Changes in Eyelid Height Based on Intra-Operative Quantification of Levator Aponeurosis Advancement in Patients with Unilateral Ptosis

ABSTRACT

Objective

To present marginal reflex distance (MRD-1) outcomes based on intra-operative quantification of levator aponeurosis advancement.

Methods

Forty-eight patients with unilateral aponeurotic ptosis underwent anterior levator aponeurosis advancement. Distance of advancement intra-operatively was compared with MRD-1 outcomes at the immediate postoperative sitting, approximately 1 week, and 1 month period. Surgical success was defined as a symmetric MRD-1 or an MRD-1 within 1 millimeter of the contralateral eyelid.

Results

Most MRD-1 exhibited the following trends: 1) initial decrease at about 1 week and increase at 1 month (n = 11), 2) initial increase at about 1 week with levelling at 1 month (n = 8), and 3) increasing through time (n = 7). Success rate significantly decreased through time (p = .0464). The change in proportion of successful and failed surgeries was insignificant. Surgical revision rate was 10.4%.

Conclusion

Levator aponeurosis advancement distances do not correlate with MRD-1 outcomes linearly. MRD-1 exhibited stability over time with a satisfactory success rate at 1 month.

KEYWORDS:

• eyelid height
• levator advancement
• marginal reflex distance-1
• ptosis surgery
• white-line

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

AUTHORS’ CONTRIBUTIONS

Conceptualization, Hirohiko Kakizaki; methodology, Jose Miguel Ambat; validation, Hirohiko Kakizaki; formal analysis, Jose Miguel Ambat; investigation, Hirohiko Kakizaki; writing – original draft preparation, Jose Miguel Ambat; writing – review and editing, Yasuhiro Takahashi and Hirohiko Kakizaki; supervision, Naoyuki Morishige, Yasuhiro Takahashi, and Hirohiko Kakizaki; project administration, Hirohiko Kakizaki. All authors have read and agreed to the published version of the manuscript. No one contributed to the work who did not meet our authorship criteria.

OTHER CONTRIBUTORS

The authors wish to thank Maria Peñafrancia L. Adversario, MD, FPPS, MSPH of the University of the East Ramon Magsaysay Memorial Medical Center (UERMMMCI) and University of the East Graduate School for formulating the statistical analysis used in this study.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.