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Lauren DeMaria, Archana Nair, Andrea Tooley, Kyle Godrey, Richard Lisman; Adjustable ptosis correction via posterior levator advancement with minimal superior tarsectomy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3968.
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The purpose of this study is to report the results of a surgical technique for adjustable ptosis correction utilizing a posterior levator advancement with minimal superior tarsectomy.
A retrospective chart review was performed. Inclusion criteria were patients who underwent adjustable ptosis repair via posterior levator advancement with minimal superior tarsectomy by a single surgeon (R.D.L.). Patient demographics including age, gender, laterality of surgery, and postoperative follow up were reviewed. Postoperative change in margin reflex distance 1 (MRD1) was documented at one week and one month (POM1). Exclusion criteria included patients who had undergone prior upper eyelid surgery by an outside surgeon. Postoperative symmetry was defined as a difference in MRD1 less than 1 mm between eyelids. Need for adjustment and complications including revision were documented.
151 eyelids of 82 patients who underwent posterior levator advancement with minimal superior tarsectomy were included in the study. 69 patients had bilateral and 13 had unilateral surgery. Average improvement in MRD1 at POM1 was 2.57 mm (SD=1.08). Postoperative symmetry was achieved in 98.5% of eyes after one surgery or in office adjustment. A total of 8 (5.3%) eyes underwent adjustment in the office within 14 days of the procedure, consisting of downward traction placed on the eyelid margin with a cotton tipped applicator. Patients were noted to have a change in MRD1 of 0-2 mm following adjustment and a final MRD1 symmetry within 1 mm. Three patients underwent reoperations. Postoperative complications included dry eye (n=10) and corneal abrasion (n=2). Average follow up time was 10.6 months (range: 1-152).
The adjustable posterior levator advancement with minimal superior tarsectomy is an effective surgical technique to correct blepharoptosis with the added benefit of in office corrections of minor asymmetries. Our study demonstrates that the majority of patients have symmetric eyelid height following the surgery with rare complications. This procedure may add to the oculoplastic surgeons’ repertoire as a simple and adjustable means of ptosis repair.
This is a 2020 ARVO Annual Meeting abstract.
Preoperative and postoperative images of a patient who underwent successful bilateral posterior levator advancement with minimal superior tarsectomy.
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