Surgical Correction of the Intractable Blepharoptosis in Patients With Ocular Myasthenia Gravis

Treatment of blepharoptosis caused by ocular myasthenia gravis (OMG) is challenging in patients with serious side effects or failed response to medical therapy. Only a few surgical reports have been published for refractory myathenic blepharoptosis. This study is aimed at the evaluation of the surgical outcome of blepharoptosis correction in intractable OMG patients.

Twelve OMG patients who accepted frontalis sling with frontalis orbicularis oculi muscle (FOOM) flap for blepharoptosis correction were reviewed. Patients' demographies, perioperative changes of the interpalpebral fissure height (IPFH), margin reflex distance 1 (MRD1), levator function (LF), and quality of life (QOL) score were evaluated.

The duration of OMG ranged from 3 to 31 years. LF was normal in 6 patients, good in 5, and poor in 1. There is no significant change of LF before and after surgery. MRD1 improved significantly from -1.8 mm (range, 0 to -5 mm) preoperatively to 2.9 mm (range, 2-4 mm) postoperatively. IPFH improved significantly from 3.8 mm (range, 2-6 mm) preoperatively to 7.8 mm (range, 6-9 mm) postoperatively. Upper eyelid margin was above the pupil in all patients. QOL score improved significantly from 18.2 (range, 14-23) preoperatively to 5.8 (range, 0-10) postoperatively.

Our report reveals that surgical correction of the blepharoptosis is effective for patients with intractable OMG and that frontalis suspension with FOOM flap is a valuable option because of its ready availability and pliability. All patients are satisfied with the results, especially the improvement of QOL.