Surgical treatment for medically refractory myasthenic blepharoptosis

Surgical treatment for medically refractory myasthenic blepharoptosis

Yusuke Shimizu,1 Shigeaki Suzuki,2 Tomohisa Nagasao,1 Hisao Ogata,1 Masaki Yazawa,1 Norihiro Suzuki,2 Kazuo Kishi1 1Department of Plastic and Reconstructive Surgery, 2Department of Neurology, Keio University School of Medicine, Tokyo, JapanPurpose: Currently, only a few reports have recommended sur...

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Autores principales: Shimizu Y, Suzuki S, Nagasao T, Ogata H, Yazawa M, Suzuki N, Kishi K
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2014
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Ophthalmology
RE1-994
Acceso en línea:https://doaj.org/article/6b3c98e3cf124421bc2144f75a7066d3
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spelling oai:doaj.org-article:6b3c98e3cf124421bc2144f75a7066d32021-12-02T04:58:36ZSurgical treatment for medically refractory myasthenic blepharoptosis1177-5483https://doaj.org/article/6b3c98e3cf124421bc2144f75a7066d32014-09-01T00:00:00Zhttp://www.dovepress.com/surgical-treatment-for-medically-refractory-myasthenic-blepharoptosis-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483 Yusuke Shimizu,1 Shigeaki Suzuki,2 Tomohisa Nagasao,1 Hisao Ogata,1 Masaki Yazawa,1 Norihiro Suzuki,2 Kazuo Kishi1 1Department of Plastic and Reconstructive Surgery, 2Department of Neurology, Keio University School of Medicine, Tokyo, JapanPurpose: Currently, only a few reports have recommended surgery as a suitable treatment for blepharoptosis associated with myasthenia gravis. The present study aims to introduce our surgical criteria, surgical options, outcomes, and precautions for medically refractory myasthenic blepharoptosis. Patients and methods: Eight patients who failed to respond to at least 2 years of medical treatment and who underwent blepharoptosis surgery, from January 2008 to December 2011, were enrolled in this study. Medical records, photographs, and questionnaire results regarding postoperative status were evaluated. Of the eleven procedures performed, four involved frontal suspension, four involved external levator advancement, one involved nonincisional transconjunctival levator advancement, and two involved subbrow blepharoplasty with orbicularis oculi muscle tucking. The margin reflex distance improved postoperatively in seven patients. Results: Seven patients had very minimal scarring, and one had minimal scarring. Five patients showed no eyelid asymmetry, one had subtle asymmetry, and two had obvious asymmetry. Seven patients were very satisfied, and one patient was satisfied with the overall result. Postoperative complications included mild lid lag with incomplete eyelid closure, prolonged scar redness, and worsened heterophoria. No patient experienced postoperative exposure keratitis or recurrent blepharoptosis during the study period. Conclusion: Our results indicate that blepharoptosis surgery is effective for patients with myasthenia gravis, especially those with residual blepharoptosis despite multiple sessions of medical treatments. We recommend that neurologists and surgeons collaborate more systematically and discuss comprehensive treatment plans to increase the quality of life for patients with myasthenia gravis.Keywords: ptosis, myasthenia gravis, ocular myasthenia, blepharoplastyShimizu YSuzuki SNagasao TOgata HYazawa MSuzuki NKishi KDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2014, Iss default, Pp 1859-1867 (2014)
institution DOAJ
collection DOAJ
language EN
topic Ophthalmology
RE1-994
spellingShingle Ophthalmology
RE1-994
Shimizu Y
Suzuki S
Nagasao T
Ogata H
Yazawa M
Suzuki N
Kishi K
Surgical treatment for medically refractory myasthenic blepharoptosis
description Yusuke Shimizu,1 Shigeaki Suzuki,2 Tomohisa Nagasao,1 Hisao Ogata,1 Masaki Yazawa,1 Norihiro Suzuki,2 Kazuo Kishi1 1Department of Plastic and Reconstructive Surgery, 2Department of Neurology, Keio University School of Medicine, Tokyo, JapanPurpose: Currently, only a few reports have recommended surgery as a suitable treatment for blepharoptosis associated with myasthenia gravis. The present study aims to introduce our surgical criteria, surgical options, outcomes, and precautions for medically refractory myasthenic blepharoptosis. Patients and methods: Eight patients who failed to respond to at least 2 years of medical treatment and who underwent blepharoptosis surgery, from January 2008 to December 2011, were enrolled in this study. Medical records, photographs, and questionnaire results regarding postoperative status were evaluated. Of the eleven procedures performed, four involved frontal suspension, four involved external levator advancement, one involved nonincisional transconjunctival levator advancement, and two involved subbrow blepharoplasty with orbicularis oculi muscle tucking. The margin reflex distance improved postoperatively in seven patients. Results: Seven patients had very minimal scarring, and one had minimal scarring. Five patients showed no eyelid asymmetry, one had subtle asymmetry, and two had obvious asymmetry. Seven patients were very satisfied, and one patient was satisfied with the overall result. Postoperative complications included mild lid lag with incomplete eyelid closure, prolonged scar redness, and worsened heterophoria. No patient experienced postoperative exposure keratitis or recurrent blepharoptosis during the study period. Conclusion: Our results indicate that blepharoptosis surgery is effective for patients with myasthenia gravis, especially those with residual blepharoptosis despite multiple sessions of medical treatments. We recommend that neurologists and surgeons collaborate more systematically and discuss comprehensive treatment plans to increase the quality of life for patients with myasthenia gravis.Keywords: ptosis, myasthenia gravis, ocular myasthenia, blepharoplasty
format article
author Shimizu Y
Suzuki S
Nagasao T
Ogata H
Yazawa M
Suzuki N
Kishi K
author_facet Shimizu Y
Suzuki S
Nagasao T
Ogata H
Yazawa M
Suzuki N
Kishi K
author_sort Shimizu Y
title Surgical treatment for medically refractory myasthenic blepharoptosis
title_short Surgical treatment for medically refractory myasthenic blepharoptosis
title_full Surgical treatment for medically refractory myasthenic blepharoptosis
title_fullStr Surgical treatment for medically refractory myasthenic blepharoptosis
title_full_unstemmed Surgical treatment for medically refractory myasthenic blepharoptosis
title_sort surgical treatment for medically refractory myasthenic blepharoptosis
publisher Dove Medical Press
publishDate 2014
url https://doaj.org/article/6b3c98e3cf124421bc2144f75a7066d3
work_keys_str_mv AT shimizuy surgicaltreatmentformedicallyrefractorymyasthenicblepharoptosis
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AT nagasaot surgicaltreatmentformedicallyrefractorymyasthenicblepharoptosis
AT ogatah surgicaltreatmentformedicallyrefractorymyasthenicblepharoptosis
AT yazawam surgicaltreatmentformedicallyrefractorymyasthenicblepharoptosis
AT suzukin surgicaltreatmentformedicallyrefractorymyasthenicblepharoptosis
AT kishik surgicaltreatmentformedicallyrefractorymyasthenicblepharoptosis
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