[Postoperative ptosis: etiopathogenesis, clinical analysis, and therapeutic management. Apropos of a series of 43 cases].
OBJECTIVE
Acquired postoperative ptosis (PP) are difficult to situate in the current classification of ptosis. Assessement of the mechanisms, the clinical features and the possible treatments of these PP would suggest a new classification of ptosis.


METHODS
Among 260 cases of surgically corrected ptosis, 43 cases of PP (16.5%) were detected and analyzed.


RESULTS
Forty cases of PP were eligible for this study. Their responsible mechanisms were aponeurotic (57.5%), mixed (aponeurotic and/or myogenic and/or neurogenic) (27.5%) and myogenic (15%). PP was assessed in most cases as being mild (77.5%) and the levator's muscle contraction was most often mildly impaired (77.5%). In these cases, surgical procedure was performed: levator aponeurosis disinsertion repair (85%), Fasanella-Servat procedure (2.5%), frontalis sling (2.5%) and other surgical procedure with synthetic materials (10%). Postoperative complications included 1 case of persistent lid edema and 4 cases of spontaneous suture rupture. Six patients (15%) were secondarily reoperated: 2 for overcorrection (5%) and 4 for undercorrection (10%). The general outcome was good in 90% of cases, insufficient in 5% of cases and unsatisfactory in 5% of cases.


CONCLUSIONS
This study confirms the previously described features of the PP: onset after anterior surgery procedures of usually moderate ptosis, induced by an aponeurotic defect mechanism in most cases. The treatment was exclusively surgical: anterior reinsertion of the levator aponeurosis. For better management, we suggest a new ptosis classification: aponeurotic, myogenic, neurogenic and mixed (aponeurotic and/or myogenic and/or neurogenic) and false or pseudo-ptosis.
Clinique Ophtalmologique du Pavillon C, Hôpital Edouard Herriot, Lyon.
E
E
Baggio
J M
JM
Ruban
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001763:Blepharoptosis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D002387:Cataract Extraction; D015353:Eye Enucleation; D017234:Eye Evisceration; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D013518:Surgery, Plastic; D016896:Treatment Outcome
Les ptosis postopératoires: étiopathogénie, analyse clinique et prise en charge thérapeutique. A propos d'une série de 43 cas.