Outcomes of posterior-approach ‘levatorpexy’ in congenital ptosis repair

Abstract

Posterior approach levatorpexy appears to be a safe and effective procedure for correction of congenital ptosis particularly with moderate or better levator function.

Minimal incision posterior approach levator plication for aponeurotic ptosis

“…Using the same success criteria, other studies of posterior approach ptosis surgery also reported similar success rate of over 80%. [5][6][7][8] McCulley et al 8,9 described a large series of traditional anterior approach to levator advancement and reported 77% success, and a simplified anterior approach technique of using a single adjustable suture had success rate of 74%. A study of 10 years' experience in MMCR in Asian unilateral ptosis reported 82.8% success defined by interlid MRD difference of r1 mm.…”

“…27 Recent techniques of posterior approach ptosis repair were modified to prevent excising any conjunctival tissue. [4][5][6][7]24,27 Regarding to the open sky mullectomy, Peter et al 24 reported that 4% of eyelids developed complications related to postoperative surface drying and presence of sutures on the palpebral conjunctiva, including corneal abrasions, suture abscesses, prolonged postoperative pain, and blood cyst. We have not encountered any of these complications because our minimal incision technique does not require placing suture on the palpebral conjunctiva.…”

“…[3][4][5][6][7] Collin's technique of levator aponeurosis reinsertion involved exposing the anterior surface of levator by excising 2 mm of the superior tarsus and Muller's muscle, followed by dissection of the orbital septum and retraction of the preaponeurotic fat pad to convert a posterior approach to the familiar anatomical view of an anterior approach ptosis repair. 3 Ichinose et al 4 reported a technique for posterior approach to levator advancement via incision of conjunctiva and Muller's muscle horizontally along medial 2/3 of the superior border of tarsus.…”

“…2 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. [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. Some surgeons may prefer intraoperative adjustment of lid height instead of using a preoperative algorithm to determine the amount of tissue resection.…”

How far we have come: A review of the evolution of posterior approach ptosis surgery

“…The distinguishing difference between Collin's levator advancement and Malhotra's white line advancement is that the white line advancement technique simply advances the exposed posterior surface of the aponeurosis and does not breach the orbital septum nor includes a tarsectomy. The white line advancement technique has subsequently been modified into the levatorpexy procedure for congenital ptosis …”