Abstract
Purpose:
To compare small-incision external approach and classic Fasanella-Servat internal approach (including tarsus resection) for correction of upper eyelid involutional ptosis.
Methods:
Retrospective review of medical records of 93 patients (104 surgical procedures) evaluated at the Northwestern University Department of Ophthalmology between December 2008 to 2011, all of whom underwent small-incision or classic Fasanella-Servat technique ptosis repairs by the same surgeon (GSL). Main outcome measures included patient satisfaction, marginal reflex distance one (MRD1), surgical complications, operating time.
Results:
Of the 93 patients, 67% (62/93) were female and 33% (31/93) were male, with overall average age of 69 (+/-14). Of the surgical procedures, 48% (50/104) were small-incision external approaches and 52% (54/104) were Fasanella-Servat internal approaches. Average length of post-operative follow-up was 34.0 days overall (+/-16.0), 32.4 days (+/-17.2) for the Fasanella-Servat group and 38.4 days (+/-15.3) for the small-incision group. MRD1 increased an average of 3.38 mm (+/-0.79) in the Fasanella-Servat group and 2.79 mm (+/-0.8) in the small incision group, and the difference was statistically significant (p<0.001). Pre-operative MRD1 was lower in the Fasanella-Servat group (-0.81 +/- 0.75 versus -0.30 +/-0.43, p<0.001), but post-operative MRD1 was similar between the two groups (2.57 +/-0.54 versus 2.49 +/- 0.56, p=0.5). Average operating time was 53 minutes (+/- 16) in the small incision group and 27 minutes (+/- 6 minutes) in the Fasanella-Servat group (p<0.001). In the Fasanella-Servat group, 61% of patients (33/54) experienced pain on post-operative day one versus 32% of patients (16/50) in the small-incision group (p=0.01). There were no surgical complications in either group with equivalent patient satisfaction between the two groups.
Conclusions:
Both the classic Fasanella-Servat internal approach and the small incision external approach lead to good surgical outcomes with equivalent patient satisfaction for cases of involutional ptosis, although the classic Fasanella-Servat approach provides a shorter average operating time with equivalent post-operative MRD1.
Keywords: 526 eyelid •
712 shape and contour •
413 aging