A Modified Levator Resection Technique Involving Retention Of The Levator Palpebrae Superioris Muscle Suspension System For Treatment Of Congenital Ptosis

Objective:To seek better surgical methods for ptosis and achieve the dual effects of function and aesthetics,this article means to introduce an improved method for levator resection(LR)that is retaining the suspensory system of levator palpabrae superioris muscle(LPS)in the correction of congenital ptosis.Methods:90 patients(132 eyelids)with congenital ptosis were collected from October 2014 to April 2016.According to the grading standard of ptosis,these patients were divided into three groups: 10 mild cases(14 eyelids),50 moderate cases(68 eyelids),30 severe cases(50 eyelids).All patients were excluded surgery prohibitions and experienced routine preoperative examination about ptosis,such as levator function,the height of lid fissure,degree of ptosis and so on.From the double eyelid incision to the upper edge of tarsus,the levator aponeurosis–Müller’s muscle composite flap(LAMCF)was just separated from conjunctival lamina to an appropriate position and fixed to upper surface of tarsus while all the suspension systems of it were reserved well.Based on our experience,2-3 mm of levator muscle resection should be performed for each mm of ptosis.The postoperative outcome measures included the following items: the position of upper eyelid margin,eyelid contour and plumpness,the degree of scleral exposure and exposure keratitis.The postoperative follow up time was 1 week,1 month and 6 months.The postoperative satisfaction survey was made after operation.Results:1 week after operation,the eyelid swelling disappeared quickly in all cases.The upper margins of eyelid were 0~2 mm below the superior corneal limbus(SCL)in all cases among different degrees of ptosis.The lagophthalmos was almost inexistence in mild and moderate cases,but presented in all severe cases with different degrees.1 month after operation,the height of palpebral margin began to decline in part of severe case while the mild and moderate cases were maintained good,in which the upper margins of eyelid were 1~2 mm below the superior corneal limbus(SCL)and the eyes were closed well.The lagophthalmos was seen to improve obviously in severe cases.6 months after operation,mild and modertae cases were still maintained good As to severe cases,however,18 cases(34 eyes)were maintained good,in which the upper margins of eyelid were 1~2 mm below the superior corneal limbus(SCL)while 12 cases(16 eyes)were residual ptosis in severe cases,in which the upper margins of eyelid were 3~4 mm below the superior corneal limbus(SCL).The lagophthalmos was seen in some severe cases and without exposure keratitis in all cases.Most severe patients were closed at either 1 or 2 degrees and 4 patients at 3 degrees.The eyelid contour,plumpness and binocular symmetry were satisfied in most patients.Conclusion:In the corrective operation of ptosis,retaining suspensory system of LPS for levator resection can protect tissues of upper eyelids effectly in order to restore the normal function and morphology of eyelids quickly.The advantages of our procedure are that it is less traumatic technique and can reduce shortening of muscle.The success rate of operation was high especially for mild and moderate ptosis.