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Margaret McGlynn, Benjamin M Levine, Charles Kim, Gary J Lelli; Ptosis from levator dehiscence, fatty infiltration, and surgical outcomes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3105.
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The presence of adipose tissue has been reported both grossly and microscopically in the levator muscle and aponeurosis of patients with ptosis from levator dehiscence. (1,2) To our knowledge, no previous study has attempted to correlate the amount of fatty infiltration of the levator muscle with surgical outcomes. This study strove to determine the relationship between ptosis from levator dehiscence, graded gross fatty infiltration of the levator muscle, and surgical outcomes.
An oculoplastics fellowship-trained ophthalmologist intra-operatively graded the amount of fatty infiltration of the levator muscle using a pre-determined scale (from 0-4+) in a cohort of patients undergoing ptosis repair due to levator dehiscence. Outcomes were analyzed determining the margin reflex distance 1 (MRD1) of photos taken at least 4 weeks post-operatively. Other data points analyzed included pre-operative MRD1 and levator function. Simple logistic models were constructed to determine variables associated with fatty infiltration and unsatisfactory surgical outcomes as determined by MRD1 of less than 2mm.
Of the 31 eyelids of 19 patients enrolled in the study preliminary results have been obtained for 10 eyelids of 6 patients. Of the two eyelids with the greatest amount of fatty infiltration (4+), one eye had a poor surgical outcome with an MRD1 of 1.5mm while the other had a satisfactory outcome with an MRD1 of 3mm. One other eyelid had a poor outcome with an MRD1 of 1.5mm; it had 1+ fatty infiltration. Of the patients, all had levator function of 12 mm or greater. The patient with the poorest levator function (12mm) had no fatty infiltration of the levator muscle. The preliminary results did not demonstrate an association between levator fatty infiltration and poor pre-operative levator function or poor post-operative surgical outcome.
This goal of this study was to analyze fatty infiltration of the levator muscle and its effects on surgical outcomes. Preliminary results did not demonstrate an association between fatty infiltration, pre-operative levator function or post-operative surgical outcome, but more patients should be included before drawing final conclusions.
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