Two-Point Fixation Levator Aponeurosis Tucking Versus Standard Levator Resection for Congenital Blepharoptosis
Sameh H. Abdelbaky, MD; Rania A. Elessawy, MD; Dina H. Hassanein, MD; Kareem B. Abdelrahman, MD; Heba H. Mohamed
Pediatric Ophthalmology Department, Cairo University
Introduction: Isolated congenital ptosis is the most common type of ptosis in children mainly caused by maldevelopment of the levator muscle. Levator aponeurosis resection remains the most frequently used technique for correction. However this surgery requires careful dissection for identification, resection, and reattachment of the levator aponeurosis to the anterior tarsus. Two-point fixation levator tucking aims to minimize tissue dissection.
Methods: This is a prospective, randomized, comparative, interventional study that included 42 eyelids of 40 children with isolated congenital ptosis with fair to good levator function. Cases were randomized into either standard levator resection or levator tucking. Outcome was compared regarding margin reflex distance (MRD) and eyelid contour.
Results: At the end of the follow up period (3 months), successful outcomes of the two techniques regarding MRD within 3-5 mm were the same in both groups as met by 18 of 21 eyelids (85.7%). Good eyelid contour was met in the resection group by 17 eyelids (80.95%) and in the tucking group by 16 eyelids (76.2%). Complications were few and included undercorrection and overcorrection.
Discussion: Levator tucking showed similar success rate as standard resection technique. No significant complications related to the technique were noted. Using two-point fixation helped to reduce the operative time while maintaining good contour. Post-operative edema was less in the tucking group which was attributed to less dissection.
Conclusion: Levator tucking is a good alternative to resection. It respects the normal physiology of the levator aponeurosis complex, avoids lacrimal gland injury or conjunctival prolapse, and is a reversible procedure.
References: Wang C, Wang Y Comparison of Surgical Efficacy of Levator Muscle Shortening and Modified Levator Aponeurosis Tucking in Treating Minimal and Moderate Congenital Blepharoptosis. Eye Sci. 2015 Mar;30(1):29-30.