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.
Highlights
Involutional ptosis is the most common etiology of ptosis encountered by oculoplastic surgeons. e cause of involutional ptosis is believed to be due to dehiscence or disinsertion of the levator palpebrae superior (LPS) aponeurosis from the anterior surface of the tarsus
Many ophthalmologists and, oculoplastic surgeons were finding the resection of the tarsal plate “destructive.” Putterman and Urist, in 1975, described their well-known technique of Müller’s muscle and conjunctival resection (MMCR) in 1975. is technique depended on the positive phenylephrine test [10]
Predictability of the surgical outcome in blepharoptosis is possibly one of the most important factors both to the patient and the surgeon. ere are many variables when assessing the outcome of any ptosis surgery. e ideal preferred technique would be the one that is highly predictable, repeatable, easy to perform, associated with minimal complications, and has a short postoperative recovery period. e preferred techniques of ptosis surgery have evolved over time
Summary
Involutional ptosis is the most common etiology of ptosis encountered by oculoplastic surgeons. e cause of involutional ptosis is believed to be due to dehiscence or disinsertion of the levator palpebrae superior (LPS) aponeurosis from the anterior surface of the tarsus. By 1952, Berke had modified Blaskovich technique and included surgeries in congenital ptosis He minimized the number of sutures to one only and did not resect the tarsal plate [6, 7]. One of the procedures that has endured test of the time is the Fasanella–Servat Procedure Fasanella and his fellow Servat resected the conjunctiva, 2–4 mm of the superior edge of the tarsal plate, and the Muller muscle to correct mild ptosis surgery. Many ophthalmologists and, oculoplastic surgeons were finding the resection of the tarsal plate (especially in a young patient) “destructive.” Putterman and Urist, in 1975, described their well-known technique of Müller’s muscle and conjunctival resection (MMCR) in 1975. There have been numerous modifications to the MMCR
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