title: Simbu Ptosis: An Outreach Approach to Myogenic Ptosis in Eastern Highlands of Papua New Guinea-Experience and Results From a High-Volume Oculoplastic Surgical Camp.
abstract: OBJECTIVE
  To present the results of a high-volume oculoplastic surgical outreach in a remote region of Simbu Province in the Eastern Highlands of Papua New Guinea. The authors describe the clinical features and evaluation and treatment of a novel ptosis syndrome found in this area.
  
  
  METHODS
  A team of 4 international ophthalmologists and 3 local doctors and 3 local nurses involved in a high-volume field intervention for all patients presenting with a bilateral ptosis to Mingende Rural Hospital.
  
  
  METHODS
  Patients were systematically evaluated and treated during a 6-day surgical outreach and followed daily for 1 week and as needed via telemedicine. Visiting surgeons provided skills-transfer instruction for 3 local doctors and 3 nurses. Data collected included demographic information, history of present illness, past medical history, family history, social history, and a complete ophthalmologic and targeted neurologic evaluation. Patients were offered surgical intervention if they met criteria for safe eyelid elevation and could present for follow ups. Detailed notes of patient geographic location, history, and risk factors were collected in addition to pre- and postoperative photos.
  
  
  METHODS
  Efficient triage and treatment of all patients referred to the remote oculoplastic clinic.
  
  
  RESULTS
  A total of 97 patients presented to the camp; of these, 87 underwent complete evaluation. There were 72 patients with ptosis, of which 60 were found to be of Simbu-type. These patients were grouped clinically by degree of ptosis: mild, moderate, and severe. Thirty-eight patients had moderate ptosis of which 34 underwent surgical intervention. Eleven patients with mild ptosis were counseled and observed. The 10 patients with severe ptosis and 2 with moderate ptosis were treated medically with ptosis crutches manufactured on site. A new technique for creating ptosis crutch glasses was developed.
  
  
  CONCLUSIONS
  A new variant of progressive myogenic ptosis was identified. A high-volume oculoplastic surgical camp is an efficient way to systematically evaluate and treat this new entity. Skills-transfer training for local doctors and staff ensured continuity of care for the surgical patients.
authors.affiliation: *Edward J. Hines VA Medical Center, Chicago, Illinois; †Department of Ophthalmology, Loyola University School of Medicine, Maywood, Illinois; ‡Department of Ophthalmology, University of Utah, Moran Eye Center, Salt Lake City, Utah; §Tilganga Institute of Ophthalmology, Kathmandu, Nepal; ‖Department of Radiology, University of Utah, Salt Lake City, Utah; and ¶Great Lakes Eye Care, Saint Joseph, Michigan, U.S.A.
authors.forename: Anna G
authors.initials: AG
authors.lastname: Gushchin
authors.forename: Alison V
authors.initials: AV
authors.lastname: Crum
authors.forename: Ben B
authors.initials: BB
authors.lastname: Limbu
authors.forename: Edward P
authors.initials: EP
authors.lastname: Quigley
authors.forename: Michael S
authors.initials: MS
authors.lastname: Seward
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Tabin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000601:surgery*; D002648:Child; D003266:Continuity of Patient Care / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010219:Papua New Guinea; D019035:Rural Health Services / Q000458:organization & administration*; D014218:Triage / Q000592:standards; D055815:Young Adult