title: Surgical Correction of the Intractable Blepharoptosis in Patients With Ocular Myasthenia Gravis.
abstract: OBJECTIVE
  Treatment of blepharoptosis caused by ocular myasthenia gravis (OMG) is challenging in patients with serious side effects or failed response to medical therapy. Only a few surgical reports have been published for refractory myathenic blepharoptosis. This study is aimed at the evaluation of the surgical outcome of blepharoptosis correction in intractable OMG patients.
  
  
  METHODS
  Twelve OMG patients who accepted frontalis sling with frontalis orbicularis oculi muscle (FOOM) flap for blepharoptosis correction were reviewed. Patients' demographies, perioperative changes of the interpalpebral fissure height (IPFH), margin reflex distance 1 (MRD1), levator function (LF), and quality of life (QOL) score were evaluated.
  
  
  RESULTS
  The duration of OMG ranged from 3 to 31 years. LF was normal in 6 patients, good in 5, and poor in 1. There is no significant change of LF before and after surgery. MRD1 improved significantly from -1.8 mm (range, 0 to -5 mm) preoperatively to 2.9 mm (range, 2-4 mm) postoperatively. IPFH improved significantly from 3.8 mm (range, 2-6 mm) preoperatively to 7.8 mm (range, 6-9 mm) postoperatively. Upper eyelid margin was above the pupil in all patients. QOL score improved significantly from 18.2 (range, 14-23) preoperatively to 5.8 (range, 0-10) postoperatively.
  
  
  CONCLUSIONS
  Our report reveals that surgical correction of the blepharoptosis is effective for patients with intractable OMG and that frontalis suspension with FOOM flap is a valuable option because of its ready availability and pliability. All patients are satisfied with the results, especially the improvement of QOL.
authors.affiliation: From the *Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China; †School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
authors.forename: Chung Sheng
authors.initials: CS
authors.lastname: Lai
authors.forename: Ya Wei
authors.initials: YW
authors.lastname: Lai
authors.forename: Shu Hung
authors.initials: SH
authors.lastname: Huang
authors.forename: Su Shin
authors.initials: SS
authors.lastname: Lee
authors.forename: Kao Ping
authors.initials: KP
authors.lastname: Chang
authors.forename: Austin Deng
authors.initials: AD
authors.lastname: Chen
mesh_terms: D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000209:etiology / Q000601:surgery*; D005152:Facial Muscles / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications*; D013524:Surgical Flaps; D016896:Treatment Outcome