Comparing anterior and posterior approaches for levator aponeurosis advancement: eyelid opening outcomes

Levator aponeurosis advancement is a technique used to treat aponeurotic ptosis, which can be performed via anterior (transcutaneous) or posterior (transconjunctival) approach, each with specific advantages. This study aims to evaluate and compare pre- and postoperative eyelid aperture outcomes for both techniques and analyze the rate of over- and undercorrections, contributing to a better understanding of their efficacy and limitations.

We conducted a retrospective study on 62 eyelids with aponeurotic ptosis and good levator function. A total of 32 anterior and 30 posterior approaches were performed, assessing marginal reflex distance 1 (MRD1), eyelid aperture (EA), and their pre- and postoperative variations, along with the rate of over- and undercorrections relative to ideal values.

MRD1: Preoperative values for the anterior approach were 1.59 ± 1.08 mm, and 0.85 ± 1.00 mm for the posterior approach. Improvements were 2.08 ± 1.59 mm for the anterior approach and 2.13 ± 1.32 mm for the posterior one (p > 0.05). EA: Improvements were 2.03 ± 2.15 mm for the anterior approach and 2.50 ± 1.66 mm for the posterior one (p > 0.05). Ideal MRD1 correction (4 mm) was achieved in 31.3% of anterior cases vs 20.0% of posterior cases (p ≈ 0.05). Ideal EA correction (10 mm) was achieved in 18.8% of anterior cases vs 3.3% of posterior cases (p < 0.05).

Both approaches are effective, but the anterior approach demonstrates higher rates of ideal corrections and fewer undercorrections. The posterior approach was used in lower preoperative MRD1 cases, which may have influenced the results. Selection should be based on the patient's specific characteristics and needs.