Recent modified technique for levator muscle tucking in blepharoptosis surgery

Abstract

Purpose The aim of this study is to introduce a new modification on the classic technique of levator muscle tucking for correction of mild to moderate blepharoptosis and to evaluate its functional and aesthetic outcome. Patients and methods This is a tertiary-center study that included 180 patients with mild to moderate ptosis with good levator function (≥8 mm) according to Beard’s classification. Patients with severe congenital, recurrent, mechanical, traumatic ptosis, third nerve palsy, Marcus–Gunn jaw winking syndrome, absent Bell’s phenomenon, or associated ophthalmoplegia were excluded. A recently introduced resection tucking procedure with a spindle excision of the levator aponeurosis was performed. The procedure outcome was assessed functionally by measuring the distance between the upper lid margin and the superior limbus in bilateral cases and accordingly they were classified as very good (2 mm), good (2–4 mm), and poor (5 mm) as well as comparing the preoperative to the postoperative margin reflex distance (MRD1) in unilateral cases. Assessing the aesthetic outcome was done by measuring the eyelid height symmetry, presence of lid crease, lid contour, and patients’ postoperative satisfaction. Results The success rate of the procedure was 92.1% [very good (77.7%) and good (14.4%), P < 0.0001]. The MRD1 improved significantly from a preoperative value of 3.28±0.44 mm to 4.44±0.57 mm postoperatively (P < 0.0001). Regarding the aesthetic outcome, symmetrical lid height was achieved in 86.1% of the unilateral cases and in 84% of the bilateral cases, while symmetry of the lid crease was reported in 88.8% of the cases and regularity of the lid contour in 91.6% of the cases. Postoperative patients’ satisfaction was reported by 83% of the patients. The time of procedure was 27.4±4.6 min/eye. Conclusion This modified technique of levator tucking was performed in a short time and proved to be an effective technique, with minimal complications and high aesthetic satisfaction outcome.

Keywords

• levator muscle
• plication
• ptosis
• tucking