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Am J Ophthalmol. 2005 Sep;140(3):426-32.

External levator advancement vs Müller's muscle-conjunctival resection for correction of upper eyelid involutional ptosis.

Author information

  • 1Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA. guybensimon@gmail.com

Abstract

PURPOSE:

To compare external levator advancement and Müller's muscle-conjunctival resection (conjunctivomullerectomy, or CJM) for correction of upper eyelid involutional ptosis.

DESIGN:

Retrospective, nonrandomized, comparative interventional case series.

METHODS:

Review of medical records of 159 patients (272 surgical procedures) who underwent external levator advancement or CJM was performed.

MAIN OUTCOME MEASURES:

Functional and cosmetic outcome, marginal reflex distance one (MRD1), and surgical complications.

RESULTS:

A total of 159 patients (51 men, 108 women, mean age 70 years) underwent 272 surgical procedures for upper eyelid ptosis; concurrent blepharoplasty was performed in 141 cases. MRD1 increased an average of 1.6 (+/-1.5) mm, from 0.8 mm (+/-1.2) preoperatively to 2.3 mm (+/-1.2) postoperatively (P < .001). Fifteen patients (5.5%) underwent reoperation for residual ptosis, nine (18%) in the external levator advancement group, two (3%) in the CJM group, three (8%) in the external plus blepharoplasty group, and one (1%) in the CJM plus blepharoplasty group (P < .001). Patients who underwent external levator advancement had significantly more severe ptosis preoperatively but attained similar eyelid position postoperatively as compared with CJM patients. Complications included overcorrection in four cases (1.4%), lagophthalmos of 1 mm in 10 (3.6%), and pyogenic granuloma in two (<1%).

CONCLUSIONS:

External levator advancement and CJM performed alone or with concurrent blepharoplasty are effective treatments for upper eyelid ptosis. Residual ptosis or postoperative eyelid retraction occurs in up to 20% of cases and can be addressed successfully with a second operation.

PMID:
16083839
[PubMed - indexed for MEDLINE]
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