Clinical and Anatomical Substantiation of Levator Resection in the Complex Surgical Treatment of BPES

Abstract

Objective: To describe the clinical and anatomical results of the complex one-stage surgical treatment of BPES by means of levator resection. Materials and Methods: 51 children (73 eyes) aged 3–16 years with BPES were operated on by the newly developed one-stage technique at the Pediatric Ophthalmology Department of the Filatov Institute of Eye Diseases and Tissue Therapy. The surgical technique included shortening of the internal canthal ligament, resection of the tarsus and levator muscle, and skin plasty. The new surgical technique is based on new data on the topography of the upper eyelid and anterior part of the orbit obtained by MRI—onward protrusion of the orbital septum with increased volume of the pre-aponeurotic fat pad; thickening of the suborbicularis fat layer; shortening and thickening of the mobile part of the upper eyelid; and slight expression and low position of the palpebral fold. Results: Elimination of ptosis and epicanthus was achieved in all cases (eye fissure widening of up to 7–11 mm, average 8.8 ± 1.04 mm, and lengthening of up to 21–30 mm, average 24.7 ± 2.87 mm). Increased levator function to 3–10 mm (average 5.6 ± 0.19 mm) was also achieved after surgery. Control MRI investigation confirmed the normalization of the topography of the eyelid and orbital structures. Conclusion: The newly developed surgical technique for BPES correction by means of levator resection permits one to obtain high cosmetic and functional results based on improvement of the topography of the upper eyelid and orbital structures.

KEYWORDS:

• Blepharophimosis
• BPES
• blepharoptosis
• epicanthus inversus
• eye fissure shortening
• congenital malformations
• pediatric ophthalmology
• ptosis correction
• cosmetic surgery
• levator resection