Dehiscence of levator aponeurosis in ptosis after sub-Tenon injection of triamcinolone acetonide

Shinji Ideta, Mika Noda, Ryosuke Kawamura, Kei Shinoda, Kotaro Suzuki, Susumu Ishida, Makoto Inoue

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: To report the incidence, intraoperative findings, and surgical outcome of secondary ptosis that developed after a sub-Tenon injection of triamcinolone acetonide (TA). Study Design: Retrospective, cross-sectional study. Participants: One hundred forty-seven cases with a total of 286 sub-Tenon TA injections. Methods: The medical records of 163 eyes of 147 cases treated with a sub-Tenon injection of 10 mg or 20 mg TA were reviewed. The incidence of secondary ptosis (palpebral fissure >2 mm narrower than that of the fellow eye) after a sub-Tenon TA injection was determined. The preoperative levator function and margin reflex distance (MRD) of the affected eyes, and the intraoperative findings in eyes that underwent reconstructive surgery, were evaluated. Results: Eight eyes (5%) developed secondary ptosis after the injection and 6 eyes were treated by reconstructive surgery. The preoperative levator function of the affected eyes did not differ from that of the fellow eyes. Intraoperatively, no septal disruption or fat herniation was noted, but an aponeurotic disinsertion was identified and repaired with an advancement of the leading edge to the anterior tarsal plate. The surgery led to satisfactory results, with improvement of the MRD from -1.3 (SD 1.5) mm preoperatively to 2.3 (SD 0.5) mm postoperatively (p = 0.027). Additional sub-Tenon TA injections were required in 2 eyes after eyelid surgery but the ptosis did not worsen. Conclusions: A sub-Tenon TA injection can occasionally cause ptosis by inducing a disinsertion of the levator aponeurosis. However, surgical reconstruction can lead to successful resolution of the ptosis.

Original languageEnglish
Pages (from-to)668-672
Number of pages5
JournalCanadian Journal of Ophthalmology
Volume44
Issue number6
DOIs
Publication statusPublished - 2009

Fingerprint

Triamcinolone Acetonide
Injections
Reconstructive Surgical Procedures
Reflex
Blepharoptosis
Aponeurosis
Incidence
Eyelids
Medical Records
Retrospective Studies
Cross-Sectional Studies
Fats

Keywords

  • Levator aponeurosis
  • Ptosis
  • Reconstruction
  • Sub-Tenon injection
  • Triamcinolone acetonide

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Ideta, S., Noda, M., Kawamura, R., Shinoda, K., Suzuki, K., Ishida, S., & Inoue, M. (2009). Dehiscence of levator aponeurosis in ptosis after sub-Tenon injection of triamcinolone acetonide. Canadian Journal of Ophthalmology, 44(6), 668-672. https://doi.org/10.3129/i09-188

Dehiscence of levator aponeurosis in ptosis after sub-Tenon injection of triamcinolone acetonide. / Ideta, Shinji; Noda, Mika; Kawamura, Ryosuke; Shinoda, Kei; Suzuki, Kotaro; Ishida, Susumu; Inoue, Makoto.

In: Canadian Journal of Ophthalmology, Vol. 44, No. 6, 2009, p. 668-672.

Research output: Contribution to journalArticle

Ideta, S, Noda, M, Kawamura, R, Shinoda, K, Suzuki, K, Ishida, S & Inoue, M 2009, 'Dehiscence of levator aponeurosis in ptosis after sub-Tenon injection of triamcinolone acetonide', Canadian Journal of Ophthalmology, vol. 44, no. 6, pp. 668-672. https://doi.org/10.3129/i09-188
Ideta, Shinji ; Noda, Mika ; Kawamura, Ryosuke ; Shinoda, Kei ; Suzuki, Kotaro ; Ishida, Susumu ; Inoue, Makoto. / Dehiscence of levator aponeurosis in ptosis after sub-Tenon injection of triamcinolone acetonide. In: Canadian Journal of Ophthalmology. 2009 ; Vol. 44, No. 6. pp. 668-672.
@article{28396d8cedf84346a722d99c27f7a45d,
title = "Dehiscence of levator aponeurosis in ptosis after sub-Tenon injection of triamcinolone acetonide",
abstract = "Objective: To report the incidence, intraoperative findings, and surgical outcome of secondary ptosis that developed after a sub-Tenon injection of triamcinolone acetonide (TA). Study Design: Retrospective, cross-sectional study. Participants: One hundred forty-seven cases with a total of 286 sub-Tenon TA injections. Methods: The medical records of 163 eyes of 147 cases treated with a sub-Tenon injection of 10 mg or 20 mg TA were reviewed. The incidence of secondary ptosis (palpebral fissure >2 mm narrower than that of the fellow eye) after a sub-Tenon TA injection was determined. The preoperative levator function and margin reflex distance (MRD) of the affected eyes, and the intraoperative findings in eyes that underwent reconstructive surgery, were evaluated. Results: Eight eyes (5{\%}) developed secondary ptosis after the injection and 6 eyes were treated by reconstructive surgery. The preoperative levator function of the affected eyes did not differ from that of the fellow eyes. Intraoperatively, no septal disruption or fat herniation was noted, but an aponeurotic disinsertion was identified and repaired with an advancement of the leading edge to the anterior tarsal plate. The surgery led to satisfactory results, with improvement of the MRD from -1.3 (SD 1.5) mm preoperatively to 2.3 (SD 0.5) mm postoperatively (p = 0.027). Additional sub-Tenon TA injections were required in 2 eyes after eyelid surgery but the ptosis did not worsen. Conclusions: A sub-Tenon TA injection can occasionally cause ptosis by inducing a disinsertion of the levator aponeurosis. However, surgical reconstruction can lead to successful resolution of the ptosis.",
keywords = "Levator aponeurosis, Ptosis, Reconstruction, Sub-Tenon injection, Triamcinolone acetonide",
author = "Shinji Ideta and Mika Noda and Ryosuke Kawamura and Kei Shinoda and Kotaro Suzuki and Susumu Ishida and Makoto Inoue",
year = "2009",
doi = "10.3129/i09-188",
language = "English",
volume = "44",
pages = "668--672",
journal = "Canadian Journal of Ophthalmology",
issn = "0008-4182",
publisher = "Canadian Ophthalmological Society",
number = "6",

}

TY - JOUR

T1 - Dehiscence of levator aponeurosis in ptosis after sub-Tenon injection of triamcinolone acetonide

AU - Ideta, Shinji

AU - Noda, Mika

AU - Kawamura, Ryosuke

AU - Shinoda, Kei

AU - Suzuki, Kotaro

AU - Ishida, Susumu

AU - Inoue, Makoto

PY - 2009

Y1 - 2009

N2 - Objective: To report the incidence, intraoperative findings, and surgical outcome of secondary ptosis that developed after a sub-Tenon injection of triamcinolone acetonide (TA). Study Design: Retrospective, cross-sectional study. Participants: One hundred forty-seven cases with a total of 286 sub-Tenon TA injections. Methods: The medical records of 163 eyes of 147 cases treated with a sub-Tenon injection of 10 mg or 20 mg TA were reviewed. The incidence of secondary ptosis (palpebral fissure >2 mm narrower than that of the fellow eye) after a sub-Tenon TA injection was determined. The preoperative levator function and margin reflex distance (MRD) of the affected eyes, and the intraoperative findings in eyes that underwent reconstructive surgery, were evaluated. Results: Eight eyes (5%) developed secondary ptosis after the injection and 6 eyes were treated by reconstructive surgery. The preoperative levator function of the affected eyes did not differ from that of the fellow eyes. Intraoperatively, no septal disruption or fat herniation was noted, but an aponeurotic disinsertion was identified and repaired with an advancement of the leading edge to the anterior tarsal plate. The surgery led to satisfactory results, with improvement of the MRD from -1.3 (SD 1.5) mm preoperatively to 2.3 (SD 0.5) mm postoperatively (p = 0.027). Additional sub-Tenon TA injections were required in 2 eyes after eyelid surgery but the ptosis did not worsen. Conclusions: A sub-Tenon TA injection can occasionally cause ptosis by inducing a disinsertion of the levator aponeurosis. However, surgical reconstruction can lead to successful resolution of the ptosis.

AB - Objective: To report the incidence, intraoperative findings, and surgical outcome of secondary ptosis that developed after a sub-Tenon injection of triamcinolone acetonide (TA). Study Design: Retrospective, cross-sectional study. Participants: One hundred forty-seven cases with a total of 286 sub-Tenon TA injections. Methods: The medical records of 163 eyes of 147 cases treated with a sub-Tenon injection of 10 mg or 20 mg TA were reviewed. The incidence of secondary ptosis (palpebral fissure >2 mm narrower than that of the fellow eye) after a sub-Tenon TA injection was determined. The preoperative levator function and margin reflex distance (MRD) of the affected eyes, and the intraoperative findings in eyes that underwent reconstructive surgery, were evaluated. Results: Eight eyes (5%) developed secondary ptosis after the injection and 6 eyes were treated by reconstructive surgery. The preoperative levator function of the affected eyes did not differ from that of the fellow eyes. Intraoperatively, no septal disruption or fat herniation was noted, but an aponeurotic disinsertion was identified and repaired with an advancement of the leading edge to the anterior tarsal plate. The surgery led to satisfactory results, with improvement of the MRD from -1.3 (SD 1.5) mm preoperatively to 2.3 (SD 0.5) mm postoperatively (p = 0.027). Additional sub-Tenon TA injections were required in 2 eyes after eyelid surgery but the ptosis did not worsen. Conclusions: A sub-Tenon TA injection can occasionally cause ptosis by inducing a disinsertion of the levator aponeurosis. However, surgical reconstruction can lead to successful resolution of the ptosis.

KW - Levator aponeurosis

KW - Ptosis

KW - Reconstruction

KW - Sub-Tenon injection

KW - Triamcinolone acetonide

UR - http://www.scopus.com/inward/record.url?scp=72849112318&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=72849112318&partnerID=8YFLogxK

U2 - 10.3129/i09-188

DO - 10.3129/i09-188

M3 - Article

C2 - 20029485

AN - SCOPUS:72849112318

VL - 44

SP - 668

EP - 672

JO - Canadian Journal of Ophthalmology

JF - Canadian Journal of Ophthalmology

SN - 0008-4182

IS - 6

ER -