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Ptosis Repair in Ocular Myasthenia Gravis
Michel J Belliveau1, James H Oestreicher1
1a Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Canada.
Seminars in Ophthalmology
|May 19, 2016
Summary
Ptosis repair surgery offers improved eyelid height in ocular myasthenia gravis patients. Levator advancement had a higher reoperation rate than the Fasanella-Servat technique.
Area of Science:
- Ophthalmology
- Neurology
Background:
- Ocular myasthenia gravis causes debilitating ptosis.
- Systemic treatments like pyridostigmine and prednisone are often ineffective or poorly tolerated.
- Surgical intervention is considered when medical management fails.
Purpose of the Study:
- To evaluate the efficacy and outcomes of ptosis repair in patients with ocular myasthenia gravis.
- To compare the results of two surgical techniques: Fasanella-Servat (posterior approach) and levator advancement.
Main Methods:
- Retrospective review of nine patients (13 eyelids) undergoing ptosis repair.
- Procedures included Fasanella-Servat (12 eyelids) and levator advancement (8 eyelids).
- Preoperative and postoperative measurements of margin-reflex distance (MRD) and levator excursion were recorded.
Main Results:
- Postoperative MRD improved significantly, with a mean of 2.3 mm compared to a preoperative mean of 0.55 mm.
- Two patients experienced mild, uncorrected lagophthalmos post-surgery.
- Three out of five patients undergoing levator advancement required revision surgery.
Conclusions:
- Both Fasanella-Servat and levator advancement can improve ptosis in ocular myasthenia gravis.
- The Fasanella-Servat technique may offer a more durable result with a lower reoperation rate compared to levator advancement in this cohort.
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