Outcomes of Frontalis Advancement With or Without External Levator Advancement for Congenital Ptosis: A Retrospective Comparative Study.

IF 4.2 1区 医学 Q1 OPHTHALMOLOGY
Marissa K Shoji,Akshara R Legala,Rolika Bansal,Nahia Dib El Jalbout,Sarah Cheng,Catherine Y Liu,Don O Kikkawa,Bobby S Korn
{"title":"Outcomes of Frontalis Advancement With or Without External Levator Advancement for Congenital Ptosis: A Retrospective Comparative Study.","authors":"Marissa K Shoji,Akshara R Legala,Rolika Bansal,Nahia Dib El Jalbout,Sarah Cheng,Catherine Y Liu,Don O Kikkawa,Bobby S Korn","doi":"10.1016/j.ajo.2025.09.021","DOIUrl":null,"url":null,"abstract":"PURPOSE\r\nTo compare outcomes of frontalis flap advancement alone versus frontalis flap advancement combined with external levator advancement (ELA) using a bilayer technique for congenital ptosis with poor levator function.\r\n\r\nDESIGN\r\nRetrospective comparative clinical cohort study.\r\n\r\nSUBJECTS\r\nEyelids of patients with severe congenital ptosis with poor levator function who underwent either frontalis advancement flap alone or in combination with ELA were included. Exclusion criteria were non-congenital, neurogenic, traumatic, or aponeurotic ptosis.\r\n\r\nMETHODS\r\nThis study evaluated characteristics and postoperative outcomes of the above subjects, with emphasis on comparing outcomes between frontalis advancement alone or combined frontalis advancement with external levator advancement using a bilayer technique. Statistical testing included paired and Students t-testing, chi-squared testing, and multivariate linear regression.\r\n\r\nMAIN OUTCOME MEASURES\r\nThe primary outcome was change in marginal reflex distance-1 (MRD1). Secondary outcomes included change in lagophthalmos, eyelid symmetry, and adverse events.\r\n\r\nRESULTS\r\nNinety-two eyelids from 76 patients (mean age 6.9 ± 9.2 years) were included. Sixty-five eyelids underwent frontalis flap alone and 27 underwent frontalis flap+ELA. Both groups showed significant MRD1 improvement postoperatively (p<0.001 for both) at mean follow-up of 12.0 months. The frontalis flap+ELA group had significantly greater postoperative MRD1 (3.9 ± 0.8 mm vs. 3.2 ± 1.2 mm, p=0.004) and change in MRD1 (3.4 ± 1.2 mm vs. 2.5 ± 1.6 mm, p=0.002). Lagophthalmos remained stable from baseline in both groups and did not significantly differ between groups. No patients in the frontalis flap+ELA group required revision, compared to 7.6% in the frontalis-alone group. All patients achieved visual axis clearance at most recent follow-up.\r\n\r\nCONCLUSIONS\r\nFrontalis advancement flap, particularly when combined with external levator advancement using a bilayer technique, is a safe and effective surgical strategy for congenital ptosis with poor levator function, providing excellent eyelid elevation that optimizes visual axis clearance without the need for synthetic or autologous suspension materials.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"40 1","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ajo.2025.09.021","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

PURPOSE To compare outcomes of frontalis flap advancement alone versus frontalis flap advancement combined with external levator advancement (ELA) using a bilayer technique for congenital ptosis with poor levator function. DESIGN Retrospective comparative clinical cohort study. SUBJECTS Eyelids of patients with severe congenital ptosis with poor levator function who underwent either frontalis advancement flap alone or in combination with ELA were included. Exclusion criteria were non-congenital, neurogenic, traumatic, or aponeurotic ptosis. METHODS This study evaluated characteristics and postoperative outcomes of the above subjects, with emphasis on comparing outcomes between frontalis advancement alone or combined frontalis advancement with external levator advancement using a bilayer technique. Statistical testing included paired and Students t-testing, chi-squared testing, and multivariate linear regression. MAIN OUTCOME MEASURES The primary outcome was change in marginal reflex distance-1 (MRD1). Secondary outcomes included change in lagophthalmos, eyelid symmetry, and adverse events. RESULTS Ninety-two eyelids from 76 patients (mean age 6.9 ± 9.2 years) were included. Sixty-five eyelids underwent frontalis flap alone and 27 underwent frontalis flap+ELA. Both groups showed significant MRD1 improvement postoperatively (p<0.001 for both) at mean follow-up of 12.0 months. The frontalis flap+ELA group had significantly greater postoperative MRD1 (3.9 ± 0.8 mm vs. 3.2 ± 1.2 mm, p=0.004) and change in MRD1 (3.4 ± 1.2 mm vs. 2.5 ± 1.6 mm, p=0.002). Lagophthalmos remained stable from baseline in both groups and did not significantly differ between groups. No patients in the frontalis flap+ELA group required revision, compared to 7.6% in the frontalis-alone group. All patients achieved visual axis clearance at most recent follow-up. CONCLUSIONS Frontalis advancement flap, particularly when combined with external levator advancement using a bilayer technique, is a safe and effective surgical strategy for congenital ptosis with poor levator function, providing excellent eyelid elevation that optimizes visual axis clearance without the need for synthetic or autologous suspension materials.
额肌前伸与外提肌前伸治疗先天性上睑下垂的疗效:回顾性比较研究。
目的比较单纯额肌瓣推进术与额肌瓣推进联合外提肌推进术治疗先天性上睑下垂并提肌功能不佳的效果。设计回顾性比较临床队列研究。研究对象为重度先天性上睑下垂且提上睑肌功能差的患者,分别单独或联合行额肌前展皮瓣。排除标准是非先天性、神经源性、外伤性或腱膜性上睑下垂。方法本研究评估了上述受试者的特点和术后结果,重点比较了单独额肌推进术或联合额肌推进术联合外提肌推进术的效果。统计检验包括配对和学生t检验、卡方检验和多元线性回归。主要观察指标:主要观察指标为边缘反射距离-1 (MRD1)的变化。次要结局包括眼球lageyes的改变、眼睑对称和不良事件。结果共纳入76例患者的92眼睑,平均年龄6.9 ± 9.2岁。单纯额肌皮瓣65只,额肌皮瓣+ELA 27只。平均随访12.0个月,两组术后MRD1均有显著改善(p<0.001)。额叶瓣+ELA组术后MRD1(3.9 ± 0.8 mm vs. 3.2 ± 1.2 mm, p=0.004)和MRD1变化(3.4 ± 1.2 mm vs. 2.5 ± 1.6 mm, p=0.002)显著增加。Lagophthalmos在两组的基线水平上保持稳定,两组之间无显著差异。额肌瓣+ELA组无患者需要翻修,而单独额肌瓣组为7.6%。在最近的随访中,所有患者都获得了视觉轴清除。结论额肌推进皮瓣,尤其是与外提上睑肌推进双层技术相结合,是一种安全有效的先天性上睑下垂提上睑肌功能差的手术策略,提供了良好的眼睑提升,优化了视轴间隙,无需人工或自体悬吊材料。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
9.20
自引率
7.10%
发文量
406
审稿时长
36 days
期刊介绍: The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信