Posterior approach white-line advancement ptosis repair: the evolving posterior approach to ptosis surgery.
Résumé
Introduction We describe a surgical technique for ptosis correction in moderate to good levator function involving advancement of the levator aponeurosis via a transconjunctival posterior approach without resection of Muller's muscle. We present our experience of and the results from this method and review the evolution of posterior approach ptosis surgery. Purpose To assess the efficacy and predictability of posterior approach white line advancement ptosis repair. Methods Retrospective analysis of all patients with primary aponeurotic ptosis undergoing posterior-approach repair using white-line advancement between December 2007 to June 2008. We describe a technique whereby after dissection of the Muller's-conjunctiva composite flap, the levator aponeurosis is advanced with double armed sutures through the white line, then through tarsus and out through skin. Results 112 ptosis procedures in total during this period of which 71 eyelids of 41 patients were eligible for inclusion. There were 14 males and 27 females. The mean age was 63.76 years (range 24 to 87 years). Minimum follow up was 3 months (12 weeks-43 weeks). Of the 71 procedures, 34 were combined with a blepharoplasty. 62 achieved their desired lid height, contour and symmetry (87.3% success rate). No patients were overcorrected. Success rate in the phenylephrine positive group (42/71) was 88.1% compared to 100 % in phenylephrine negative group (4/71). Conclusions We present a modified approach to ptosis correction via a posterior approach. It has a high success rate and good cosmetic outcome. It is technically straightforward and easy to learn.
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