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Modified Tarsal Resection Operation for Congenital Ptosis With Fair Levator Function

Patel, Sarit M. M.D.*; Linberg, John V. M.D.*; Sivak-Callcott, Jennifer A. M.D.*; Gunel, Erdogan Ph.D.

Ophthalmic Plastic & Reconstructive Surgery: January-February 2008 - Volume 24 - Issue 1 - p 1-6
doi: 10.1097/IOP.0b013e31815e72a3
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Purpose: There are many options for surgical repair of congenital ptosis with fair levator function. The authors review their 10-year experience with an en bloc resection of tarsus, Müller muscle, and conjunctiva in conjunction with graded levator aponeurosis advancement (a variation of the tarsectomy operation).

Methods: This is a retrospective case series that reviews all cases of ptosis repair performed at West Virginia University from 1994 to 2004 using the “modified tarsal resection method.” Thirty patients with congenital ptosis and fair levator function were identified. Follow-up ranged from 6 weeks to 8 years. Charts were reviewed for type of ptosis, pre- and postoperative upper eyelid margin to reflex distance, degree of levator function, amount of operative tarsus and Müller muscle resection, postoperative eyelid symmetry, and postoperative complications.

Results: In patients with congenital ptosis and fair levator function, the average preoperative upper eyelid margin to reflex distance was 0.0 mm and the average postoperative upper eyelid margin to reflex distance was 2.8 mm. Twenty-five of 30 (83%) patients were deemed to have a “good” surgical outcome. The amount of tarsus-Müller muscle resection reliably predicts the amount of eyelid elevation. The only complications to date have been transient lagophthalmos with exposure keratitis.

Conclusions: In the authors’ hands, an en bloc resection of tarsus, Müller muscle, and conjunctiva combined with levator aponeurosis advancement reliably produces excellent results in the treatment of fair levator function congenital ptosis, superior to their previous experience with isolated maximal levator aponeurosis advancement.

The authors review their 10-year experience with en bloc resection of tarsus, Müller muscle, and conjunctiva, in conjunction with graded levator aponeurosis advancement for the treatment of congenital ptosis with fair levator function.

*Department of Ophthalmology, West Virginia University Eye Institute; and †Department of Statistics, West Virginia University, Morgantown, West Virginia, U.S.A.

Accepted for publication May 11, 2007.

This paper was presented as a thesis submission for the Fall 2005 Annual ASOPRS Meeting in Chicago, IL.

Any animal research involved in this study was performed according to the affiliated institution standards for animal research. Any human studies were performed under approval of the Institutional Review Board.

Address correspondence and reprint requests to Dr. Sarit M. Patel, The Eye Center of Grove Hill, 1 Lake Street, New Britain, CT 06052. E-mail: saritpatel@alumni.lehigh.edu.

©2008The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.