Oh Lawrence J, Wong Eugene, Bae Sol, Tsirbas Angelo
Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia.
Department of Medicine, Sydney University, Sydney, Australia.
Plast Reconstr Surg Glob Open. 2018 May 15;6(5):e1781. doi: 10.1097/GOX.0000000000001781. eCollection 2018 May.
Repair of blepharoptosis from the posterior eyelid approach has usually been done utilizing a Müller's muscle-conjuctival resection (MMCR) or an "open sky" technique. We present a new technique to advance the levator muscle from the posterior-approach in a closed fashion that can be used in patients with severe involutional ptosis.
A retrospective chart review was performed for consecutive patients with severe involutional blepharoptosis during a 6-year period treated by a single surgeon with a Closed Posterior Levator Advancement. The inclusion criteria were good levator function (≥ 10 mm), graded response to phenylephrine (change in lid height, 0-5 mm), and no concomitant procedures. Severe involutional blepharoptosis was defined as a margin-to-reflex-distance-1 (MRD1) of ≤ 1.5 mm. Follow-up for all patients was a minimum of 9 months. The main outcome variables were MRD1, upper eyelid contour, intereye symmetry, and reoperation rates.
Three hundred three eyes from 192 patients, with severe ptosis were identified. The average age was 65 years, and the mean preoperative MRD1 was 0.3 mm. Postoperatively, mean MRD1 was 3.5 mm with a median improvement of 3.2 mm. The upper eyelid contour was deemed to be satisfactory by patient and surgeon in 98.3% of eyes. Intereye symmetry was excellent in 96% of our cohort. An overall revision rate of 1.8% was found.
We present a new technique that involves an advancement of the levator muscle in a closed posterior eyelid approach. The technique has produced satisfactory outcomes in our cohort of patients with severe ptosis with a low revision rate.
睑下垂的后睑缘入路修复术通常采用米勒肌-结膜切除术（MMCR）或“开放式”技术。我们提出一种新技术，以闭合方式从后入路推进提上睑肌，该技术可用于重度退行性睑下垂患者。
对一位外科医生在6年期间连续治疗的重度退行性睑下垂患者进行回顾性病历审查。纳入标准为提上睑肌功能良好（≥10毫米）、对去氧肾上腺素分级反应（睑裂高度变化，0 - 5毫米）且无伴随手术。重度退行性睑下垂定义为缘-反射距离-1（MRD1）≤1.5毫米。所有患者的随访时间至少为9个月。主要结局变量为MRD1、上睑轮廓、两眼间对称性和再次手术率。
确定了192例患者的303只严重睑下垂眼。平均年龄为65岁，术前平均MRD1为0.3毫米。术后，平均MRD1为3.5毫米，中位数改善为3.2毫米。98.3%的患眼中，患者和外科医生认为上睑轮廓令人满意。96%的队列两眼间对称性极佳。总体翻修率为1.8%。
我们提出一种新技术，即在闭合的后睑缘入路中推进提上睑肌。该技术在我们的重度睑下垂患者队列中产生了令人满意的结果，翻修率较低。
