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Treatment of ptosis in chronic progressive external ophthalmoplegia
CURRENT
OPHTHALMOLOGY
437
This study is extremely important in light of the current epidemic of so-called “eye exercise and training” therapies advocated by some in the treatment of learning disabilities. This study places a challenge clearly in front of the enthusiasts of these forms of therapy. (larefully controlled age-matched studies need to bc performed before any of these therapies can be considered pro\‘rn and indicated in the treatment of this perplexing group of children. CKI,:I(. S. Ho\Y, Rl.1). s.\s FK.\Z(:l\(:o. (.: \I.IFOKUI.\
Treatment of Ptosis in Chronic and
J.R.O.
Collins.
Progressive
Br J Ophthalnzol 72:290-294,
External
Ophthalmoplegia,
11~. (: .kl. Lant
1987
Seventeen patients with ptosis as a feature ofchronic progressi\.c estcrnal o~~t~thalmoplcgia \\‘f‘re managed in accordance with a new protocol. An anterior approach le\,ator adlxncement \vas perti)rmcd on se\~‘n patients (13 lids) x\ith more than 4 mm of levator function, and a brow suspension procedure \vas perfbrmed on eight patients (14 lids) with minimal levator function, in bvhom the frontalis muscle \~as relatively spared. Ptosis props were prescribed for two patients with a very xveak orbicularis and fi)relid closure. Six patients required longterm lubricants and one developed a postoperati\,e cornea1 abscess associated \j.ith a poor Bell’s phenomena. Satisfactory elevation ofthe lid was achie\,ed in 16 patients (2.5 lids). (.luthor’s xltl~~t~ss:(:.\l. IAIW. F.R.C:.S.. Moodields Eye Hospital. High Holhorrl. I,ondon \YC: I \‘i.lS En:land. 1
Comment The past one-halt‘centur); has seen an increase in the understanding ofhlepharoptosis and impro\.ements in surgical techniques. In an eff‘ort to achieve optimal function and cosmetic results. the surgical approach tbr a given case is selected after appropriate consideration of lc\xtor action and degree of ptosis. Chronic progressive external ophthalmoplegia (CPEO) presents a difficult challenge to the ptosis sturgeon, who is often faced with \.isually significant blepharoptosis ofvar!,ing degrees and progrcasi\,e loss of‘levator function o\‘er time. In addition. postoperative lagophthalmos may allow cornea1 exposure as a result of the the surgeon must carefull!. titrate e)-(xlirl ele\xunderlying CPEO-induced orbicularis weakness. Therefore. tion versus orbicularis \s-eakness in selecting the appropriate surgical approach. Lane and Collins utilized these concepts in formulating their protocol for the management of ptosis associated with CPEO. The surgical goal was to achieve upper eyelid elevation to clrar the visual axis. Patients with good levator function were treated with an anterior levator resection w~hilc those with poor function were treated with a brow suspension, providing orhicularis function was aclequatca t;)r e\.elid closure. In severe orbicularis weakness. surgery was avoided and ptosis props lvere prescribed. The therapeutic suggestions proposed in this stud>- have significant merit and ma! ser1.e as ;I qllide to the ptosis surgeon faced with a patient with CPEO. However. individual \.ariations of technique (i.e.. the use of instead of fascia latai ma). he appropriate. nonabsorbable suture or silicone for suspension. S I’(- \I< I K. SI.II,F, hl.1). s.\s 1:1<.\\-(.I\(.( ). (1 \I.ll‘OliUI.\
Retinal Venous Sheathing in Optic Neuritis: Its Significance for the Pathogenesis of Multiple Sclerosis, by S. Lightman, W.I. McDonald, A.C. Bird, et al. Brain 200:40.5-414, 1987 It has long been known that the cerebral venules are abnormal in the lesion of multiple sclerosis. Plaques are oriented around them and perivenous cupping is a prominent feature of the active lesion. k’ascular abnormalities have also been detected in the retina in multiple sclerosis patients. Their signilicance has
OPHTHALMOLOGY
437
This study is extremely important in light of the current epidemic of so-called “eye exercise and training” therapies advocated by some in the treatment of learning disabilities. This study places a challenge clearly in front of the enthusiasts of these forms of therapy. (larefully controlled age-matched studies need to bc performed before any of these therapies can be considered pro\‘rn and indicated in the treatment of this perplexing group of children. CKI,:I(. S. Ho\Y, Rl.1). s.\s FK.\Z(:l\(:o. (.: \I.IFOKUI.\
Treatment of Ptosis in Chronic and
J.R.O.
Collins.
Progressive
Br J Ophthalnzol 72:290-294,
External
Ophthalmoplegia,
11~. (: .kl. Lant
1987
Seventeen patients with ptosis as a feature ofchronic progressi\.c estcrnal o~~t~thalmoplcgia \\‘f‘re managed in accordance with a new protocol. An anterior approach le\,ator adlxncement \vas perti)rmcd on se\~‘n patients (13 lids) x\ith more than 4 mm of levator function, and a brow suspension procedure \vas perfbrmed on eight patients (14 lids) with minimal levator function, in bvhom the frontalis muscle \~as relatively spared. Ptosis props were prescribed for two patients with a very xveak orbicularis and fi)relid closure. Six patients required longterm lubricants and one developed a postoperati\,e cornea1 abscess associated \j.ith a poor Bell’s phenomena. Satisfactory elevation ofthe lid was achie\,ed in 16 patients (2.5 lids). (.luthor’s xltl~~t~ss:(:.\l. IAIW. F.R.C:.S.. Moodields Eye Hospital. High Holhorrl. I,ondon \YC: I \‘i.lS En:land. 1
Comment The past one-halt‘centur); has seen an increase in the understanding ofhlepharoptosis and impro\.ements in surgical techniques. In an eff‘ort to achieve optimal function and cosmetic results. the surgical approach tbr a given case is selected after appropriate consideration of lc\xtor action and degree of ptosis. Chronic progressive external ophthalmoplegia (CPEO) presents a difficult challenge to the ptosis sturgeon, who is often faced with \.isually significant blepharoptosis ofvar!,ing degrees and progrcasi\,e loss of‘levator function o\‘er time. In addition. postoperative lagophthalmos may allow cornea1 exposure as a result of the the surgeon must carefull!. titrate e)-(xlirl ele\xunderlying CPEO-induced orbicularis weakness. Therefore. tion versus orbicularis \s-eakness in selecting the appropriate surgical approach. Lane and Collins utilized these concepts in formulating their protocol for the management of ptosis associated with CPEO. The surgical goal was to achieve upper eyelid elevation to clrar the visual axis. Patients with good levator function were treated with an anterior levator resection w~hilc those with poor function were treated with a brow suspension, providing orhicularis function was aclequatca t;)r e\.elid closure. In severe orbicularis weakness. surgery was avoided and ptosis props lvere prescribed. The therapeutic suggestions proposed in this stud>- have significant merit and ma! ser1.e as ;I qllide to the ptosis surgeon faced with a patient with CPEO. However. individual \.ariations of technique (i.e.. the use of instead of fascia latai ma). he appropriate. nonabsorbable suture or silicone for suspension. S I’(- \I< I K. SI.II,F, hl.1). s.\s 1:1<.\\-(.I\(.( ). (1 \I.ll‘OliUI.\
Retinal Venous Sheathing in Optic Neuritis: Its Significance for the Pathogenesis of Multiple Sclerosis, by S. Lightman, W.I. McDonald, A.C. Bird, et al. Brain 200:40.5-414, 1987 It has long been known that the cerebral venules are abnormal in the lesion of multiple sclerosis. Plaques are oriented around them and perivenous cupping is a prominent feature of the active lesion. k’ascular abnormalities have also been detected in the retina in multiple sclerosis patients. Their signilicance has