Efficacy of Combined Conjoint Fascial Sheath and Levator Muscle Composite Flap Suspension for Congenital Severe Ptosis

Shi, Junhu; Liu, Zhaochuan; Li, Yadi; Song, Lan; Li, Yan; Yang, Jianwei; Pang, Runhui; Zhang, Hongbin; Xiao, Li; Bai, Péter

doi:10.1097/prs.0000000000010947

Cited by 2 publications

(11 citation statements)

References 19 publications

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“…Intraoperative or postoperative swelling or bleeding may also result in the prolapse of the superior fornix. 7 This study found that the BCVA (logMAR) was greater in the severe ptotic eyes than the nonseverely ptotic ones, which may indicate inferior visual acuity in the former. Severe congenital ptosis can result in amblyopia, which has a detrimental effect on BCVA.…”

Section: Discussionmentioning

confidence: 60%

“…17 Upper lid excursion was worse because the frontalis flap was less elastic than the LM, increasing the risk of lagophthalmos and closure insufficiency. 7 Thus, CFS suspension was born.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Long-term follow-up observations have revealed the shortcomings of CFS suspension surgery on severe ptosis, including undercorrection or recurrence, which can be attributed to the relatively weak and nonfirm adhesion of only CFS suspension. 7 Recently, a modified surgery known as CFS + LM complex suspension has exhibited positive outcomes in correcting severe ptosis. [6][7][8][9][10] However, CFS + LM surgery for simple severe congenital ptosis in children is Supplemental digital content is available for this article.…”

mentioning

confidence: 99%

“…7 Recently, a modified surgery known as CFS + LM complex suspension has exhibited positive outcomes in correcting severe ptosis. [6][7][8][9][10] However, CFS + LM surgery for simple severe congenital ptosis in children is Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.op-rs.com).…”

mentioning

confidence: 99%

“…7 Recently, a modified surgery known as CFS + LM complex suspension has exhibited positive outcomes in correcting severe ptosis. 6–10 However, CFS + LM surgery for simple severe congenital ptosis in children is performed under general anesthesia, and the amount of surgical correction cannot be adjusted during the operation according to the patient’s cooperation. Hence, the operation is more challenging than in adults.…”

mentioning

confidence: 99%

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Modified Conjoint Fascial Sheath and Levator Muscle Complex Suspension for the Correction of Simple Severe Congenital Ptosis in Pediatrics and the Effect on Refractive Status

Li,

Yu,

Wang

et al. 2024

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To evaluate the outcomes of modified combined fascia sheath and levator muscle complex suspension to correct severe congenital ptosis in pediatrics and the effect on refractive status. Methods: This prospective, case series study enrolled patients (aged ≤18 years) with simple severe congenital ptosis at Zhongshan Ophthalmic Center. All patients were treated with combined fascia sheath + levator muscle suspension and followed up for 3 months. Preoperative and postoperative cycloplegic refraction and the best-corrected visual acuity were performed. The types of astigmatism include with-the-rule, against-the-rule, and oblique. Results: Thirty-six patients (50 eyes) were enrolled. The mean age was 7.11 ± 3.72 years. The surgery success rate was 90.0%. Following surgery, the eyelid contour of all eyes exhibited natural symmetry and satisfactory curvature. The eyelid height difference in OUs was ≤1 mm for 42 eyes. For 47 eyes, the eyelid crease was symmetry. Two eyes had conjunctival prolapse, and 1 eye developed trichiasis. After surgery, cylinder power changed from mean −1.14 ± 1.27 D to −1.54 ± 1.25 D (p < 0.001) and best-corrected visual acuity improved from mean 0.205 ± 0.217 logarithm of the minimum angle of resolution to 0.168 ± 0.176 logarithm of the minimum angle of resolution (p = 0.048). The quantities of with-the-rule increased from 35 eyes to 41 eyes, oblique from 4 eyes to 6 eyes, while against-the-rule decreased from 11 eyes to 3 eyes (p = 0.01). Conclusions: Combined fascia sheath + levator muscle suspension under general anesthesia is effective and safe for severe congenital ptosis in pediatrics. However, astigmatism increased and the types of astigmatism changed after surgery.

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Section: Discussionmentioning

confidence: 60%

“…17 Upper lid excursion was worse because the frontalis flap was less elastic than the LM, increasing the risk of lagophthalmos and closure insufficiency. 7 Thus, CFS suspension was born.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Modified Conjoint Fascial Sheath and Levator Muscle Complex Suspension for the Correction of Simple Severe Congenital Ptosis in Pediatrics and the Effect on Refractive Status

Li,

Yu,

Wang

et al. 2024

Ophthalmic Plastic &Amp; Reconstructive Surgery

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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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Efficacy of Combined Conjoint Fascial Sheath and Levator Muscle Composite Flap Suspension for Congenital Severe Ptosis

Cited by 2 publications

References 19 publications

Modified Conjoint Fascial Sheath and Levator Muscle Complex Suspension for the Correction of Simple Severe Congenital Ptosis in Pediatrics and the Effect on Refractive Status

Modified Conjoint Fascial Sheath and Levator Muscle Complex Suspension for the Correction of Simple Severe Congenital Ptosis in Pediatrics and the Effect on Refractive Status

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

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