Dr.Trivedi Nitin Vinaykant,
Abstract: A prospective study comprised of 8patients(12lids)of blepharoptosis due to aponeurotic defects. Four of the patientshad bilateral and 4 unilateral ptosis. Age of patientsvaried from 30 to 75 years.Amount of ptosis ranged from 2-6 mm.LPS function was moderate to excellent. All cases were operated under LA.1cm incision was put incenter of lid crease.Underlying orbicularis was undermined to expose orbital septum and the orbital fat. Upward dissection was carried out to identify recessed lower edge of LPS. Tarsal plate was exposed. Lower edge of LPS was fixed to front of tarsus. Lid level was assessed and adjusted if necessary. Two such sutures were taken on bothsides. Skin incision was closed with1-2 stitches of 6/0 prolene. A satisfactory results were obtained in all patients after3 months,except in one having mild under correction. On repeat surgery on same patient, mild overcorrection was seen which was satisfactorily adjusted.
Introduction :
Drooping of upper lid may be due to so many causes. One type is Aponeurotic ptosis in which the LPS aponueurosis is disinserted from its attachment to the front of the tarsal plate.So the logical treatment is to reinsert back to tarsal plat. Routine reinsertion is done putinig lid crease incision of about 2.5 mm incision wcich is quite long requiring extensive surgical explpration and manipulation. We ainm to do the same procedure of LPS reinsertion through a small incision of about 1.-1.5 mm.
Aim of the study: To perform LPS reinsertion surgery throught a small incision, and obsewrve its outcome.
Material: A prospective study comprised of 8 patients (12 lids)of blepharoptosis due to aponeurotic defects. Four of the patients had bilateral and 4 unilateral ptosis. Age of patients varied from 30 to 75 years. Amount of ptosis ranged from 2-6 mm. LPS function was moderate to excellent. Cases previously operated for any lid surgery,trauma and inflammation or any othe disesease were excluded from study.
Method:All cases were operated under LA.1cm incision was put in center of lid crease. Underlying orbicularis was undermined to expose orbital septum and the orbital fat. Upward dissection was carried out to identify recessed lower edge of LPS. Tarsal plate was exposed. Lower edge of LPS was fixed to front of tarsus. Lid level was assessed and adjusted if necessary. Two such sutures were taken on both sides. Skin incision was closed with 1-2 stitches of 6/0 prolene.
Post operative Cure :
All patients were treated with
1. Topical Antibiotic+ Steroid drops for 7 days
Systemic Non steroidal 5 days
Patients were followed up after day 1,7,30 days and then after 3 months .
Observation : Inflammation and condition of the lid was noted. A satisfactory results were obtained in all patients after 3 months, except in one having mild under correction. On repeat surgery on same patient, mild overcorrection was seen which was satisfactorily adjusted.
- Discussion: Jones at al (1975)were the first to identify the condition of aponeurotic ptosis and subsequently suggest it surgery.It became a standard procedure for treatment of aponeurotic ptosis due to different causes like senile, traumatic and inflammatory .Jong wook et al suggested small surgery aponeurotic ptosis repailin 2008 claiming excellent results. In our series of 12 lid , we also found surgery very satisfactory .
- Conclusion : Reattachment of the LPS aponeurosis is a cause oriented surgery and so if the case selection is proper, it gives perfect results.
Further reading
- Jones LT, Quickert MH,WobigJL: The cure of ptosis by aponeurotic repair. Arch Ophthalmol93:629,1975
- Jong Wook Lee, M.D., Dong Su Shin, M.D., and Kyoo Won Lee, M.D. Department of Ophthalmology, Cheil Eye Hospital, Daegu, Korea.J Korean Ophthalmol Soc. 2008 May;49(5):721-726.
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