Changes in Lid Crease Measurements in Levator Advancement for Ptosis

Abstract

Purpose Although previous reports addressed the differences in marginal reflex distance 1 (MRD-1) measurements based on various techniques of levator advancement, eyelid crease measurements have not been studied as markers in perioperative planning. In addition to possible benefits in optimal results for improvement of visual field defects and functional impairment, recent work has suggested that eyelid crease is important in the perception of attractiveness. Therefore, the aims of this study were to determine the change in eyelid crease measurements in levator advancement and to further expand on numerical correlation of levator advancement in preoperative planning to avoid overcorrection or undercorrection. Methods The authors performed a retrospective analysis of preoperative and postoperative eye measurements in patients who underwent levator advancement for ptosis between August 2016 and April 2019. This study included 13 patients, all of whom had recorded preoperative and postoperative measurements of MRD-1, whereas 8 of 13 patients had additional preoperative and postoperative measurements of the mid pupil to crease and lateral limbus to crease at the level of mid pupil. Results All patients had increased in MRD-1, mid pupil to crease, and lateral limbus to crease measurements postoperatively. The average advancement of 4.8 mm led to an elevation of MRD-1 to 2.6 mm (n = 25) and an improvement in mid pupil to crease distance of 1.9 mm (n = 15) and lateral limbus to crease distance of 2.6 mm (n = 15). No cases of undercorrection or overcorrection were found. All patients reported satisfaction with the results, including improvement in function and quality of life. No infections, hematomas, or other complications were noted postoperatively in any of the patients. Conclusions Marginal reflex distance 1 is a consistently reliable planning tool in preoperative assessment of levator advancement, with beneficial patient outcomes including improvement of visual field defects caused by ptosis and satisfaction with cosmetic results. This study is the first to report use of crease measurements (mid pupil to crease and lateral limbus to crease), which may provide additional understanding to the aesthetic value of to the levator advancement.

Three-Point Vertical Mattress Suture: A Simple Technique for Mild Blepharoptosis Correction in Partial-Incision Double-Eyelid Surgery

“…Makeeva et al 16 have found that a 4-mm advancement resulted in an average MRD1 increase of 2.26 mm and a 5-mm advancement increased to 2.74. Alkeswani et al 17 have found that a 4-mm average advancement led to an average of 2.2 mm increase in MRD1, whereas a 5mm advancement led to an average increase of 2.9 mm. Although these studies suggested a consistent relationship between the levator advancement distance and improvement in MRD1 measurement can be used to plan the amount of advancement required to elevate the eyelid.…”

Changes in Lid Crease Measurements in Levator Advancement for Ptosis

“…To the Editor: W e thank the authors for sharing their useful experience in microsurgical reconstruction of lower leg defects using the medial sural artery and vein(s) as recipient vessels. 1 This possibility has been widely explored in literature in the setting of posttraumatic conditions; however, only a few articles addressed it in postoncological reconstruction. Vessels depletion, indeed, is a common issue in lower leg traumatic injuries, but is less frequent in oncological surgery.…”

“…We read with great interest the article titled “Changes in lid crease measurements in levator advancement for ptosis” by Alkeswani et al, 1 in which authors reported the change in eyelid crease measurements in levator advancement, also explaining preoperative planning to avoid overcorretion or undercorretion during ptosis surgery.…”