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P.R. Boulos, I. Hardy, N. Tucker, Y. Almazroui; Oculopharyngeal Dystrophy: Should We Suspend Resections? . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1948.
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Purpose: Oculopharyngeal dystrophy (OPD) is a myopathy that leads to severe ptosis and dysphagia. Because of its progressive nature, it often poses a surgical challenge. This study attempts to evaluate surgical correction results in oculopharyngeal dystrophy by comparing two methods: levator resection vs frontalis suspension. Methods: A retrospective comparative case series of 135 ptoses due to oculopharyngeal dystrophy that were followed for a maximum of 5 years was performed. Eyelids were divided according to their levator function (LF) and according to the type of procedure performed for the initial intervention and for the revision. Results: The resections performed on eyelids with LF of ≤ 9,9, 10-12 and >12 were revised in 18%, 16% and 12% of cases respectively (p=0,84 for the difference between these groups). Suspensions with LF of ≤ 9,9 were revised in 9% of cases (p=0,60 for the difference with the resection LF ≤ 9,9 group). Out of all initial surgeries performed, the total revision rate was 13%. With resections, the mean delay to revision due to progression of disease was 37 months. Revisions were performed sooner when LF was lower : 16 months for the LF ≤ 9,9 group. Suspensions only required revision when adjustments were necessary (11 months). Patient satisfaction was 67% with resections and 75% with suspensions (p=0,51) Conclusions: In OPD, It is generally accepted that suspension should be chosen at a lower threshold than with non-myogenic ptoses because the disease is progressive and often leads to recurrence. In this series, revision rate increases when resection rather than suspension is chosen for a LF ≤ 9,9. Resection revision rates follow an upward trend when the LF decreases. Low LF seems to hasten recurrence of ptosis. Patients are generally more satisfied with initial suspension. Frontalis suspension is therefore advisable for LF <10 mm but, this cannot be confirmed with certainty because the results were not statistically significant due to a limited number of patients.
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