J Korean Ophthalmol Soc.  2017 Jun;58(6):627-633. 10.3341/jkos.2017.58.6.627.

Eyelid Contour Analysis Following Müller's Muscle-conjunctival Resection and Levator Aponeurosis Advancement in Mild to Moderate Belpharoptosis

• Lee SM
• Lew H

• KMID: 2382669
• DOI: http://doi.org/10.3341/jkos.2017.58.6.627

Abstract

PURPOSE
To analyze both the effects and the eyelid contour of Müller's muscle-conjunctival resection and levator aponeurosis advancement in patients with mild to moderate belpharoptosis.
METHODS
We conducted a retrospective cross-sectional study including 20 eyes of 16 patients who underwent Müller's muscle-conjunctival resection and 25 eyes of 17 patients who underwent levator aponeurosis advancement from January 2012 to December 2015, where each patient was followed up for at least 6 months. Surgical success was defined as either a marginal reflex distance 1 (MRD₁) elevation greater than 2.5 mm postoperatively or a bilateral MRD₁ difference less than 0.5 mm. Both the conventional and 12 oblique mid-pupil lid distances were measured every 15 degrees using custom software developed in the MATLAB program (MathWorks, Natick, MA, USA).
RESULTS
The average correction of Müller's muscle-conjunctival resection was 1.1 mm, while that of levator aponeurosis advancement was 0.9 mm. There was no significant difference in MRD₁, MRDâ‚‚, function of levator palpebrae muscle, or lid contour in the preoperative status between the Müller's muscle-conjunctival resection group and the levator aponeurosis advancement group. The surgical success rate was 85% in the Müller's muscle-conjunctival resection group and 84% in the levator aponeurosis advancement group, but this difference was not significant. The postoperative lid contour (superomedial side, 15°) was more effective in the Müller's muscle-conjunctival resection group (p < 0.05).
CONCLUSIONS
Overall, both types of blepharoptosis surgery were effective at correcting mild to moderate blepharoptosis. The correction of mild to moderate blepharoptosis using Müller's muscle-conjunctival resection is an effective technique for elevating the eyelid and normalizing the eyelid contour.

Keyword

Blepharoptosis; Eyelid contour; Levator aponeurosis advancement; Müller's muscle-conjunctival resection

MeSH Terms

Blepharoptosis
Cross-Sectional Studies
Eyelids*
Humans
Reflex
Retrospective Studies

Figure

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  Figure 1 Measurement of marginal reflex distance 1 (MRD1), marginal reflex distance 2 (MRD2), and brow to pupil distance (BPD). MRD1, MRD2, BPD are measured by Image J program (NIH, Bethesda, MD, USA).

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  Figure 2 Eyelid contour analysis. Equally spaced multiple radial mid-pupil lid lines (15°) by MATLAB program (MathWorks, Natick, MA, USA).

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  Figure 3 Polar plot of lid contour of preoperative of ptosis patients. (A) Müller's muscle-conjunctival resection group. (B) levator aponeurosis advancement group. (C) Comparision with two groups. MMCR Pre-OP = preoperative lid contour of Müller's muscle-conjunctival resection group; LAA Pre-OP = preoperative lid contour of levator aponeurosis advancement group.

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  Figure 4 Polar plot of lid contour between preoperative and postoperative ptosis patients. (A) Müller's muscle-conjunctival resection group. (B) Levator aponeurosis advancement group. MMCR Pre-OP = preoperative lid contour of Müller's muscle-conjunctival resection group; MMCR Post-OP = postoperative lid contour of Müller's muscle-conjunctival resection group; LAA Pre-OP = preoperative lid contour of levator aponeurosis advancement group; LAA Post-OP = postoperative lid contour of levator aponeurosis advancement group.

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  Figure 5 Polar plot of postoperative lid contour between Müller's muscle-conjunctival resection group and levator aponeurosis advancement group. The postoperative lid contour (superomedial side, 15°) was more effective in the Müller's muscle-conjunctival resection group (p < 0.05). MMCR Post-OP = postoperative lid contour of Müller's muscle-conjunctival resection group; LAA Post-OP = postoperative lid contour of levator aponeurosis advancement group.

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