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T.J. McCulley, R.C. Kersten, W.J. Feuer; Outcome and Influencing Factors of External Levator Palpebrae Superioris Aponeurosis Advancement for Blepharoptosis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1943.
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Purpose: This study evaluates, in patients with acquired good-function blepharoptosis, external levator superioris aponeurosis advancement success and characteristics identifying patients at risk for surgical failure. Methods: This was a retrospective cohort and case-control study utilizing an estimated 828 patients that consecutively underwent external levator aponeurosis advancement for acquired good-function. Seventy-two patients underwent re-operation during the first post-operative year. Out of 153 randomly selected patients not undergoing re-operation, 125 met the criteria for desired outcome: post-operative margin-reflex-distance (MRD) > 2.0 mm and < 4.5 mm in operated eyes and < 1.0 mm asymmetry between eyelids. Mean MRD, mean levator function, and prevalence of Herring's law dependence (ipsilateral eyelid elevation causing contralateral blepharoptosis exacerbation) were determined for re-operated and desired outcome groups and compared using two-sample t-test and Fisher's exact test, respectively. Results: Re-operative rates were as follows: 8.7% overall, 5.2% of unilateral, and 12.8% of bilateral cases. Fourteen percent of patients had results outside the desired range but declined re-operation. Differences in pre-operative characteristics were seen between desired and under-corrected re-operated groups: MRD, 1.0 versus 0.32 mm (p=0.001); levator function, 15.4 versus 14.7 mm (p=0.013); and Herring's law dependence, 50% versus 79% (p=0.005), respectively. No differences were seen between desired and over-corrected groups. Conclusions: Following levator advancement for acquired good-function blepharoptosis, approximately 8.7% of patients require re-operation. Patients with severe blepharoptosis, less levator function, Herring's-law-driven eyelid height interdependence, and those undergoing bilateral procedures have increased risk of under-correction.
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