Results of standard and small incision levator advancement surgery in patients with aponeurotic ptosis

ABSTRACT Introduction and Purpose: Levator advancement is considered an effective surgical technique in the treatment of aponeurotic ptosis and is applied through the incision made along the entire upper lid crease. The aims of small incision surgery are to reduce tissue injury, shorten the operation time, have rapid healing and reduced scar formation. In our study, the results of small incision and standard levator surgery were compared. Materials and Methods: The files and images of patients who underwent small incision levator advancement or standard levator reinsertion surgery in our clinic between 2018 and 2020 with the diagnosis of aponeurotic ptosis were reviewed retrospectively, as were the surgical findings and patient information. Results: A total of 82 eyes; including 46 eyes of 31 patients in the first group operated through small incision and 36 eyes of 26 patients in the second group who underwent standard levator surgery, were enrolled to the study. Age, gender, systemic and ophthalmological pathologies, levator function (LF), preoperative margin-reflex distance (MRD), postoperative MRD, symmetry between the eyes, MRD change before and after surgery, follow-up period, perioperative and postoperative complications (under/overcorrection, contour disorder, lagophthalmos) of both groups were recorded. There was no statistically significant difference between the two groups in terms of surgical success (80% and 81%, p=0.131, respectively). When the correlation of surgical success with preoperative MRD and LF value was investigated, a positive correlation was observed only between preoperative MRD and successful surgical outcome (p=0.01). Conclusion: Small incision levator advancement surgery is a less invasive procedure due to the shorter skin incision and preservation of orbital septum integrity; however, performing this operation requires good knowledge of eyelid anatomy and experience in eyelid surgery. Small incision levator surgery can be performed as a safe and effective surgical technique for levator advancement in patients with aponeurotic ptosis.