Yucel Ozturk, Taha Ayyildiz, Ozlen Rodop Ozgur, Oral Yesim, Seyhan Kocabas


Objective: Our aim was to analyze the success rates of patients who underwent levator aponeurosis or frontal suspension with silicone tube surgery due to blepharoptosis according to the elevator function (LF) and to compare our results with the literature.

Material and Methods: We included twenty-five eyes of 47 patients who had levator aponeurosis or frontal suspension with silicone tube surgery in this study. The patients were grouped as good, moderate, and poor according to their LF. Good and moderate patients had levator aponeurosis while poor patients had frontal suspension with silicon tube surgery. The follow-up period after surgery was 2 to 36 months. The results were evaluated with margin reflex distance (MRD) which greater than 2 mm was considered as successful, between 1 and 2 mm was satisfactory, and less than 1 mm was unsuccessful. Also, patients required revision surgery was considered as unsuccessful.

Results: Twenty-nine (61.7%) men and 18 (38.3%) women with a mean age of 35.16 years (range=0-84 years) were included in this retrospective study. Thirteen cases (27.7%) had bilateral, and34 cases had unilateral ptosis(72.4%). Eight of the 13 patients with bilateral ptosis had bilateral and 5 of them had unilateral surgery. Blepharoptosis was due to congenital (60.0%), aponeurotic (19%), traumatic (1.8%), Horner’s syndrome(1.8%)  and myotonic dystrophy(1.8%). The preoperative mean MRD value was 0.56±0.85 mm (0-3 mm). The levator function (LF) was poor in 18 eyes (32.7%), moderate in 9 eyes (16.4%) and good in 28 eyes (50.9%). Thirty-seven patients (67.3%) underwent levator aponeurosis, and 18 patients had frontal suspension with silicon tube surgery. In our postoperative controls, 33 patients were considered as successful. Three patients were considered as satisfactory, and one patient was considered unsuccessful.

Discussion: Levator aponeurosis and frontal suspension with silicone tube surgeries are both effective surgical methods to treat ptosis. Postoperative success is positively affected by determining the surgery method, according to LF. Our results showed that elevator aponeurosis surgery is more satisfying in good and moderate cases, and frontal suspension with silicone tube is best in poor cases.



ptosis, surgical, techniques

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Kaynak, P. Pitozis Cerrahisinde Secenekler. Turkiye Klinikleri Ophthalmology-Special Topics. 2018; 11(2): 21-31.

Gul A, Duran M, Can E, Niyaz L, Beden Ü.Frontalis suspension materials for the treatment of blepharoptosis: clinical results. Kafkas J Med Sci. 2016; 6(1):14–7.

Yadegari, S. Approach to a patient with blepharoptosis. Neurol Sci. 2016; 37(10): 1589-96.

Kusbeci T, Yavas G, Polat O.Evaluation of surgical results in patients with blepharopytosis. Turkiye Klinikleri J Ophthalmol. 2015;24(1):29-34.

Ozdal PC, Goka S, Teke MY, Fırat E. Levator surgery in the treatment of pitosis. Turkiye Klinikleri J Ophthalmol. 2001; 10:139-45.

Beden U,Sullu Y,Gungor İU,Sayım İ,Erkan D. Results of external levator aponeurosis surgery in blepharoptosis. Turk J Ophthalmol. 2005;35(3):265-70.

Unal M. Levator aponeurosis surgery. Turkiye Klinikleri J Ophthalmol. 1997; 6:98-105.

Jordan DR,Anderson RL. The aponeurotic approach to congenital ptosis. Ophthalmic Surg. 1990; 21(4):237-44.

Wang Y, Xu Y, Liu X, Lou L, Ye J. Amblyopia, strabismus and refractive errors in congenital ptosis: a systematic review and meta-analysis. Sci Rep.2018;8(1): 8320.

Zhang JY,Zhu XW,Ding X,Lin M,Li J.Prevalence of amblyopia in congenital blepharoptosis: a systematic review and Meta-analysis.Int J Ophthalmol. 2019;12(7):1187-93.

Oral Y, Ozgur OR, Akcay L, Ozbas M, Dogan OK. Congenital ptosis and amblyopia. J Pediatr Ophthalmol Strabismus. 2010; 47(2):101-4.

Can İ, Can B, Konkuralp Y, İnan Y, Kural G. Ptosıs surgery wıth mersılene mesh slıng materıal. T Klin J Ophthalmol. 1995; 4:184-8.

Cakmak SS, Unlu K, Caca I, Bilek B. Anterior approach in levator resection in congenital ptosis. Dicle Med J. 2004;31:4.

Ozay S, Ersoy G, Onder F. Results of levator aponeurosis surgery in patients with blepharoptosis.Turk J Ophthalmol. 2002; 32(6): 809-18.

Older JJ. Levator aponeurosis surgery for the correction of acquired ptosis. Ophthalmology. 1983; 90(9):1056-9.

Ali F, Khan MS, Sharjeel M, Din ZU, Murtaza B, Khan A. Efficacy of brow suspension with autogenous fascia lata in simple congenital ptosis Pak J Med Sci. 2017; 33(2): 439–42.

Tillett CW, Tillett GM. Silicone sling in the correction of ptosis. Am J Ophthalmol. 1966;62(3):521-3.

Carter SR,Meecham WJ, Seiff SR. Silicone frontalis slings forthe correction of blepharoptosis:indications and efficacy. Ophthalmology. 1996;103(4):623-30.

Unal M,Bozan E,Konuk O,Hasanreisoglu B. Choice of frontalis suspension material: ten-years experience, Turk J Ophthalmol, 2005; 35(3);271-9.

Bayramlar H,Borazan M, Hepşen İ, Dağlıoğlu MC, Yılmaz H.Levator Strengthening Surgery Results in Ptosis Strengthening. MN Ophthalmology. 2004;11(2):173-8.

Wilson M, Johnson RW. Congenital ptosis: long-term results of treatment using lyophilized fascia lata for frontalis suspension. Ophthalmology. 1991; 98(8): 1234-7.



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