Lawrence Oh, Eugene Wong, Sol Bae, Angelo Tsirbas
Purpose: Repair of Blepharoptosis from the poste- rior eyelid approach has usually been done utilising a M?ller?s muscle-Conjuctival resection (MMCR) or an ?open sky? technique. We present a new technique to advance the Levator Muscle from the posterior-approach in a closed fashion that can be used in patients with severe involutional ptosis.
Methods: A retrospective chart review was per- formed for consecutive patients with severe involu- tional blepharoptosis during an 8 year period treated by a single surgeon with a Closed Posterior Levator Advancement (CPLA). The inclusion criteria were good levator function (?10mm), graded response to phenylephrine (change in lid height 0 to 5mm), and no concomitant procedures. Severe invo- lutional blepharoptosis was deftned as a margin-to- re?ex-distance-1 (MRD1) of ?1.5mm. Follow up for all patients was a minimum of 9 months. The main outcome variables were MRD1, upper eyelid con- tour, intereye symmetry and reoperation rates.
Results: 303 eyes from 192 patients, with severe ptosis were identifted.The average age was 65, and the mean preoperative MRD1 was 0.3mm. Postoperatively mean MRD1 was 3.5mm with a median improvement of 3.2mm. The upper eyelid contour was deemed to be satisfac- tory by patient and surgeon in 98.3% of eyes. Inter- eye symmetry was excellent in 96% of our cohort. An overall revision rate of 1.8% was found.
Conclusions: We present a new technique that involves an advancement of the Levator Muscle in a closed posterior eyelid approach. The technique has produced satisfactory outcomes in our cohort of patients with severe ptosis with a low revision rate.