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. 2018 Jan;32(1):81-86.
doi: 10.1038/eye.2017.128. Epub 2017 Aug 4.

Outcomes for severe aponeurotic ptosis using posterior approach white-line advancement ptosis surgery

Affiliations

Outcomes for severe aponeurotic ptosis using posterior approach white-line advancement ptosis surgery

Z Antus et al. Eye (Lond). 2018 Jan.

Abstract

PurposeThe purpose of the study was to report the outcome of posterior approach white-line advancement surgery for severe involutional aponeurotic ptosis.Patients and methodsThis was a retrospective review of an interventional case series of all patients undergoing surgery for severe involutional aponeurotic ptosis during a 42-month period at a single center. The inclusion criteria were severe involutional ptosis (upper eyelid margin reflex distance (MRD) ≤1 mm) undergoing posterior approach surgery. There was minimum 3-month follow-up. The main outcome measures were type of ptosis (primary or recurrent), preoperative margin reflex distance, levator function and eyelid skin crease height, presence of visible iris sign (VIS), documented unusual intraoperative findings, postoperative complications, and follow-up time.ResultsOf the 836 procedures for ptosis, 122 procedures (76 patients) met the inclusion criteria for this study. Mean postoperative follow-up was 28 (median 18, range 12-98) weeks. Success rates were 80.3% (98/122) overall, 81.5% (66/81) in the non-VIS group, and 78% (32/41) in the VIS group. There was no significant difference between the two groups (P=0.411). Failures were due to undercorrection, with <2 mm MRD in 75% (18/24), overcorrection with >4.5 mm MRD in 16.7% (4/24), and inter-eyelid height asymmetry of >1 mm in 8.3% (2/122).ConclusionsOutcomes of ptosis surgery for severe aponeurotic ptosis using a posterior approach white-line advancement are comparable to, and possibly better than, anterior approach in eyelids with VIS.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a, b) Examples for visible iris sign (VIS)-positive and VIS-negative ptosis. (a) Visible iris sign left side: apparent visibility of the iris colour and/or part of the circumferential outline of the iris through a closed upper eyelid, with its overlying skin gently stretched both above and below. (b) Bilateral VIS-negative upper eyelid (Raman Malhotra, Corneoplastic Unit, Queen Victoria Hospital, NHS Foundation Trust).
Figure 2
Figure 2
(a–d) Pre- and postoperative pictures of VIS-negative and VIS-positive cases. (a) Bilateral VIS-negative severe aponeurotic ptosis preoperatively. (b) Following bilateral posterior approach white-line advancement (WLA) ptosis repair and upper blepharoplasty. (c) Bilateral VIS-positive severe aponeurotic ptosis preoperatively. (d) Following bilateral posterior approach white-line advancement (WLA) ptosis repair and upper blepharoplasty (Raman Malhotra, Corneoplastic Unit, Queen Victoria Hospital, NHS Foundation Trust).

References

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