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Surgical algorithm may aid surgical treatment of involutional ptosis with normal levator function

A surgical algorithm involving a small incision to expose the levator aponeurosis was effective in terms of margin reflex distance-1 and surgical time in patients with involutional ptosis.

The researchers aimed to develop an algorithm-based technique for external surgical treatment of involutional ptosis with normal levator function in a cohort of 15 patients. There were 26 eyelids treated in 2015 and 2016 included in the retrospective cohort study.

According to the researchers, the technique was done with a small incision in the eyelid case through the orbital septum, exposing the levator aponeurosis. They then clamped the aponeurosis to a spring scale with the aim of standardizing stress on the eyelids. They resected 2 mm of aponeurosis for every millimeter of desired ptosis correction, according to the findings. The aponeurosis was connected to the tarsus at predetermined locations using two sutures.

The main outcome measure was the actual margin reflex distance-1 (MRD-1) compared with a preoperative prediction of this value.

Results indicated a mean preoperative of was 0.44 mm (range, −0.5 to 2 mm; 95% CI, 0.18-0.7) and a final value of 3.2 mm (range, 2.5-4.0 mm; 95% CI, 3.1-3.4 mm; P < .001).

The researchers noted that the mean predicted MRD-1 goal was 3.4 mm (range, 2.5-4.0 mm; 95% CI, 3.2-3.5). All eyelids were within 1 mm of the goal for MRD-1, according to the final analysis.

Other findings indicated that 14.6 minutes (range 10.5-34.0 minutes) was required per eyelid to perform the surgery. No intraoperative suture adjustments were reported in 46% of the eyelids. – by Rob Volansky

Disclosure: The researchers report no relevant financial disclosures.