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Surgery for upper eyelid retraction: three techniques
• A comprehensive, reproducible, quick, and prac tical method of grading the anterior chamber angle. Spaeth GL*. Trans Am Ophthalmol Soc 1995; 93:337-52.
T
HE PRIMARY PURPOSE OF THIS INVESTIGATION WAS
to validate anatomically, if possible, the Spaeth gonioscopic grading system. The gonioscopic appear ance of the anterior chamber angle of 22 patients was described, using a Zeiss 4-mirror gonioscopic lens; the angle was graded according to the Spaeth gonioscopic grading system (SGGS) previously described else where. This system provides a more comprehensive characterization of the angle than other methods, including the site of iris insertion, the angular ap proach to the recess, and the curvature of the peripheral iris. The same patients were then evaluated with biomicroscopic ultrasound examination of the anterior segment; the nature of the anterior chamber angles was described independently by two observers. The two methods of characterizing the anterior chamber angle were then compared. There was a high correlation between the two different methods of characterizing the anterior chamber angle. Ultra sound biomicroscopy had limitations relating to ina bility to distinguish between iris-cornea apposition and iris-cornea adhesion, and to the exact location of the posterior trabecular meshwork. The angularity of the approach to the anterior chamber angle using the SGGS tended to be underestimated by about 5 degrees. Other aspects showed high correlation. The SGGS appears to be an accurate method of charac terizing the anatomic appearance of the anterior chamber. It also provides a more comprehensive description of the angle than other grading systems. —Author's abstract *Wills Eye Hospital, Ninth and Walnut Streets, Philadelphia, PA 19107.
• Surgery for upper eyelid retraction: three tech niques. Small RG*. Trans A m Ophthalmol Soc 1995;93:353-70.
T
HIS PAPER IS BASED ON THE AUTHOR'S EXPERIENCE
with 145 operations (three techniques) on 181 upper eyelids in 100 patients with eyelid retraction. The results include 15 years' experience with adjust able sutures in upper eyelid recession surgery. The VOL. 121, NO. 1
three techniques that were used included: (1) the "prewhitnall" levator recession (Trans Am Ophthal mol Soc 1988;86:725-93), which is unique because the levator is operated on proximal to Whitnall's ligament; (2) recession of the levator aponeurosis; and (3) the Henderson operation (Arch Ophthalmol 1965;74:205-16). Adjustable sutures were used in all of the prewhitnall recessions, in approximately 50% of the levator aponeurosis recessions, and in none of the Henderson operations. Complications were divided between overcorrections and undercorrections. The reoperation rates were 24% among 73 patients with thyroid eye disease and 14% in 17 patients who had eyelid retraction after overcorrected ptosis repair. The overall reoperation rate was 23%. Adjustable sutures were effective in prewhitnall recessions but less so in levator aponeurosis recessions. There were fewer Hen derson operations but the results were good. The prewhitnall operation is good for marked bilateral eyelid retraction in thyroid eye disease. It is technical ly challenging but has advantages. Recession of the levator aponeurosis can be used for thyroid eye disease and overcorrections after ptosis repair. The Hender son operation is useful in lesser degrees of eyelid retraction. The need for reoperation is an acceptable occurrence and can be expected in up to one fourth of patients.—Author's abstract *Dean A. McGee Eye Institute, 608 Stanton L. Young Dr., Oklahoma City, OK 73104.
• The differential diagnosis and classification of eyelid retraction. Bartley GB*. Trans Am Ophthal mol Soc 1995;93:371-90.
C
LASSIFICATION SCHEMES ARE USEFUL IN THE FOR-
mulation of differential diagnoses. Thoughtful commentary has been devoted to the classincation of blepharoptosis, but the causes of eyelid retraction have received less attention in published reports. Although eyelid retraction most frequently is associat ed with Graves' ophthalmopathy, numerous other entities may cause the sign. This study was undertak en to provide a more comprehensive differential diagnosis and classification of eyelid retraction. A series of patients with eyelid retraction was studied, and pertinent published reports were reviewed. Forty four patients with different causes for eyelid retraction are described. Normal thyroid function and regula-
ABSTRACTS
111
T
HE PRIMARY PURPOSE OF THIS INVESTIGATION WAS
to validate anatomically, if possible, the Spaeth gonioscopic grading system. The gonioscopic appear ance of the anterior chamber angle of 22 patients was described, using a Zeiss 4-mirror gonioscopic lens; the angle was graded according to the Spaeth gonioscopic grading system (SGGS) previously described else where. This system provides a more comprehensive characterization of the angle than other methods, including the site of iris insertion, the angular ap proach to the recess, and the curvature of the peripheral iris. The same patients were then evaluated with biomicroscopic ultrasound examination of the anterior segment; the nature of the anterior chamber angles was described independently by two observers. The two methods of characterizing the anterior chamber angle were then compared. There was a high correlation between the two different methods of characterizing the anterior chamber angle. Ultra sound biomicroscopy had limitations relating to ina bility to distinguish between iris-cornea apposition and iris-cornea adhesion, and to the exact location of the posterior trabecular meshwork. The angularity of the approach to the anterior chamber angle using the SGGS tended to be underestimated by about 5 degrees. Other aspects showed high correlation. The SGGS appears to be an accurate method of charac terizing the anatomic appearance of the anterior chamber. It also provides a more comprehensive description of the angle than other grading systems. —Author's abstract *Wills Eye Hospital, Ninth and Walnut Streets, Philadelphia, PA 19107.
• Surgery for upper eyelid retraction: three tech niques. Small RG*. Trans A m Ophthalmol Soc 1995;93:353-70.
T
HIS PAPER IS BASED ON THE AUTHOR'S EXPERIENCE
with 145 operations (three techniques) on 181 upper eyelids in 100 patients with eyelid retraction. The results include 15 years' experience with adjust able sutures in upper eyelid recession surgery. The VOL. 121, NO. 1
three techniques that were used included: (1) the "prewhitnall" levator recession (Trans Am Ophthal mol Soc 1988;86:725-93), which is unique because the levator is operated on proximal to Whitnall's ligament; (2) recession of the levator aponeurosis; and (3) the Henderson operation (Arch Ophthalmol 1965;74:205-16). Adjustable sutures were used in all of the prewhitnall recessions, in approximately 50% of the levator aponeurosis recessions, and in none of the Henderson operations. Complications were divided between overcorrections and undercorrections. The reoperation rates were 24% among 73 patients with thyroid eye disease and 14% in 17 patients who had eyelid retraction after overcorrected ptosis repair. The overall reoperation rate was 23%. Adjustable sutures were effective in prewhitnall recessions but less so in levator aponeurosis recessions. There were fewer Hen derson operations but the results were good. The prewhitnall operation is good for marked bilateral eyelid retraction in thyroid eye disease. It is technical ly challenging but has advantages. Recession of the levator aponeurosis can be used for thyroid eye disease and overcorrections after ptosis repair. The Hender son operation is useful in lesser degrees of eyelid retraction. The need for reoperation is an acceptable occurrence and can be expected in up to one fourth of patients.—Author's abstract *Dean A. McGee Eye Institute, 608 Stanton L. Young Dr., Oklahoma City, OK 73104.
• The differential diagnosis and classification of eyelid retraction. Bartley GB*. Trans Am Ophthal mol Soc 1995;93:371-90.
C
LASSIFICATION SCHEMES ARE USEFUL IN THE FOR-
mulation of differential diagnoses. Thoughtful commentary has been devoted to the classincation of blepharoptosis, but the causes of eyelid retraction have received less attention in published reports. Although eyelid retraction most frequently is associat ed with Graves' ophthalmopathy, numerous other entities may cause the sign. This study was undertak en to provide a more comprehensive differential diagnosis and classification of eyelid retraction. A series of patients with eyelid retraction was studied, and pertinent published reports were reviewed. Forty four patients with different causes for eyelid retraction are described. Normal thyroid function and regula-
ABSTRACTS
111