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. 2020 Jul 15:2020:9021848.
doi: 10.1155/2020/9021848. eCollection 2020.

Conjunctival Sparing Ptosis Correction by White-Line Advancement Technique

Fatima A Habroosh  1 , Habibullah Eatamadi  1
Affiliations

Conjunctival Sparing Ptosis Correction by White-Line Advancement Technique

Fatima A Habroosh et al. J Ophthalmol. .

Abstract

Purpose: To describe a modified technique of white line advancement posterior ptosis surgery and to report the success rate of the procedure.

Methods: A retrospective case series of 60 patients who presented with ptosis with good levator function. The success rate was defined as an MRD1 of greater than or equal to 3.5 mm, symmetrical eyelid position with an intereyelid height asymmetry of ≤1 mm, and a satisfactory eyelid contour at 3 months follow-up.

Results: Sixty patients (91 eyelids) met the inclusion criteria. Mild postoperative complications occurred in 11 patients that resolved without surgical intervention. Seven patients had recurrence of ptosis: four patients had early recurrence and 3 had late recurrence. The success rate was 88.33% with an average follow-up of 9 months.

Conclusion: This procedure is a promising technique in cosmetic and functional ptosis correction. The advantage of this posterior approach procedure is that there is no conjunctival resection; it is suitable for young patients who do not have excess eyelid skin. The procedure is quick with a short recovery period. Additionally, it can be combined with another procedure and in different pathology.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Surgical steps. (a) Infiltration of the local anesthesia intended skin crease. (b) A 4-0 silk suture was passed through the grey line of the upper lid. (c) The conjunctiva was cut 1 mm away from the upper border of the tarsal plate by monopolar. (d) Blunt dissection of the conjunctiva off the Müller muscle. (e) Conjunctival tractional suture. (f) Incision of the Müller muscle along the same line with monopolar cautery. (g) The white line is often found posteriorly. (h) Dissection of the anterior surface of the tarsal plate from the pretarsal orbicularis muscle.
Figure 2
Figure 2
Surgical steps (continue). (a) After placing a vertical suture in the tarsal plate, the same suture was passed through the white line, incorporating no more than 1 mm of its thickness. (b) A knot (2 throws) is tied onto the anterior surface of the tarsal plate to position the levator onto it. (c) Both ends of the suture are passed under upper part of the tarsal plate and exteriorized through the initial skin incision. (d) The suture is tied over the orbicularis oculi muscle.
Figure 3
Figure 3
Pre- and postoperative pictures. (a) Bilateral involutional blepharoptosis. (b) One month after bilateral blepharoptosis repair by white-line advancement technique. (c) Bilateral mechanical blepharoptosis due to vernal keratoconjunctivitis. (d) One month after bilateral blepharoptosis repair by white-line advancement technique.
See this image and copyright information in PMC

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