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Blepharoptosis surgery in patients with myasthenia gravis
  1. Andre S Litwin1,
  2. Bhupendra Patel2,
  3. Alan A McNab3,
  4. John D McCann4,
  5. Brian Leatherbarrow5,
  6. Raman Malhotra1
  1. 1Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, UK
  2. 2Division of Facial and Orbital Cosmetic & Reconstructive Surgery, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
  3. 3Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
  4. 4Center for Facial Appearances, Salt Lake City, Utah, USA
  5. 5Manchester Royal Eye Hospital, Manchester, UK
  1. Correspondence to Andre S Litwin, Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex RH19 3DZ, UK; andre{at}doctors.org.uk

Abstract

Background/aims To review our approach of cautious surgical correction of blepharoptosis in patients with myasthenia gravis (MG) to minimise risk of exposure complications.

Methods Retrospective case note review of 30 patients with symptomatic eyelid concerns despite appropriate medical treatment, who underwent eyelid surgery. The mean age at diagnosis was 47 years. 13/30 patients had systemic MG, 14/30 ocular MG and 3/30 congenital MG. The main outcome measures were improvement in eyelid height and/or position, duration of a successful postoperative result, need for further surgical intervention, and intraoperative or postoperative complications.

Results 38 blepharoptosis procedures were performed on 23 patients. Mean age at time of surgery was 62 years, with an average follow-up of 29 months. 10 patients (16 eyelids) underwent anterior approach levator advancement, 4 patients (5 eyelids) posterior approach surgery and 8 patients (15 eyelids) brow suspension. One patient (2 eyelids) had tarsal switch surgery. An average improvement in eyelid height of 1.9 mm was achieved. Postoperative symptoms or signs of exposure keratopathy occurred in 17% of patients. This necessitated lid lowering in one eyelid of one patient. During follow-up, 37% of eyelids required further surgical intervention to improve the upper eyelid height, after an average of 19 months (range 0.5–49 months).

Conclusions Over a third of patients in our series required repeat surgery, which would be expected when the initial aim was to under-correct this group. In contrast to previous commentaries, the amount of eyelid excursion was not the main factor used to guide the surgical approach.

  • Eye Lids

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