A review of surgical management of progressive myogenic ptosis

ABSTRACT

Purpose

Surgical correction of myogenic ptosis is a sophisticated endeavor, as the disease is progressive and the post-operative course is prone to significant complications. We sought to review the literature for repair techniques in different types of myogenic ptosis.

Methods

A PubMed/MEDLINE literature search of publications pertaining to surgical outcomes of progressive myogenic ptosis repair was performed. Studies included were original retrospective studies with a minimum of four patients.

Results

A total of 27 articles were identified and divided by etiology of myogenic ptosis; either chronic progressive external ophthalmoplegia (CPEO), oculopharyngeal muscular dystrophy (OPMD), myasthenia gravis (MG), or mixed. Surgical techniques predominantly involved levator advancement, levator resection, frontalis sling, blepharoplasty, and Fasanella-Servat. Success rates ranged from 60.5% to 100%. Significant postoperative complications included ptosis recurrence, under-correction, over-correction, keratopathy, lagophthalmos, sling exposure, and sling infection.

Conclusion

Like surgical repair for other forms of ptosis, correction of progressive myogenic ptosis is guided by levator excursion. However, myogenic ptosis is especially challenging as it is characterized by worsening ptosis and the loss of protective corneal mechanisms. The goals of care with myogenic ptosis involves repairing ptosis just sufficiently to alleviate visual obstruction while avoiding adverse post-operative complications. This intentional under-correction subsequently increases susceptibility for ptosis recurrence. Myogenic ptosis repair therefore requires delicate balancing between function, sustained repair, and corneal protection.

KEYWORDS:

• progressive myogenic ptosis
• CPEO
• MG
• myopathic ptosis
• OPMD

Disclosure statement

Dr. Vinay K. Aakalu: Patents owned by the Board of Trustees of the University of Illinois and equity ownership ViSo Therapeutics Inc. These do not pertain to the subject matter reported in this article.

Additional information

Funding

This work was supported by The National Institutes of Health, National Eye Institute under Grant [P30EY001792] and by Research to Prevent Blindness NY, NY under an Unrestricted Grant; and Research to Prevent Blindness [Unrestricted Grant].