Improvement Of Surgical Methods For Congenital Ptosis And Study Of Histopathological Characteristics Of Levator Aponeurosis Under Pathological And Physiological Conditions

Background:Ptosis reoccurrence and dissatisfaction with the eyelids contour are commonly observed among congenital blepharoptosis patients who have received surgery correction.Besides,the eyelids lag is observed before or after surgical correction every now and then.According to reported articles,ptosis reoccurrence and improper eyelids contour are the two main factors undermining the success rate of surgical correction for simple congenital blepharoptosis.Therefore,we come up with our new suture methods which could be used during the surgical correction for simple congenital blepharoptosis.However,even the static appearance of the patients after surgical correction is satisfying,lagophthalmos,and eyelids lag are observed among some patients.Then,we did the research about the histological changes in the levator aponeurosis from simple congenital blepharoptosis patients and explored the potential effect of aging on the eyelids position and histological features of the levator aponeurosis.Objectives:all three parts of the research are shown below:1?modification of the surgical treatment for simple congenital blepharoptosis patients and assessment of its clinical outcomes;2?the histological changes in the levator aponeurosis of simple congenital blepharoptosis patients;3?the effect of aging on the eyelids position and histological features of the levator aponeurosis.Methods:This study is composed of three parts.We will show the methods of the three parts respectively.The first partWe come up with a new suture technique to solve the existing problems in the surgical treatment and conducted a retrospective study to gather the clinic and eyelids data and count the success rate and compare it with data reported in the previous literature.The second partWe used several histological stain methods to observe the pathological changes in the levator aponeurosis from those simple congenital blepharoptosis patients when compared with normal individuals.Then wen calculated the type and content of collagen,the content of elastin.Then we compared the data between the simple congenital blepharoptosis group,the normal group,and the frontalis muscle fascia group and try to find the difference as well as its potential effect on the biological mechanical features of the tissue.The third part1?We stained the levator aponeurosis from normal individuals with several methods and calculated the content of collagen?elastin.After that,we did the correlation analysis between the content of collagen?elastin and age.Then we divided the sample into different groups according to the age and compared the data between different groups.2?We measured the MRD with Image-Pro Plus of photos gathered from the patients.After that,we did a correlation analysis between MRD and age.Then we divided the samples into different groups according to the age and compared the data between different groups.Results:The first partOur new suture is efficient in improving the surgical success rate for simple congenital blepharoptosis patients;The second part1?Fat diffuse,reduction and abnormal distribution of muscle bundles,hypertrophy,and disorganization of collagen fibers were observed in the levator aponeurosis from simple congenital blepharoptosis patients;2?The content of collagen fibers and the ration of type I collagen increased in the levator aponeurosis from the simple congenital blepharoptosis patients group when compared with the normal group;3?Both the content of collagen and elastin were higher in the frontalis muscle fascia than in the normal levator aponeurosis.The third part1?There is no significant correlation between age and the eyelids position,content of collagen or elastin in the levator aponeurosis.2?No difference of MRD or content of collagen and elastin in the levator aponeurosis was observed between different age groups.ConclusionsThe first partOur new suture technique is effective in reducing reoccurrence and improving bilateral symmetry and eyelids contour,which then increase the success rate.The second partThere used to be a vacuity of researches about the histological changes in the levator aponeurosis from simple congenital blepharoptosis patients,and our research enriched it.The research offers us a clue for further research about the biological mechanical changes in levator aponeurosis from simple congenital blepharoptosis changes.The third partThe MRD,collagen,and elastin content remain stable with aging which may guarantee a stable visual axis.However,further researches should be made to explore the effect of aging on the spatial structure as well as mechanical features of the levator aponeurosis.