range 3.6-50.9%) for external levator resection compared with 22.2% (range 0.0-25.8%) for internal approaches. The commonest postoperative complications were not sight-threatening. The most consistently reported complication was undercorrection, occurring at rates of 8.4% (range 2.4-16.7%) and 15.3% (range 2.7-75.0%) for external levator resection and internal approaches, respectively. There were no consistently applied, validated patient-reported outcomes or cosmetic outcomes. CONCLUSIONS External and internal approaches have been successfully employed in pediatric blepharoptosis repair. However, noncomparative designs and risk-of-bias limit existing studies. Thus, prospectively designed studies with standardized outcome measures are required to minimize reporting bias, facilitate evidence synthesis, and support clinical decision making.
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Affiliation(s)
- Hong Kai Lim
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, United Kingdom
| | - Ashton Z Lau
- The Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Walton N Charles
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ankur Khajuria
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Nuffield Department of Surgical Sciences, Kellogg College, University of Oxford, Oxford, United Kingdom
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6
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Dawood AS, Hassan OA, El Sayed MO. Maximal levator resection versus Gore-Tex ® sling for congenital blepharoptosis with poor levator function. Oman J Ophthalmol 2021; 14:173-178. [PMID: 34880579 PMCID: PMC8597826 DOI: 10.4103/ojo.ojo_127_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/09/2021] [Accepted: 07/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Treating congenital blepharoptosis is often mandatory to clear the visual access and avoid amblyopia; however, when the levator function is poor, achieving a satisfactory long-term outcome is challenging. This study aimed to compare the outcomes of maximal levator resection (MLR) with those of frontalis suspension (FS) using Gore-Tex
®, in the treatment of congenital blepharoptosis with poor levator function. PATIENTS AND METHODS: The study included 102 eyelids of 66 patients of mean age 4.3 ± 1.6 standard deviation (SD) years, randomly divided into two groups (51 eyes each). Group A: FS using Gore-Tex
®, Group B: MLR. Postoperative outcomes were evaluated at 1, 6 and 12 months. Patients' ophthalmic examination including margin-reflex distance (MRD1) before and after surgery and postoperative complications were recorded. RESULTS: At the end of the follow-up, the mean MRD1 increased from 0.3 ± 0.7 SD mm in Group A, 0.4 ± 0.8 SD mm in Group B preoperatively, to 2.7 ± 0.5 SD mm and 2.9 ± 0.7 SD mm, respectively (P < 0.001 in both groups). Results of Group B were significantly higher than Group A (P = 0.047). Success was achieved in 77 eyelids (75.4%), distributed as follows: 36 eyelids (70.6%) in Group A, and 41 eyelids (80.1%) in Group B. The total recurrence rate was 6.9% (seven eyes), while other complications were recorded in 23 eyes (22.5%). CONCLUSION: MLR, compared to FS with Gore-Tex® sling, can be a more efficient surgical option to correct congenital blepharoptosis with poor levator excursion. Prominent postoperative lagophthalmos warrants close ocular surface observation in early follow-up weeks.
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Affiliation(s)
- Ahmed Said Dawood
- Department of Ophthalmology, The James Cook University Hospital, Middlesbrough, United Kingdom
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Song X, Tong W, Lei C, Huang J, Fan X, Zhai G, Zhou H. A clinical decision model based on machine learning for ptosis. BMC Ophthalmol 2021; 21:169. [PMID: 33836706 PMCID: PMC8033720 DOI: 10.1186/s12886-021-01923-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background To establish a decision model based on two- (2D) and three-dimensional (3D) eye data of patients with ptosis for developing personalized surgery plans. Methods Data of this retrospective, case-control study was collected from March 2019 to June 2019 at the Department of Ophthalmology, Shanghai Ninth People’s Hospital, and then the patients were followed up for 3 months. One hundred fifty-two complete feature eyes from 100 voluntary patients with ptosis and satisfactory surgical results were selected, with 48 eyes excluded due to any severe condition or improper collection and shooting angle. Three experimental schemes were set as follows: use 2D distance alone, use 3D distance alone, and use two distances at the same time. The five most common evaluation indicators used in the binary classification problem to test the decision model were accuracy (ACC), precision, recall, F1-score, and area under the curve (AUC). Results For diagnostic discrimination, recall of “3D”, “2D” and “Both” schemes were 0.875, 0.875 and 0.938 respectively. And precision of the three schemes were 0.8333, 0.7778 and 1.0000 for the surgical procedure classification. Values of “Both” scheme that combined 2D and 3D data were the highest in two classifications. Conclusions In this study, 3D eye data are introduced into clinical practice to construct a decision model for ptosis surgery. Our decision model presents exceptional prediction effect, especially when 2D and 3D data employed jointly.
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Affiliation(s)
- Xuefei Song
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Weilin Tong
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chaoyu Lei
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingxuan Huang
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Guangtao Zhai
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Huifang Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
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Su Z, Fan J, Zhang X, Chen H, Liu L, Tian J, Gan C, Jiao H, Yang Z, Cao J. The Application of Temporal-Fasciae-Complex Sheet in Treating Severe Blepharoptosis. Aesthetic Plast Surg 2021; 45:556-563. [PMID: 31485765 DOI: 10.1007/s00266-019-01488-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/22/2019] [Indexed: 11/30/2022]
Abstract
AIM To introduce the application of the temporal-fasciae-complex sheet in treating severe blepharoptosis by frontalis suspension and evaluate its postoperative effect. METHODS Between 2008 and 2016, 25 patients (33 eyelids) underwent this procedure. A 3-cm incision in the temporal region was made to harvest a sheet of deep temporal fascia with the loose aponeurosis attached on both sides. The sheet was then grafted through a preseptal tunnel to perform the suspension. The margin reflex distance 1 after suspension (MRD1S), the margin reflex distance 1 as lifting eyebrow forcefully (MRD1F), the eyelid excursion and the closable eyelid function were used to evaluate the postoperative effect. RESULTS A total of 22 patients (30 eyelids) completed the study with a mean follow-up period of 23 ± 8.78 months. There was a statistically significant difference between the MRD1 and MRD1S (p < 0.05), the preoperative and postoperative MRD1F (p < 0.05), the preoperative and postoperative eyelid excursion (p < 0.05). All the upper palpebral margins were located above the pupils and no longer affected visual acuity in primary gaze. No severe complication and recurrence were documented within a maximum follow-up period of 36 months. CONCLUSIONS Frontalis suspension with the temporal-fasciae-complex sheet is an efficient method to correct severe blepharoptosis with less complications and recurrences. The application of the sheet can not only overcome the influence of adhesion but also lift the eyelid both functionally and cosmetically. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Zhiguo Su
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jincai Fan
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xinyu Zhang
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongbo Chen
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liqiang Liu
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Tian
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng Gan
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hu Jiao
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zengjie Yang
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiankun Cao
- Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Amendola F, Cottone G, Zilio D, Borelli F, Cross KJ, Vaienti L. Levator palpebrae superioris muscle advancement for steinert myotonic dystrophy eyelid ptosis. J Plast Reconstr Aesthet Surg 2020; 74:1355-1401. [PMID: 33358128 DOI: 10.1016/j.bjps.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 10/30/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Francesco Amendola
- Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan 20097, San Donato Milanese, Italy; Department of Plastic Surgery, Faculty of Medicine, University of Milan, Via Festa del Perdono 20122, Milan, Italy
| | - Giuseppe Cottone
- Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan 20097, San Donato Milanese, Italy; Department of Plastic Surgery, Faculty of Medicine, University of Milan, Via Festa del Perdono 20122, Milan, Italy.
| | - Dino Zilio
- Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan 20097, San Donato Milanese, Italy
| | - Francesco Borelli
- Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan 20097, San Donato Milanese, Italy; Department of Plastic Surgery, Faculty of Medicine, University of Milan, Via Festa del Perdono 20122, Milan, Italy
| | - Kevin J Cross
- Plastic surgeon in private practice in Philadelphia (2200 Arch Street Suite 120, Philadelphia, PA 19103) and affiliated with Penn Presbyterian Medical Center, Philadelphia, PA, United States
| | - Luca Vaienti
- Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan 20097, San Donato Milanese, Italy; Department of Plastic Surgery, Faculty of Medicine, University of Milan, Via Festa del Perdono 20122, Milan, Italy
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Liu Y, Pan H, Wang J, Yao Q, Lin M, Ma B, Li J. Ophthalmological features and treatments in five cases of Waardenburg syndrome. Exp Ther Med 2020; 20:3072-3077. [PMID: 32855674 PMCID: PMC7444341 DOI: 10.3892/etm.2020.9035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 06/19/2020] [Indexed: 11/25/2022] Open
Abstract
The present study aimed to investigate the ocular characteristics and treatment of Waardenburg syndrome (WS). A total of five patients with Waardenburg syndrome from our hospital, aged between 1 and 8 years, were included in the present study. The clinical data of these patients were analyzed, and the ocular manifestations and treatments were described. The general manifestations included hearing loss (1/5), broad high nasal root (2/5) and hypoplasia of alae nasi (2/5). Ophthalmological evaluations revealed ptosis (1/5), strabismus 1 (1/5), synophrys (2/5), telecanthus (5/5), iris hypopigmentation (5/5), high intraocular pressure (1/5) and choroidal hypopigmentation (1/5). For patients with characteristic external eye abnormalities, including ptosis, ocular plastic surgery was performed. For patients with only symptoms of iris heterochromia, no special treatment was required. The findings from the present study suggest that patients with WS may have several characteristic ocular manifestations. Abnormalities in the eyelid can be corrected by ocular plastic surgery, which is beneficial to children's physical and mental development.
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Affiliation(s)
- Yan Liu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, P.R. China
| | - Hui Pan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, P.R. China
| | - Jing Wang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, P.R. China
| | - Qinke Yao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, P.R. China
| | - Ming Lin
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, P.R. China
| | - Bo Ma
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, P.R. China
| | - Jin Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, P.R. China
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11
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Young SM, Imagawa Y, Kim YD, Park JW, Jang J, Woo KI. Lagophthalmos after congenital ptosis surgery: comparison between maximal levator resection and frontalis sling operation. Eye (Lond) 2020; 35:1261-1267. [PMID: 32651544 DOI: 10.1038/s41433-020-1081-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES To compare postoperative lagophthalmos after maximal levator resection (MLR) and frontalis suspension (FS) in congenital ptosis patients with poor levator function (LF). METHODS A cross-sectional study was performed to compare postoperative outcomes in patients with preoperative LF ≤ 4 mm who had undergone MLR or FS at a single tertiary institution, and who had visited the outpatient clinic between February 2017 and August 2018. Main outcome measures were as follows: (1) Preoperative LF and margin reflex distance 1 (MRD1), (2) Postoperative MRD1, lagophthalmos and grade of superficial punctate keratopathy (SPK). RESULTS Our study comprised 152 eyelids of 122 patients. There were 71 eyelids in the MLR group and 81 eyelids in the FS group. The MLR group had comparable mean postoperative MRD1 (2.8 ± 0.8 mm) to the FS with autogenous fascia lata (AFL) group (3.0 ± 0.7 mm), while the FS with preserved fascia lata (PFL) group had the lowest mean postoperative MRD1 (2.2 ± 1.0 mm). The PFL group had significantly less lagophthalmos (0.6 ± 1.0 mm) than the AFL (1.9 ± 1.4 mm) and maximal levator resection (1.9 ± 1.7 mm) groups. In the MLR group, there was no significant difference in postoperative surgical measurements between the LF 0-2 mm group and LF 2.5-4 mm group in terms of exposure keratopathy, degree of lagophthalmos and MRD1. CONCLUSION MLR is an effective alternative to FS in congenital ptosis patients with poor levator function, with the risk of postoperative lagophthalmos related to postoperative MRD1 rather than preoperative LF.
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Affiliation(s)
- Stephanie Ming Young
- Ophthalmic Plastic and Reconstructive Surgery, Eagle Eye Centre, Singapore, Singapore
| | - Yukihiro Imagawa
- Department of Ophthalmology, Osaka Kaisei Hospital, Osaka, Japan
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Ji Woong Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jaeho Jang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Pascoletti G, Pressanto MC, Putame G, Terzini M, Franceschini G, Zanetti EM. Data from cyclic tensile tests on sutured organs to evaluate creep behaviour, distraction, and residual thread strength. Data Brief 2020; 30:105644. [PMID: 32435679 PMCID: PMC7231839 DOI: 10.1016/j.dib.2020.105644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/28/2022] Open
Abstract
A number of applications in the surgical practice are based on tensile sutures aimed to keep soft tissues in place and compensate the exit of neuropathies, prolapses or general tissue relaxation. Long-term behaviour of these constructs need to be carefully examined in order to define tensile forces to be applied and to compare different suture anchors. Data here reported refer to equine laryngoplasties, where a suitable loading system has been designed in order to be able to test sutures in-sito, applying known forces ("On-site testing of sutured organs: an experimental set up to cyclically tighten sutures" (Pascoletti et al., 2020 [1])). The loading protocol was made of two steps: in the first step, 3000 loading cycles have been performed; in the following step, a tensile test up to rupture was performed. Cyclic load/displacement curves allow evaluating suture distraction, as a consequence of suture migration and/or soft tissues creep. Tensile curves allow evaluating the residual thread strength and its ultimate displacement. These data can provide a detailed insight of long-term suture behaviour and can be a reference to compare different threads and/or suture anchors.
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Affiliation(s)
| | - Maria Chiara Pressanto
- Dip. di Medicina Veterinaria – Sezione Chirurgia e Radiodiagnostica, University of Perugia, Italy
| | - Giovanni Putame
- PolitoMedLab, Politecnico di Torino, Italy
- DIMEAS, Politecnico di Torino, Italy
| | - Mara Terzini
- PolitoMedLab, Politecnico di Torino, Italy
- DIMEAS, Politecnico di Torino, Italy
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On-site testing of sutured organs: An experimental set up to cyclically tighten sutures. J Mech Behav Biomed Mater 2020; 109:103803. [PMID: 32543391 DOI: 10.1016/j.jmbbm.2020.103803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/11/2020] [Accepted: 04/15/2020] [Indexed: 11/20/2022]
Abstract
A number of surgical practices are aimed to compensate for tissue relaxation or weakened/atrophied muscles by means of suture prostheses/thread lifts. The success rate of these procedures is often very good in the short term, while it is quite variable among subjects and techniques in the middle-long term. Middle-long term failures are mostly related to suture distraction, loosening or wear, coming from repeated loading cycles. In this work, an experimental device to perform ex vivo tests on prosthetic sutures has been set up. An equine laryngoplasty has been used as a benchmark, being representative of sutures aimed to compensate for atrophied muscles. The peculiarity of this experimental set up is that the suture is on-site and it has been tightened with known, repeated loads, which do not depend on thread deformation at different load levels. Preliminary tests have been performed applying over 3000 load cycles and finally a tensile test up to rupture. Force/displacement curves obtained with this experimental set up have been reported and parameters useful to classify the biomechanical performance of sutures versus time (mainly its creep behaviour), have been outlined. Results have outlined that the organ-suture system undergoes significant creep over 3000 cycles, and this should be taken into account in order to foresee its long-term behaviour; in addition, the suture anchorage to cartilage should be improved. The experimental set up can be used to perform on-site testing of sutures, taking into account the compliance and creep response at both suture anchorage ends, in order to compare different surgeries and different kinds of thread.
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Balsak S, Dağ U, Güneş Y, Çakmak S, Keklikçi U. Outcomes of Maximal Levator Resection Procedure in Cases of Congenital Myogenic Ptosis. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.620581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Orbital Septum Fibrosis in Congenital Ptosis Correlates With Eyelid Function: A Clinicopathologic Study. Ophthalmic Plast Reconstr Surg 2019; 35:469-473. [DOI: 10.1097/iop.0000000000001330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Son KY, Kim YD, Woo KI, Park KA. Clinical Outcomes and Refractive Error Characteristics in Patients with Congenital Blepharoptosis after Ptosis Repair Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.12.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ki Young Son
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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