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. 2022 Apr 30;28(4):216-220.
doi: 10.4103/meajo.meajo_472_20. eCollection 2021 Oct-Dec.

Outcomes of Posterior Approach Surgery in Various Types and Grades of Upper Eyelid Blepharoptosis in Indian Eyes

Nidhi Pandey  1 , Swati Singh  2
Affiliations

Outcomes of Posterior Approach Surgery in Various Types and Grades of Upper Eyelid Blepharoptosis in Indian Eyes

Nidhi Pandey et al. Middle East Afr J Ophthalmol. .

Abstract

Purpose: To present the outcomes of levator plication (levatorpexy) surgery by posterior approach for correction of ptosis of different aetiologies in Indian eyes.

Methods: Retrospective review of clinical notes and clinical photos of consecutive ptosis patients who underwent levatorpexy from January 2017 to September 2018. Surgery was considered successful if the following four criteria were simultaneously met: a postoperative MRD1 of ≥2 mm and ≤4.5 mm, inter eyelid height asymmetry of ≤1 mm, no overcorrection compared to the opposite eye, and a satisfactory eyelid contour determined by patient.

Results: Thirty six eyelids of 36 patients (mean age, 23.6 years; 25 females) underwent unilateral levatorpexy with the left eyelid affected in 66.6 %. Twenty one congenital (58.3%) (C), 12 (33.3%) aponeurotic (A) and 3 (8.3%) complex ptosis (CX) had a mean levator function of 9.8 mm (range, 6 to 15). Mean pre and post operative margin reflex distance (MRD 1) was 0.611mm (range, -1 to 3 mm) and 3 .00 mm (range, 2 to 4 mm) respectively. At the final follow up of 12 months, four patients remained under corrected (11.1%). At the final follow up of twelve months, the success rate was 78 percent.

Conclusion: Posterior approach for ptosis repair offers a scar less, minimally invasive, easy to revise, and successful lid height correction in congenital and acquired ptosis.

Keywords: Levatorpexy; posterior approach; ptosis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Local anesthetic injection (b) conjunctival incision was made with a no. 11 Bard-parker blade along the conjunctiva immediately distal to the superior border of the tarsus (c) Muller's muscle and conjunctiva dissected off as a composite flap (d) double armed 6-0 absorb-able suture was placed placed at a point in vertical line with the central peak of the tarsal plate, through the posterior surface of the Levator muscle (e) The needle exteriorized at or below the skin crease
Figure 2
Figure 2
Preoperative (a-c) and postoperative (d-f) photos of left eye mild, moderate, and severe ptosis, respectively
Figure 3
Figure 3
Preoperative (a and b) and postoperative (c and d) photos of a case of the left eye ptosis in monocular elevation deficit corrected by levator plication
Figure 4
Figure 4
Spontaneous improvement of residual ptosis showing (a) preoperative, (b) 3-month follow-up with residual mild ptosis left eye, and (c) symmetrical lid height at 1-year follow-up
Figure 5
Figure 5
(a) Preoperative left eye severe congenital ptosis, (b) residual ptosis at 3-month follow-up (c) postrepeat levatorpexy at 6-month follow-up with symmetrical lid height
See this image and copyright information in PMC

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