Clinical efficacy of conjoint fascial sheath suspension and frontalis muscle suspension in treating moderate or severe congenital ptosis and the effects on ocular surface and refractive status

Pan, Xuehong; Wei, Ting; Wang, Xiaodong; Xu, Chao

doi:10.3892/etm.2020.9053

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…Over the past decade, CFS suspension surgery has attracted considerable attention ( 23 , 24 ). The safety, therapeutic and cosmetic effects of CFS suspension surgery have been reported to be significantly superior compared with those of traditional frontalis muscle suspension ( 4 , 25 - 26 ). In addition, these results have been found to be closely associated with the anatomical characteristics of the CFS.…”

Section: Discussionmentioning

confidence: 99%

Elastin expression in the conjoint fascial sheath and levator palpebrae superioris muscle of children with unilateral severe congenital ptosis with different muscle strengths

Jia,

Liu,

Shi

et al. 2024

Exp Ther Med

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Elastin expression in the conjoint facial sheath (CFS) of patients of different ages with severe ptosis has been extensively studied, but its expression in the CFS of pediatric patients with severe ptosis with different muscle strengths remains poorly understood. The aim of the present study was to investigate the expression of elastin in the CFS and levator palpebrae superioris muscle (LM) of children with severe congenital ptosis with different LM strengths. In total, 20 pediatric patients with unilateral severe congenital ptosis (20 eyes) were included, who underwent CFS + LM complex suspension surgery from June 2020 to February 2022. Among these patients, the LM strength was 0-1 mm in 10 patients and 2-3 mm in the other 10 patients. Excess CFS and LM tissue samples were obtained from the patients during surgery, before the protein expression levels of elastin in the specimens were measured by western blotting. During the 6-month postoperative follow-up period, the good correction rate, the degree of incomplete eyelid closure and the incidence of complications were observed. Western blotting results showed that, compared with that in the 0-1 mm group, elastin expression was not significantly different in the CFS, whereas it was significantly increased (P=0.021) in the LM of the 2-3 mm group. In addition, elastin expression in the CFS was markedly higher compared with that in the LM in both groups (in the 0-1 mm group, P=0.005; in the 2-3 mm group, P=0.009). Additionally, the curative effect evaluation revealed that the good correction rates in the 0-1 and 2-3 mm groups were 90 and 100%, respectively. In total, 3 patients experienced conjunctival prolapse during the follow-up period, including 2 patients in the 0-1 mm group and 1 patient in the 2-3 mm group, but there were no other complications. To conclude, elastin expression in the CFS was found to be higher compared with that in the LM of children with severe congenital ptosis. Although elastin expression in the LM was positively associated with LM strength, its expression in the CFS displayed no clear association with LM function. Therefore, these observations suggested that CFS + LM complex suspension surgery is viable to correct severe congenital ptosis in pediatric patients.

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Section: Discussionmentioning

confidence: 99%

Elastin expression in the conjoint fascial sheath and levator palpebrae superioris muscle of children with unilateral severe congenital ptosis with different muscle strengths

Jia,

Liu,

Shi

et al. 2024

Exp Ther Med

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show abstract

“…Therefore, we primarily used the frontalis sling technique to correct ptosis, and limited use of frontalis flap or levator surgery, considering factors such as the patient's age and the patient and guardian's aversion to incision scars. Recent studies have reported that for moderate to severe ptosis, where the function of the levator muscle is less than 4 mm, using the conjoint fascial sheath instead of the traditional frontalis muscle sling surgery has yielded positive results [22].…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Correlation between Ptosis Improvement and Immediate Postoperative Lagophthalmos following Blepharoptosis Surgery under General Anesthesia in Pediatric Patients

Jeong,

Park

2024

JCM

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Background: The objective of this study is to establish a potential correlation between postoperative improvement in upper eyelid ptosis, measured by the marginal reflex distance 1 (MRD1), and the immediate postoperative degrees of lagophthalmos (IPDL). The established correlation is then used to assess whether IPDL can be used as a reliable indicator of successful treatment of eyelid ptosis. Methods: This retrospective study involved 19 patients, aged 1 to 11, with a total of 28 eyes affected by ptosis, who underwent surgery under general anesthesia at Seoul National University Bundang Hospital from January 2018 to December 2022. We monitored the MRD1 of the patients for over six months postoperatively and measured the IPDL. Results: After ptosis correction surgery, no statistically significant correlation was observed between the improvement in MRD1 and IPDL. Furthermore, the degree of postoperative eyelid ptosis improvement was found to vary and was not consistently sustained, attributable to a range of factors. Conclusions: Our study did not establish a statistically significant correlation between IPDL and ptosis improvement as measured by MRD1. Further research is needed to draw definitive conclusions about their correlation.

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“…Volume 153, Number 1 • Bulbar Conjunctival Prolapse 45e Conjoint fascial sheath (CFS) suspension, a new clinical therapy, has been proven to provide satisfactory functional and aesthetic outcomes. [4][5][6][7] Our long-term follow-up results showed that CFS suspension could provide more than half of severe ptosis patients with normal palpebral fissure height (PFH) 1 year after surgery. However, in our early practice, bulbar conjunctival prolapse represented a risk of CFS suspension 8 because this operation was performed right around the conjunctiva fornix-bulbar conjunctiva-Tenon capsule (CBT) and tended to destabilize the conjunctiva.…”

mentioning

confidence: 89%

“Key Roles of Conjunctiva Fornix-Bulbar conjunctiva-Tenon's Capsule in Bulbar Conjunctival Prolapse after Conjoint Fascial Sheath Suspension.”

Hao

Fan

Cao

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Bulbar conjunctival prolapse is one of the complications of conjoint fascial sheath (CFS) suspension and has a negative impact on surgical results. To explore the prevention methods of this complication, the authors compared the incidence of it between the below–conjunctiva fornix–bulbar conjunctiva–Tenon capsule (CBT) approach and the above-CBT approach to dissecting CFS in CFS suspension and shared their experience in the treatment of bulbar conjunctival prolapse. Methods: From January of 2020 to August of 2021, 81 patients with severe congenital ptosis who underwent CFS suspension were enrolled and divided into two groups. Forty-five patients’ (group A) CFS was dissected by means of the below-CBT approach and 36 patients’ (group B) CFS was dissected by means of the above-CBT approach. Data regarding the incidence and outcomes of bulbar conjunctival prolapse and the postoperative condition were collected and analyzed. Results: The incidence of bulbar conjunctival prolapse was 24.44% in group A and 2.78% in group B. Of the 12 bulbar conjunctival prolapse patients, seven patients’ conditions improved after conservative treatment, and five did not. All of them underwent bulbar conjunctiva resection within 1 year and were cured. No recurrent prolapse was observed within 3 months postoperatively. At the last follow-up, the mean marginal reflex distance 1 and palpebral fissure height were 4.09 ± 0.19 mm and 9.85 ± 0.62 mm, respectively. There were no complications except lagophthalmos (16 eyelids), asymmetric eyelid contour (one patient), and trichiasis (two eyelids). Conclusions: The incidence of bulbar conjunctival prolapse decreased significantly by dissecting CFS by means of the above-CBT approach. For patients with bulbar conjunctival prolapse after CFS suspension, bulbar conjunctiva resection could provide satisfactory results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Clinical efficacy of conjoint fascial sheath suspension and frontalis muscle suspension in treating moderate or severe congenital ptosis and the effects on ocular surface and refractive status

Cited by 4 publications

References 20 publications

Elastin expression in the conjoint fascial sheath and levator palpebrae superioris muscle of children with unilateral severe congenital ptosis with different muscle strengths

Elastin expression in the conjoint fascial sheath and levator palpebrae superioris muscle of children with unilateral severe congenital ptosis with different muscle strengths

Evaluating the Correlation between Ptosis Improvement and Immediate Postoperative Lagophthalmos following Blepharoptosis Surgery under General Anesthesia in Pediatric Patients

“Key Roles of Conjunctiva Fornix-Bulbar conjunctiva-Tenon's Capsule in Bulbar Conjunctival Prolapse after Conjoint Fascial Sheath Suspension.”

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