Closed Posterior Levator Advancement in Severe Ptosis

Area of Science:

• Ophthalmology
• Oculoplastics
• Surgical Techniques

Background:

• Traditional posterior eyelid approaches for blepharoptosis include Müller's muscle-conjuctival resection (MMCR) and the "open sky" technique.
• Severe involutional ptosis presents a surgical challenge, often requiring specialized approaches for effective repair.

Purpose of the Study:

• To introduce and evaluate a novel closed posterior levator advancement technique for severe involutional blepharoptosis.
• To assess the efficacy and outcomes of this new surgical approach in terms of functional and aesthetic results.

Main Methods:

• A retrospective chart review of patients with severe involutional blepharoptosis (MRD1 ≤ 1.5 mm) undergoing closed posterior levator advancement.
• Inclusion criteria included good levator function (≥ 10 mm) and no concurrent procedures, with a minimum 9-month follow-up.
• Outcome variables assessed were margin-to-reflex-distance-1 (MRD1), eyelid contour, intereye symmetry, and reoperation rates.

Main Results:

• The study included 303 eyes from 192 patients with a mean preoperative MRD1 of 0.3 mm.
• Postoperative mean MRD1 improved to 3.5 mm (median improvement of 3.2 mm).
• High patient and surgeon satisfaction (98.3%) with eyelid contour, excellent intereye symmetry (96%), and a low revision rate (1.8%) were reported.

Conclusions:

• The closed posterior levator advancement technique is a viable and effective surgical option for severe involutional blepharoptosis.
• This novel approach yields satisfactory functional and aesthetic outcomes with a low rate of complications and revisions.