What's New in Treatment of Poor Levator Function with Severe Blepharoptosis

Purpose:

Frontalis suspension is a surgical procedure to perform on patients with poor levator

 aponeurosis function and severe blepharoptosis. However, there are drawback of the

 frontalis suspension method. Conventional prognosis depends on clinical observations

 and lacks of quantitatively analysis for the eyelid muscle controlling. With our

 previous study, we examine the possibility of using the assessments of temporal

 correlation and complexity¹in surface electromyography (SEMG) as a quantitative

 description for the change of muscle controlling after operation.

According to the finding above, we designed methods for correction of poor levator

function with severe blepharoptosis. This formed the basis of our study.

 Materials and methods: Medical records were reviewed for 12 severe

 blepharoptosis patients ( 5 unilateral, 7 bilateral) with poor levator function receiving

 transconjunctival operation at Mackay Memorial Hospital, Taipei, from December 1,

 2011 through December 30, 2013. Among the 12 patients, all the levator aponeurosis

 and levator sheath were dissected, shortened and advanced to the upper of the tarsal

 plate while the orbicularis oculi muscle were left intact. Outcome measures were

 margin reflex distance-1, length of excised levator aponeurosis and levator sheath for

 ptosis correction and eyelid symmetry.

 Results:  Complete or near-complete correction of ptosis (degree of ptosis, <1mm)

 was achieved in 16 eyelids (84.2 percent) and mild residual ptosis (degree of ptosis, 1

 to 2 mm) was observed in 2 eyelids (10.5 percent) in postoperative follow-up after 6

 months.  The preoperative MRD1 ranged from -5 to 2mm with a mean of  -1.4 mm

 and postoperative MRD1 ranged from 2.5mm to 5.5 mm with a mean of 3.6 mm.

 The most common complication was reoperation, which was done in 4 eyelids ( 21.1

 percent) because of under correction. Lagophthalmos was found or not found

 immediately post operation and recovered to normal within 2 weeks in all the

 patients.

 Conclusions:The advancement of two levator tissue ( levator aponeurosis and levator

 sheath ) procedure was effective in treatment of poor levator function with severe

 blepharoptosis through transconjunctival incision. Our technique produced eyelid

 excusion in a superior-posterior direction physiologically.