PURPOSE: We describe a minimally invasive technique and report our experience of posterior approach levator plication ('levatorpexy') for congenital ptosis. STUDY DESIGN: Retrospective review. PARTICIPANTS: Consecutive series of 16 patients. MATERIALS AND METHODS: Posterior approach levatorpexy was performed for congenital ptosis under general anaesthesia. This surgical procedure involves exposing the posterior surface of the levator muscle through a transconjunctival approach. The levator muscle is advanced and plicated using a suture passed through its posterior surface, partial-thickness, to tarsal plate and tied on the skin. No tissue (conjunctiva, Muller's muscle, levator) are excised during this procedure. MAIN OUTCOME MEASURES: Data collected included margin reflex distance (MRD1), symmetry of eyelid height, contour and complications. Surgery was considered successful if the following three criteria were simultaneously met: A postoperative MRD1 of ≥2 mm and ≤4.5 mm, inter-eyelid height asymmetry of ≤1 mm, and satisfactory eyelid contour. RESULTS: Mean age was 9.1 years (range 3-26 years). Mean postoperative follow-up was 8.1 months (4-24 months). Preoperative phenylephrine test was positive in 81% of patients. Mean levator function was 11 mm (5-15 mm). Mean preoperative MRD1 was 1.5 mm and the mean postoperative MRD1 was 2.6 mm. Fourteen patients (87%) achieved the desired eyelid height and fulfilled our criteria set for success. CONCLUSIONS: Posterior approach levatorpexy appears to be a safe and effective procedure for correction of congenital ptosis particularly with moderate or better levator function. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
PURPOSE: We describe a minimally invasive technique and report our experience of posterior approach levator plication ('levatorpexy') for congenital ptosis. STUDY DESIGN: Retrospective review. PARTICIPANTS: Consecutive series of 16 patients. MATERIALS AND METHODS: Posterior approach levatorpexy was performed for congenital ptosis under general anaesthesia. This surgical procedure involves exposing the posterior surface of the levator muscle through a transconjunctival approach. The levator muscle is advanced and plicated using a suture passed through its posterior surface, partial-thickness, to tarsal plate and tied on the skin. No tissue (conjunctiva, Muller's muscle, levator) are excised during this procedure. MAIN OUTCOME MEASURES: Data collected included margin reflex distance (MRD1), symmetry of eyelid height, contour and complications. Surgery was considered successful if the following three criteria were simultaneously met: A postoperative MRD1 of ≥2 mm and ≤4.5 mm, inter-eyelid height asymmetry of ≤1 mm, and satisfactory eyelid contour. RESULTS: Mean age was 9.1 years (range 3-26 years). Mean postoperative follow-up was 8.1 months (4-24 months). Preoperative phenylephrine test was positive in 81% of patients. Mean levator function was 11 mm (5-15 mm). Mean preoperative MRD1 was 1.5 mm and the mean postoperative MRD1 was 2.6 mm. Fourteen patients (87%) achieved the desired eyelid height and fulfilled our criteria set for success. CONCLUSIONS: Posterior approach levatorpexy appears to be a safe and effective procedure for correction of congenital ptosis particularly with moderate or better levator function. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.