|Year : 1982 | Volume
| Issue : 5 | Page : 505-506
Surgical correction of ptosis
M Subramanyam, K Vengala Rao, V Santosh Kumar
Department of Ophthalmology Guntur Medical College, Guntur, India
Dept. of Ophthalmology, Guntur Medical College Guntur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Subramanyam M, Rao K V, Kumar V S. Surgical correction of ptosis. Indian J Ophthalmol 1982;30:505-6
Ptosis surgery account for less than 1% of ophthalmic surgery. This does not help an average ophthalmic surgeon to develop high degree of proficiency. Pooling the experiences of many workers could be useful. Considering all these aspects, we are presenting our experience in ptosis surgery in twenty cases.
| Materials and methods|| |
A total of twenty two ptotic lids were corrected in twenty patients.
The types of ptosis encountered were simple congenital associated with Marcus Gunn phenomenon ; progressive external ophthalmoplegia, congenital with cepicanthus ; acquired of neurogenic origin and post surgical.
In evaluating each case, a careful note of the following was made :- (1) History including the time of onset ; progression ; diplopia and trauma ; (ii) The amount of ptosis in different directions of gaze ; (iii) The action of levator palpebrae superioris ; (iv) Position of superior lid-fold ; (v) Ocular movements and synkinetic movements ; (vi) Presence of Bell's phenomenon.
Myasthenia gravis was excluded by prostigmine test. The clinical diagnosis of ocular myopathy was confirmed by muscle biopsy and E.M.G.
The most important factors that decided the type of surgery were type and amount of ptosis and levator function. When the levator function was fair, levator resection was performed ; when it was poor brow-suspension was done ; and when it was good, and the amount of ptosis was moderate ; FasanellaServat procedure was performed.
Skin approach levator resection as described by Beard was performed in nine persons [Figure - 1]A
Brow suspension with autogenous fascia lata as described by Stallard was done in eight cases [Figure - 1]B
Fasanella-Servat's procedure 2 was performed in two cases in which 2 haemostats were applied 3 mm. from the upper tarsal margin of the everted lid. The tissue grasped by the haemostats was excised and the out ends were sutured.
Dickey's operation was performed in one case in which a strip of fascia lata, attached to tarsus at two points was carried beneath the superior rectus.
Frost stitch was placed for every patient ; and single eye bandage was applied. Local antibiotics, Mythyl cellulose drops and bandage were given for 5 days. The patient was prescribed a systemic antibiotic for one week. Sutures were removed on the 7th postoperative day. Local antibiotic drops and methyl cellulose eye drops were continued for one month.
In the post-operative followup, careful examination was made for any evidence of over correction, under correction, lagophthalmos, keratities, and other complications.
| Observations|| |
11 males and 9 females underwent ptosis correction. 70% were in the first 2 decades; 50% were seen in the second decade. 4 cases (20%) were bilateral and the 16 unilateral cases were equally distributed between the right and left eyes. 60% of cases were congenital and 40% were acquired. There were three cases of Marcus-Gunn Synkinetic ptosis (15%) in two of which ipsilateral superior rectus was weak. All the three cases involved right eye ; though it is said to be more common in left eye. The minimum amount of ptosis was 3mm. (9 cases) and themaximum/was 6 mm. (5 cases). In 14 cases (70%) the action of levator was poor ; and good in 2 (10%); Levator resection was done for 9 lids in 9 cases and brow-suspension was done for 10 lids in 8 cases. The greater number of brow - suspensions in our series is due to the unusually higher incidence of Marcus-Gunn ptosis and ocular myopathy, which together accounted for surgery on 8 lids (40%). In none of our cases there was family history of ptosis. No other congenital abnormalities were found. The commonest complications were slight lidlag which was common with brow-suspension procedure, and under correction.
| Discussion|| |
From our experience the following comments can be made 1. Congenital ptosis is the commonest type encountered while deciding the amount of resection, not only the amount of ptosis. but also the action levator must betaken into consideration, and so is the type of ptosis. In acquired ptosis, over correction could be easily produced. For the same amount of resection of levator, the lid-elevation was more, if preparative levator function was good than in cases with poor levator function.
In our series congenital ptosis is not as .sub sociated with other congenital abnormalities.
Five lids in 3 patients of ocular myopathy were corrected and none of them developed any keratitis. The maximum follow up period was eighteen months. These results show that surgery has a positive role in the treatment of ocular myopathy : and the absence of Bell's phenomenon is not an absolute contraindica
Levator resection and brow - suspension were performed in 19 out of 22 correction. It means if one is well versed with these two procedures, most of the cases can be dealt with, Faranella-Servat is yet another simple, and useful procedure.
Our experience with Marcus-Gunn ptosis was not satisfactory.
| References|| |
Beard, 1976, PTOSIS, 2nd Edition MOSBY, St, Louis.
Fasanella, R.M., and Servat, J., 1961, Arch. Opthalmol, 65: 493.
[Figure - 1], [Figure - 2]