Limits...
Tarsoaponeurectomy as an alternative in difficult blepharoptosis cases.

Sendul SY, Dirim B, Demir M, Acar Z, Demir AG, Olgun A, Tiryaki S, Ucgul C, Guven D - BMC Ophthalmol (2016)

Bottom Line: Seven patients had ptosis in the left eye whereas one patient had ptosis in the right eye.All patients were given a tarsoaponeurectomy as the basic surgical procedure while the patient with entropion was given a tarsal fracture and ear cartilage grafting as additional surgery.Two patients with vertical notching were also given a vertical blepharotomy through which a strip of tarsus was removed.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street 34280, Sisli, Istanbul, Turkey. sysendul@hotmail.com.

ABSTRACT

Background: The purpose of this study was to evaluate the results of tarsoaponeurectomy in patients with unsuccessful results after repetitive surgery or who developed post-traumatic blepharoptosis.

Methods: The files of 107 patients (136 eyes) on whom surgery was performed between January 2010 and December 2014 due to blepharoptosis were scanned retrospectively. Among these patients, the files and operational notes of eight patients who underwent surgery through the method of tarsoaponeurectomy were examined in detail. The epidemiological data, indication for surgery, previous ptosis and/or eyelid surgeries and trauma histories, preoperative and postoperative measurement data (palpebral space (PS), margin reflex distance (MRD1, MRD2), levator muscle function (LMF)) of the patients were recorded. The follow-up time of the patients was 7 to 34 months with an average of 16 months.

Results: A total of eight patients consisting of three females and five males were included in the study. The age range was 19 to 63 years with an average of 39 ± 16.2 years. Four patients had traumatic ptosis history whereas four patients had previous multiple levator procedure surgery history. Those patients with a history of ptosis had undergone surgery with levator procedure at least two times. Additionally, one patient had upper eyelid entropion, one had anophthalmic socket syndrome, and one had exposure keratopathy and traumatic dilated pupil. Seven patients had ptosis in the left eye whereas one patient had ptosis in the right eye. All patients were given a tarsoaponeurectomy as the basic surgical procedure while the patient with entropion was given a tarsal fracture and ear cartilage grafting as additional surgery. Two patients with vertical notching were also given a vertical blepharotomy through which a strip of tarsus was removed.

Conclusions: Tarsoaponeurectomy is an alternative method for oculoplastic surgeons used to deal with patients on whom sufficient and desired results have not been achieved despite repetitive surgery and in post-traumatic cases where levator muscle and aponeurosis cannot be dissociated peroperatively.

Show MeSH

Related in: MedlinePlus

Increase in LMF is observed postoperatively in ptotic eyes, although not at statistically significant rates. (It probably occurred due to the enlargement of the movement range of the muscle following the recovery of adhesions)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4815071&req=5

Fig4: Increase in LMF is observed postoperatively in ptotic eyes, although not at statistically significant rates. (It probably occurred due to the enlargement of the movement range of the muscle following the recovery of adhesions)

Mentions: The basic success criterion was taken as a quantitative ptosis measurement (Table 2). All measurements were made during clinical examination. Preoperatively, the PS value was significantly lower in the eye with ptosis compared to the normal eye (p <0.05) whereas postoperatively no significant difference was detected between the two eyes (p >0.05) and again postoperatively a significant increase was detected in the eye with ptosis compared to the preoperative values (p <0.05) (Fig. 3). With respect to levator muscle function, it was significantly reduced in the eye with ptosis both preoperatively and postoperatively compared to the healthy eyelid (p <0.05) whereas no significant difference was detected in the postoperative levator function of the unhealthy eye compared to the preoperative value (p <0.05) (Fig. 4). In terms of MRD1 value, the preoperative MRD1 value in the eye with ptosis was significantly lower than that of the healthy eye (p <0.05) while there was no significant difference between the two postoperative values (p >0.05). Again, in the eye with ptosis, the postoperative MRD1 value showed a significant increase compared to the preoperative value (p <0.05) (Fig. 5). We did not observe any serious complications such as eyelid instability, ectropion or entropion in any of our cases. However, all cases showed temporary lagophthalmos of 1–3 mm continuing until postoperative month 1. Within this period, all patients were given intense eye-drop and gel therapy thereby preventing any ocular surface damage that might have developed due to lagophthalmos.Table 2


Tarsoaponeurectomy as an alternative in difficult blepharoptosis cases.

Sendul SY, Dirim B, Demir M, Acar Z, Demir AG, Olgun A, Tiryaki S, Ucgul C, Guven D - BMC Ophthalmol (2016)

Increase in LMF is observed postoperatively in ptotic eyes, although not at statistically significant rates. (It probably occurred due to the enlargement of the movement range of the muscle following the recovery of adhesions)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4815071&req=5

Fig4: Increase in LMF is observed postoperatively in ptotic eyes, although not at statistically significant rates. (It probably occurred due to the enlargement of the movement range of the muscle following the recovery of adhesions)
Mentions: The basic success criterion was taken as a quantitative ptosis measurement (Table 2). All measurements were made during clinical examination. Preoperatively, the PS value was significantly lower in the eye with ptosis compared to the normal eye (p <0.05) whereas postoperatively no significant difference was detected between the two eyes (p >0.05) and again postoperatively a significant increase was detected in the eye with ptosis compared to the preoperative values (p <0.05) (Fig. 3). With respect to levator muscle function, it was significantly reduced in the eye with ptosis both preoperatively and postoperatively compared to the healthy eyelid (p <0.05) whereas no significant difference was detected in the postoperative levator function of the unhealthy eye compared to the preoperative value (p <0.05) (Fig. 4). In terms of MRD1 value, the preoperative MRD1 value in the eye with ptosis was significantly lower than that of the healthy eye (p <0.05) while there was no significant difference between the two postoperative values (p >0.05). Again, in the eye with ptosis, the postoperative MRD1 value showed a significant increase compared to the preoperative value (p <0.05) (Fig. 5). We did not observe any serious complications such as eyelid instability, ectropion or entropion in any of our cases. However, all cases showed temporary lagophthalmos of 1–3 mm continuing until postoperative month 1. Within this period, all patients were given intense eye-drop and gel therapy thereby preventing any ocular surface damage that might have developed due to lagophthalmos.Table 2

Bottom Line: Seven patients had ptosis in the left eye whereas one patient had ptosis in the right eye.All patients were given a tarsoaponeurectomy as the basic surgical procedure while the patient with entropion was given a tarsal fracture and ear cartilage grafting as additional surgery.Two patients with vertical notching were also given a vertical blepharotomy through which a strip of tarsus was removed.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Etfal Street 34280, Sisli, Istanbul, Turkey. sysendul@hotmail.com.

ABSTRACT

Background: The purpose of this study was to evaluate the results of tarsoaponeurectomy in patients with unsuccessful results after repetitive surgery or who developed post-traumatic blepharoptosis.

Methods: The files of 107 patients (136 eyes) on whom surgery was performed between January 2010 and December 2014 due to blepharoptosis were scanned retrospectively. Among these patients, the files and operational notes of eight patients who underwent surgery through the method of tarsoaponeurectomy were examined in detail. The epidemiological data, indication for surgery, previous ptosis and/or eyelid surgeries and trauma histories, preoperative and postoperative measurement data (palpebral space (PS), margin reflex distance (MRD1, MRD2), levator muscle function (LMF)) of the patients were recorded. The follow-up time of the patients was 7 to 34 months with an average of 16 months.

Results: A total of eight patients consisting of three females and five males were included in the study. The age range was 19 to 63 years with an average of 39 ± 16.2 years. Four patients had traumatic ptosis history whereas four patients had previous multiple levator procedure surgery history. Those patients with a history of ptosis had undergone surgery with levator procedure at least two times. Additionally, one patient had upper eyelid entropion, one had anophthalmic socket syndrome, and one had exposure keratopathy and traumatic dilated pupil. Seven patients had ptosis in the left eye whereas one patient had ptosis in the right eye. All patients were given a tarsoaponeurectomy as the basic surgical procedure while the patient with entropion was given a tarsal fracture and ear cartilage grafting as additional surgery. Two patients with vertical notching were also given a vertical blepharotomy through which a strip of tarsus was removed.

Conclusions: Tarsoaponeurectomy is an alternative method for oculoplastic surgeons used to deal with patients on whom sufficient and desired results have not been achieved despite repetitive surgery and in post-traumatic cases where levator muscle and aponeurosis cannot be dissociated peroperatively.

Show MeSH
Related in: MedlinePlus