Outcome and influencing factors of external levator palpebrae superioris aponeurosis advancement for blepharoptosis

Timothy J. McCulley, Robert C. Kersten, Dwight R. Kulwin, William J Feuer

Research output: Contribution to journalArticle

73 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)388-393
Number of pages6
JournalOphthalmic Plastic and Reconstructive Surgery
Volume19
Issue number5
DOIs
StatePublished - Sep 2003

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Oculomotor Muscles
Blepharoptosis
Reoperation
Reflex
Eyelids
Multivariate Analysis
Aponeurosis
Cohort Studies

ASJC Scopus subject areas

  • Ophthalmology
  • Surgery

Cite this

Outcome and influencing factors of external levator palpebrae superioris aponeurosis advancement for blepharoptosis. / McCulley, Timothy J.; Kersten, Robert C.; Kulwin, Dwight R.; Feuer, William J.

In: Ophthalmic Plastic and Reconstructive Surgery, Vol. 19, No. 5, 09.2003, p. 388-393.

Research output: Contribution to journalArticle

McCulley, Timothy J. ; Kersten, Robert C. ; Kulwin, Dwight R. ; Feuer, William J. / Outcome and influencing factors of external levator palpebrae superioris aponeurosis advancement for blepharoptosis. In: Ophthalmic Plastic and Reconstructive Surgery. 2003 ; Vol. 19, No. 5. pp. 388-393.
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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.",
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AB - 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.

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