EUROMEDICA  Hanover 1-2  Juni 2007	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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Blepharoptosis is drooping of the upper eyelid caused by insufficient of inadequate functioning of the muscles.

In the period of 1999 - 2006 there were 234 operations in 197 patients, 160 patients underwent surgery in one eye and 37 patients – in both eyes. Patient’s age: 11 patients aged 2-4 years; 31 patients aged 5- 7 years; 41 patients aged 8-14 years; 56 patients aged 15-25; 24 patients aged 26-45 years; 12 patients aged 46-60 years; 9 patients older 60 years.

According to the degree: 21 patients with the first degree; 115 patients with the second degree; 83 patients with the third degree, severe ptosis was found in 15 patients.

According to aetiology: congentital - 158 cases (including 22 cases combined with strabismus), acquired - in 76 cases including 58 cases of neurogenic origin (among them 18 cases with strabismus), traumatic origin - 2 cases, 6 cases of mechanical (blepharochalasis), senile origin – 4 cases and 6 cases of myasthenic origin.

The following surgeries were performed: in 206 cases - resection of levator (aponeurosis), in 25 cases – suspension of the eyelid to the frontal muscle, 3 cases with tarsotomy.

45 patients had previously undergone surgeries on removal of ptosis mostly of the suspension type.

The result of the surgery was estimated three month later at looking straight ahead with a straight head position. Criteria for estimation: good - edge of the lip is higher than the upper edge of the pupil, difference in the width of the palpebral fissure – 1 mm and less; satisfactory - edge of the lid is in the line with the pupil, the difference between the eyes - up to 2 mm; unsatisfactory – the edge of the lid is lower than the pupil and the difference is more than 2 mm.

Regarding first-degree ptosis (levator resection – 18 cases, tarsotomy – 3 cases) as good results were estimated 17 cases (81%); as satisfactory - 3 cases (14,3%); unsatisfactory -1 case (4,7%). In one case a secondary surgery with a positive outcome was performed.

Under ptosis of the second degree (with resection of levator): good – 78 cases (67,8%), satisfactory - 33 (28,7%), unsatisfactory - 4 (3,5%).

In third cases a secondary surgery with a positive result was performed.

Under ptosis of the 3^rd degree (with resection of levator in 71 cases and 10 suspension surgeries): good - 51 cases (61,5%), satisfactory - 27 cases (32,5%), unsatisfactory - 5 cases (6,0%).

In 5 cases a secondary operation with a positive result was carried out.

Under the complete ptosis (with a suspension surgery): good - 9 cases (60,0 %), satisfactory - 4 cases (26,7%), unsatisfactory - 2 cases (13,3%). In the second case a secondary surgery with a good output was performed.

Thus, a good result was achieved in 66,7 % cases, satisfactory - in 28,2 %. An unsatisfactory result was revealed in 12 cases (5,1 %), however corrected in 10 cases after a secondary surgery. In one case a hypereffect surgically corrected in 6 month was observed.

Conclusions:

1. Surgical treatment of ptosis is effective for all degrees of severity.
2. The right type of the surgery enables to obtain a good result in the treatment of ptosis.