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Primary bilateral silicone frontalis suspension for good levator function ptosis in oculopharyngeal muscular dystrophy
  1. Richard C Allen1,2,3,4,
  2. M Bridget Zimmerman5,
  3. Emily A Watterberg2,
  4. Leslie A Morrison6,
  5. Keith D Carter3,4
  1. 1Department of Surgery, Division of Ophthalmology, University of New Mexico School of Medicine, Albuquerque, New Mexico USA
  2. 2Eye Associates of New Mexico, Albuquerque, New Mexico, USA
  3. 3Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  4. 4Department of Otolaryngology—Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa USA
  5. 5Department of Biostatistics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  6. 6Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
  1. Correspondence to Dr Richard C Allen, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA; richard-allen{at}uiowa.edu

Abstract

Aim To evaluate outcomes of patients with oculopharyngeal muscular dystrophy (OPMD) with levator function (LF) ≥10mm who underwent primary bilateral silicone frontalis suspension.

Methods 31 patients with OPMD satisfied the following inclusion criteria: LF ≥10 mm; no previous eyelid surgery; and pre-operative measurements, silcone frontalis suspension and post-operative measurements performed by a single individual. The following data were collected: age; gender; pre-operative margin reflex distance (MRD), palpebral fissure height (PF), and LF; post-operative MRD, PF and lagophthalmos; follow-up; and complications.

Results Mean age at surgery was 61.5±5.8 years. Pre-operative measurements for MRD, PF and LF were −0.05±0.82 mm (OD), −0.13±0.91 mm (OS); 5.2±1.2 mm (OD), 5.2±1.3 mm (OS); 11.6±1.3 mm (OD), and 11.7±1.3 mm (OS), respectively. Post-operative measurements for MRD and PF were 2.23±0.97 mm (OD), 2.10±1.09 mm (OS), 7.9±1.4 mm (OD), and 7.7±1.6 mm (OS), respectively (all p<0.0001). The mean follow-up period was 22.8±22.4 months. There was no sling (infection or extrusion) or ophthalmic (significant corneal compromise) complication after the surgery. Six patients (19%) underwent early (within 3 months) tightening of their slings for under correction. Three patients (10%) underwent late (>39 months) tightening of their frontalis slings for recurrent ptosis after their initial surgery.

Conclusions Primary bilateral silicone frontalis suspension for good LF ptosis secondary to OPMD appears to be an effective, safe treatment which gives symmetrical upper lid elevation. Early sling adjustment may be required to attain optimal eyelid height and late tightening for expectant loosening of the sling is safe and effective.

  • Oculopharyngeal muscular dystrophy
  • blepharoptosis
  • frontalis sling
  • levator function
  • eye lids
  • genetics
  • lacrimal drainage
  • orbit

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study adhered to the principles of the Declaration of Helsinki and was approved by the Human Research Review Committee at the University of New Mexico School of Medicine (Protocol #03-298) located in Albuquerque, New Mexico USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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