Outcome and Influencing Factors of External Levator Palpebrae Superioris Aponeurosis Advancement for Blepharoptosis

Abstract

Purpose 

To evaluate, in patients with acquired good-function blepharoptosis, levator advancement success and surgical failure risk factors.

Methods 

This retrospective, case-cohort study was university based. An estimated 828 patients underwent levator advancement for acquired good-function blepharoptosis between January 1, 1990, and December 31, 1999. Seventy-two patients underwent reoperation during the first postoperative year. Of 125 randomly selected patients not undergoing reoperation, 106 met the desired outcome criteria: postoperative margin reflex distance (MRD) ≥2.0 mm and ≤4.5 mm in operated eyes and ≤1.0 mm asymmetry between eyelids. Mean MRD, levator function, and Hering dependence (ipsilateral eyelid elevation exacerbating contralateral blepharoptosis) prevalence were determined for reoperated and desired-outcome groups and compared by using 2-sample t test and the Fisher exact test, respectively. Multivariate analysis was also performed.

Results 

Reoperative rates were 8.7% overall, 5.2% of unilateral, and 13% of bilateral cases. Fourteen percent of patients had results outside the desired range but declined reoperation. Univariate analysis revealed significant differences in preoperative characteristics between desired and undercorrected groups: MRD, 1.0 versus 0.32 mm (p =0.001); levator function, 15.4 versus 14.7 mm (p =0.013); and Hering dependence, 50% versus 79% (p =0.005). With multivariate analysis, bilateral blepharoptosis was statistically significant (p =0.014), whereas levator function and Herring dependence were not. No differences were seen between desired and overcorrected groups.

Conclusions 

After levator advancement for acquired good-function blepharoptosis, 77% of patients had ideal results and 8.7% underwent reoperation. Patients with bilateral or severe blepharoptosis have increased risk of undercorrection.

In Brief

After levator advancement for acquired good-function blepharoptosis, 77% of patients had desirable results and 8.7% underwent reoperation; characteristics of patients at higher risk of unfavorable outcome include bilateral and severe blepharoptosis.