Blepharospasmus vom Levator-Inhibitions-Typ, Analyse von Patienten nach Lid-Frontalis-Suspensions-Operation und Literaturübersicht

Blepharospasm is a neurological condition characterised by forceful involuntary eyelid closures. It may be accompanied by eyelid opening apraxia (EOA) reducing the efficacy of botulinum toxin (BT) therapy. The frontalis suspension operation (FSO) is then the only effective treatment option available. We wanted to report our long-term results with FSO, making an analysis of pre-and postoperative factors that affect the operation outcome and patient satisfaction. For this, we studied 15 patients with blepharospasm and EAO and unresponsive to BT therapy(9 female, 6 male, age 61.93 ± 11.5 years). FSO was performed applying 2 polytetrafluorethylen threads (PTFE, Gore-Tex®) per eye connecting the frontalis muscle to the upper eye lid. Tension of the 2 carres was set to produce a palpebral fissure width of 2-3mm). Therapy outcome was monitored by a Quality of Life Questionnaire (QoL-Q) and a Self-Assessment Calendar reviewing postoperative days 0-10 (T1), 10-90 (T2), 90-180 (T3), 180-365 (T4) and > 365d (T5). Altogether 40 FOS were performed. 36 of them were performed under inhalation anaesthesia. Seven patients were treated during one session, eight during two sessions. 3 patients underwent altogether 10 revisions involving 5 eyelids. At T1, all of the 15 patients treated (100%) reported improved eyelid opening. Four patients treated (26.7%) reported 100% improvement (lack of symptoms). From T1 to T5 the improvement was 71.5% ± 23.22%. All 19 items on the QoL-Q except for presence of involuntary eye lid closure showed postoperative improvement in 8 to 100% of patients affected. All patients had upper eyelid haematomas, 9% of the threads showed suture extrusion, 6% suture granuloma. 8% of the operated eyelids showed postoperative lacrimation, 8% infections. In all patients BT therapy had to be continued to treat orbicularis oculi contractions. FSO applied additionally to BT therapy is a benign, reversible procedure improving EOA in blepharospasm substantially for a prolonged period of time.