![]() ![]() LF of less than 6 mm, inadequate follow-up (less than 3 months postoperatively), required skin or fat blepharoplasty, those who underwent concurrent brow surgery, presence of a superior filtering bleb, previous history of trauma and ptosis of congenital, myogenic and neurogenic etiologies were excluded. Inclusion criteria included patients’ age greater than 18 years, acquired aponeurotic ptosis, levator function (LF) equal or above 6 mm and surgery performed under local anesthesia without sedation. Institutional Review Board approval was obtained for a retrospective chart review of these patients. Surgical records from a single surgeon (DSN) were reviewed to identify all patients undergoing minimal incision posterior levator plication for ptosis repair between August 2013 and June 2014. This study aims to evaluate the effectiveness of this technique for correction of adult involutional ptosis under local anesthesia which allows intraoperative adjustments of lid height and contour. No suture is required to close the small incision site(s). This study describes a technique of posterior approach to levator plication through minimal incision(s) near the fornix without resection of conjunctiva and Muller’s muscle. Less invasive, yet effective, surgical techniques are of interest to both patients and surgeons. Some surgeons may prefer intraoperative adjustment of lid height instead of using a preoperative algorithm to determine the amount of tissue resection. 3, 4, 5, 6, 7 These techniques avoid resection of conjunctiva which prevents dry eyes, and may be more effective in patients with negative response to phenylephrine test as well as correcting severe ptosis. On the basis of the theory that the aponeurosis is the main transmitter of contraction of the levator to tarsus, techniques for levator aponeurosis advancement through posterior approach have been previously described. A comparative study of anterior levator advancement vs MMCR reported a 22% lower revision rate for MMCR and a statistically better outcome. 1 Muller’s muscle-conjunctival resection (MMCR), in particular, was found to attain better cosmetic results as compared with patients who underwent anterior approach levator advancement, and predictable outcomes without the need for intraoperative cooperation of the patient or adjustment. Nevertheless, a survey of members of the American Society of Ophthalmic Plastic and Reconstructive Surgery published in 2011 revealed that 74% of surgeons performed posterior approach ptosis surgery. The popularity of posterior approach ptosis repair has waxed and waned over the years. Minimal incision posterior approach to levator plication was effective for the correction of aponeurotic ptosis with moderate to good levator function. The overall success rate was 38/44 (86.4%). The postoperative mean MRD was 2.49 +/− 0.53 mm, and mean improvement was 2.02 +/− 0.61 mm, which was statistically significant ( P<0.001). Severe ptosis of MRD<1 mm was present in 34/44 patients (77.3%). Preoperative mean MRD was 0.48 +/− 0.56 mm. ![]() Resultsįorty-four lids of 27 patients were included. Surgical success was defined as a postoperative margin reflex distance (MRD)>2 mm and<4.5 mm, interlid height<1 mm and satisfactory contour. Then insertion of aponeurosis was dissected away from the anterior tarsal surface, and the more superiorly located levator was plicated on it with double arm suture(s). ![]() The incision(s) was similar to performing incision and curettage of chalazion, except that the site was above the tarsal plate and extended towards the fornix. The upper lid was double everted, and the conjunctiva and Muller’s muscle layers were incised vertically until the levator aponeurosis could be identified. Retrospective chart review of patients with involutional aponeurotic ptosis underwent minimal incision posterior approach levator plication technique between August 2013 and June 2014 by a single surgeon. To assess the efficacy and predictability of a minimal incision posterior approach levator plication technique for correction of involutional ptosis. ![]()
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