[Surgical management of blepharoptosis: a report of 500 cases]

To investigate the various surgical techniques and their results for different types of blepharoptosis.

620 eyes of 500 cases with blepharoptosis who underwent surgical treatment were retrospectively analyzed. The patients were diagnosed as congenital, neurogenic, myogenic, traumatic, senile and mechanical ptosis. The used techniques included resection of levator muscle, anastomosis of frontalis muscle and levator aponeurosis, Whitnall's ligament sling, Friedenwald- Guyton's frontalis muscle fixation, levator aponeurosis reconstruction, modified Hotz's tarsectomy.

The overall success rate was 90.3% (560/620). 60 eyes with unsatisfactory result showed overcorrection in 5 eyes and undercorrection in 55 eyes in which the patients also suffered from combined eyelid deformities in 4 eyes, entropion in 6 eyes and ectropion in 2 eyes. The success rate of resection of levator muscle for the mild and moderate congenital ptosis was 93.8%. The success rates of resection of levator muscle and anastomosis of levator aponeurosis and frontalis muscle for the severe congenital ptosis were 72.4% and 100% respectively. The success rate of Whitnall's ligament sling for the recurrent congenital ptosis was 90%. The success rates of Friedenwald-Guyton's frontalis muscle fixation, Whitnall's ligament sling and anastomosis of levator aponeurosis and frontalis muscle for the neurogenic and myogenic ptosis was 41.6%, 80% and 90% respectively. The success rates of levator aponeurosis reconstruction for the traumatic and senile ptosis were 94.7% and 100%, respectively. The success rate of modified Hotz' tarsectomy for the mechanical ptosis was 93.3%.

The key point for successful correction of ptosis is the selection of the right indication for each technique depended on the type and severity of the ptosis. The technique skill is also very important.