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Transconjunctival blepharoptosis surgery: a review of posterior approach ptosis surgery and posterior approach white-line advancement.

Patel V, Malhotra R - Open Ophthalmol J (2010)

Bottom Line: Posterior approach blepharoptosis surgery, via the transconjunctival route, was probably the first method of surgery employed to shorten the levator palpebrae superioris (LPS) muscle.A review of the literature demonstrates how surgery has evolved since Blaskovics' first described his technique in 1923.We describe our newer method of posterior approach white-line advancement blepharoptosis repair which is now an option in the majority of aponeurotic ptosis with moderate to good levator function.

View Article: PubMed Central - PubMed

Affiliation: CorneoPlastic Unit, Queen Victoria Hospital, East Grinstead, RH19 3DZ, UK.

ABSTRACT
Posterior approach blepharoptosis surgery, via the transconjunctival route, was probably the first method of surgery employed to shorten the levator palpebrae superioris (LPS) muscle. A review of the literature demonstrates how surgery has evolved since Blaskovics' first described his technique in 1923. We describe our newer method of posterior approach white-line advancement blepharoptosis repair which is now an option in the majority of aponeurotic ptosis with moderate to good levator function.

No MeSH data available.


Related in: MedlinePlus

Surgical Technique. A double armed 5-0 vicryl® suture isplaced centrally through the posterior belly of the white-line (A), ina forehand manner and is then passed through the conjunctivalsurface of the tarsal plate, 1 mm below its superior border (B), andthen through to the skin. The eyelid height and contour is assessedafter tying this first suture in a bow (C).
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Figure 1: Surgical Technique. A double armed 5-0 vicryl® suture isplaced centrally through the posterior belly of the white-line (A), ina forehand manner and is then passed through the conjunctivalsurface of the tarsal plate, 1 mm below its superior border (B), andthen through to the skin. The eyelid height and contour is assessedafter tying this first suture in a bow (C).

Mentions: The procedure is usually performed under local anaesthesia with subcutaneous infiltration, both along the skin crease and in the mid-pupil pretarsal region and 0.5 ml subconjunctival infiltration upon eyelid eversion using 2 % lignocaine with 1:80000 adrenaline. The desired skin crease is marked and a 4-0 silk traction suture placed in the grey line of the upper eyelid, which is then everted over a Desmarres retractor. Gentle diathermy is applied prior to a conjunctival incision with a no 15 Bard parker blade along but above the superior border of the tarsus. Müller’s muscle and conjunctiva is dissected off as a composite flap until the white-line is identified. A double armed 5-0 vicryl® suture is placed centrally through the posterior belly of the white-line (Fig. 1A), in a forehand manner and is then passed through the conjunctival surface of the tarsal plate, 1 mm below its superior border (Fig. 1B), and then through to the skin. Gentle diathermy and scraping away of the epithelial surface of the superior border of the tarsal plate prior to passing the suture may be performed in order to provide a better more reliable long term adhesion between the white-line and the tarsus. The suture is captured through the skin in the region of the skin crease. The eyelid height and contour is assessed after tying this first suture in a bow (Fig. 1C) and care is taken to ensure there is no slippage of the suture. If the eyelid position is deemed to be satisfactory, the suture is relaxed and a second suture is placed within 2-3 mm lateral to the first in the method described above. Both sutures are then tied. If the eyelid height is too low after the first suture, it can then be relaxed and a second suture passed higher through the white-line and again through the tarsal plate and skin. If the upper eyelid contour appears peaked after the first suture, then this is relaxed and a second suture placed more central to the location of the peak. Using this method of altering the position of the second suture enables minor adjustments to eyelid height and contour without the undue delay of removing the first suture in the majority of cases. In such situations, the first suture is gently tied to act as a “support” rather than a “cardinal” suture. In the post-operative period the absorbable sutures are not removed and left to dissolve spontaneously. Both Müller’s muscle and conjunctiva are left to heal spontaneously with no excision of these structures. In those cases with significant dermatochalasis the procedure can be combined with a blepharoplasty. This is carried out prior to eyelid eversion and white-line advancement.


Transconjunctival blepharoptosis surgery: a review of posterior approach ptosis surgery and posterior approach white-line advancement.

Patel V, Malhotra R - Open Ophthalmol J (2010)

Surgical Technique. A double armed 5-0 vicryl® suture isplaced centrally through the posterior belly of the white-line (A), ina forehand manner and is then passed through the conjunctivalsurface of the tarsal plate, 1 mm below its superior border (B), andthen through to the skin. The eyelid height and contour is assessedafter tying this first suture in a bow (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3040997&req=5

Figure 1: Surgical Technique. A double armed 5-0 vicryl® suture isplaced centrally through the posterior belly of the white-line (A), ina forehand manner and is then passed through the conjunctivalsurface of the tarsal plate, 1 mm below its superior border (B), andthen through to the skin. The eyelid height and contour is assessedafter tying this first suture in a bow (C).
Mentions: The procedure is usually performed under local anaesthesia with subcutaneous infiltration, both along the skin crease and in the mid-pupil pretarsal region and 0.5 ml subconjunctival infiltration upon eyelid eversion using 2 % lignocaine with 1:80000 adrenaline. The desired skin crease is marked and a 4-0 silk traction suture placed in the grey line of the upper eyelid, which is then everted over a Desmarres retractor. Gentle diathermy is applied prior to a conjunctival incision with a no 15 Bard parker blade along but above the superior border of the tarsus. Müller’s muscle and conjunctiva is dissected off as a composite flap until the white-line is identified. A double armed 5-0 vicryl® suture is placed centrally through the posterior belly of the white-line (Fig. 1A), in a forehand manner and is then passed through the conjunctival surface of the tarsal plate, 1 mm below its superior border (Fig. 1B), and then through to the skin. Gentle diathermy and scraping away of the epithelial surface of the superior border of the tarsal plate prior to passing the suture may be performed in order to provide a better more reliable long term adhesion between the white-line and the tarsus. The suture is captured through the skin in the region of the skin crease. The eyelid height and contour is assessed after tying this first suture in a bow (Fig. 1C) and care is taken to ensure there is no slippage of the suture. If the eyelid position is deemed to be satisfactory, the suture is relaxed and a second suture is placed within 2-3 mm lateral to the first in the method described above. Both sutures are then tied. If the eyelid height is too low after the first suture, it can then be relaxed and a second suture passed higher through the white-line and again through the tarsal plate and skin. If the upper eyelid contour appears peaked after the first suture, then this is relaxed and a second suture placed more central to the location of the peak. Using this method of altering the position of the second suture enables minor adjustments to eyelid height and contour without the undue delay of removing the first suture in the majority of cases. In such situations, the first suture is gently tied to act as a “support” rather than a “cardinal” suture. In the post-operative period the absorbable sutures are not removed and left to dissolve spontaneously. Both Müller’s muscle and conjunctiva are left to heal spontaneously with no excision of these structures. In those cases with significant dermatochalasis the procedure can be combined with a blepharoplasty. This is carried out prior to eyelid eversion and white-line advancement.

Bottom Line: Posterior approach blepharoptosis surgery, via the transconjunctival route, was probably the first method of surgery employed to shorten the levator palpebrae superioris (LPS) muscle.A review of the literature demonstrates how surgery has evolved since Blaskovics' first described his technique in 1923.We describe our newer method of posterior approach white-line advancement blepharoptosis repair which is now an option in the majority of aponeurotic ptosis with moderate to good levator function.

View Article: PubMed Central - PubMed

Affiliation: CorneoPlastic Unit, Queen Victoria Hospital, East Grinstead, RH19 3DZ, UK.

ABSTRACT
Posterior approach blepharoptosis surgery, via the transconjunctival route, was probably the first method of surgery employed to shorten the levator palpebrae superioris (LPS) muscle. A review of the literature demonstrates how surgery has evolved since Blaskovics' first described his technique in 1923. We describe our newer method of posterior approach white-line advancement blepharoptosis repair which is now an option in the majority of aponeurotic ptosis with moderate to good levator function.

No MeSH data available.


Related in: MedlinePlus