Does Modified Levator Resection Improve Moderate Congenital Blepharoptosis?

A modified levator resection technique effectively corrected moderate congenital blepharoptosis, reported researchers of a study published in Aesthetic Plastic Surgery.

Noting several continuing disadvantages of levator resection — including residual lagophthalmos (RL), undercorrection, conjunctival prolapse, and eyelid contour abnormality  — the researchers retrospectively evaluated the clinical impact of 3 modifications to the technique: releasing the levator muscle sufficiently, preserving the supporting structure of the conjunctiva, and placing multiple suture sites.

Included in the study were patients who underwent the modified levator resection technique to correct moderate blepharoptosis from January 2020 to April 2022. All participants had moderate blepharoptosis (degree of ptosis, 3-4 mm) and fair levator function (LF) (5-8 mm), and participated in a follow-up period of at least 6 months.

Preoperative data were obtained for age, sex, margin reflex distance 1 (MRD1), LF, and Hering phenomenon. Postoperative data and information collected included MRD1, residual lagophthalmos (RL), patient satisfaction, complications, and follow-up duration. The correction result at final follow-up was assessed according to MRD1.

The analysis included 57 patients (64.9% women) who had levator resection (81 eyes). The patients’ mean age was 24.2±4.6 years (range, 18 to 39 years), and all ptosis was moderate (average MRD1, 1.45±0.65 mm). Mean LF was 6.49±1.12 mm, and mean follow-up duration was 16.1±5.1 months (range, 6 to 28 months).

The participants’ mean MRD1 increased significantly from 1.45±0.65 mm preoperatively to 3.57±0.51 mm at the final postoperative follow-up (paired t test; P =.000). Their mean LF increased significantly, from 6.49±1.12 mm preoperatively to 9.48±1.39 mm during the last follow-up (paired t test; P =.000).

Correction was successful in 77 eyes (95.1%), undercorrection occurred in 3 eyes (3.7%), and overcorrection occurred in 1 eye (1.2%). The patients’ mean RL was 1.09±0.57. Excellent or good eyelid closure function was observed in 72 eyes (88.9%), fair eyelid closure function was noted in 8 eyes (9.9%), and eyelid closure function was poor in 1 eye (1.2%).

A total of 54 patients (94.7%) were completely satisfied with the final result. Three patients (5.3%) were dissatisfied, and 2 of these 3 patients (3.5%) underwent reoperation. Hematoma, infection, conjunctival prolapse, suture exposure, corneal abrasion, and keratitis were not observed during the follow-up period.

Contrary to the conventional technique, the researchers used prolene sutures in this study. They noted, “The prolene suture is chemically synthesized, monofilament, non-absorbable, and highly histocompatible, which can maintain permanent tension strength after being implanted into the tissue and help to avoid postoperative wound infection.” The researchers concluded that this new technique “is effective in correcting moderate congenital blepharoptosis while minimizing RL, undercorrection, conjunctival prolapse, [and] eyelid contour abnormality by releasing the levator muscle sufficiently, preserving the supporting structure of the conjunctiva, and placing multiple suture sites.”

This article originally appeared on Dermatology Advisor