What Stage of Intraoperative Margin Reflex Distance Should be Used as a Guide in Blepharoptosis Repair?

Levator aponeurosis advancement is one of the most well-known surgical procedures performed for blepharoptosis globally. Nevertheless, a patient's condition at 6 months after surgery is difficult to accurately predict before or during levator aponeurosis advancement. This study aimed to determine which margin reflex distance (MRD) during levator aponeurosis advancement strongly correlates with MRD at 6 months after surgery. This study included 126 eyelids of 63 patients who underwent bilateral levator aponeurotic advancement for acquired ptosis and were followed up for >6 months. Frontal-view photographs were taken in the sitting position for all patients before surgery, during surgery (at the time of levator aponeurosis fixation to the tarsal plate, at the time of double eyelid formation, and at the time immediately after surgery), and at 1, 3, and 6 months after surgery. Subsequently, the MRD was measured using a photograph displayed on the personal computer screen. The time of double eyelid formation showed a higher correlation with all time points (1, 3, and 6 mo after surgery) than the time of levator aponeurosis fixation and the time immediately after surgery. In particular, the correlation coefficients at 6 months after surgery were 0.243 ( P =0.006) when the levator aponeurosis was fixed, 0.348 ( P =0.000063) when the double eyelid was created, and 0.278 ( P =0.002) immediately after surgery. The MRD at the time of double eyelid formation during surgery is important for determining postoperative eyelid opening.