Stabilization of eyelid height after aponeurotic ptosis repair
Presented in part at the European Society of Ophthalmic Plastic and Reconstructive Surgery, Rome, Italy, October 1997.
Received 26 March 1998; accepted 4 September 1998.
Abstract
Objective
To develop guidelines for revision of ptosis surgery in the early postoperative period by establishing what percentage of eyelids after anterior levator advancement have reached their final height by the first postoperative week.
Design
Prospective noncomparative case series.
Participants
An analysis was performed on 164 eyelids in 97 patients with involutional aponeurotic ptosis.
Intervention
Anterior levator advancement was performed on each of these 164 eyelids. Exclusion criterion consisted of a history or evidence of neurologic or muscular disease, preceding trauma, an anophthalmic socket, or prior eyelid surgery.
Main outcome measures
The marginal reflex distance, eyelid excursion, and degree of swelling were recorded perioperatively; additionally, photographs were obtained before surgery and at 1 and 6 weeks after surgery.
Results
At 1 week after surgery, only 40% of eyelids had reached their final height; 52% continued to rise a mean of 1.1 mm. The percentage of eyelids continuing to rise after the first postoperative week varied with the amount of swelling present at 1 week, although a direct correlation did not exist (Pearson correlation, 0.22; P < 0.26). Although this increase ranged from 0.5 to 3.0 mm for 71% of eyelids, the subsequent increase was 1 mm or less. Maximal eyelid height was achieved almost universally by 6 weeks, after which 18% of eyelids subsequently dropped a mean of 0.8 mm.
Conclusions
Based on this study, the authors suggest revision at 1 week after anterior levator advancements in which minimal-to-moderate eyelid swelling exists for contour abnormalities, if the eyelid height is 0.5 mm or more above or more than 1.0 mm below the target height, or if asymmetry between the eyelids is 1.0 mm or more. The authors do not advise early revision for patients with excessive swelling still present 1 week after surgery.
Manuscript no. 98163.
1Department of Surgery, Division of Ophthalmology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
2Department of Statistics, Southern Illinois University School of Medicine, Springfield, Illinois, USA
Reprint requests to Susan M. Tucker, MD, Department of Ophthalmology, Boston University School of Medicine, 715 Albany Street, Boston, MA 02118–2526 USA
1 Dr. Tucker is currently affiliated with Boston University School of Medicine.
ABSTRACT