A Modified Technique Using Levator Aponeurosis–Müller Muscle–Reinforced Plication for Blepharoptosis Correction:

Transconjunctival Levator Aponeurosis-Müller Muscle Complex Plication to Correct the Acquired Ptosis Following Double-Eyelid Surgery

One of the most common adverse outcomes of an upper blepharoplasty involving double-eyelid surgery is asymmetric upper eyelids due to unbalanced supratarsal folds or a difference in the palpebral fissure height. This study aimed to evaluate the efficacy and safety of transconjunctival levator aponeurosis-Müller muscle complex plication for correcting acquired ptosis following double-eyelid surgery. This retrospective study evaluated 18 patients who underwent transconjunctival levator aponeurosis-Müller muscle complex plication between June 2016 and June 2019 to correct acquired ptosis. On the basis of the main area of eyelid drooping, ptosis was categorized as central (mid-pupillary), medial (medial limbus), or lateral (lateral limbus). Preoperative and postoperative palpebral fissure heights were measured and compared. Three months postsurgery, the mean difference in palpebral fissure height between bilateral eyes decreased from 0.96 to 0.04 mm in the medial (P<0.001), from 0.93 to 0.00 mm in central (P=0.003), and from 1.30 to -0.03 mm in lateral ptosis (P=0.079). In 13 patients who underwent unilateral correction, the amount of plication was significantly associated with increased palpebral fissure height at the medial limbus (P=0.043) and mid-pupillary line (P=0.035). All patients reported a significant improvement in satisfaction. Five patients experienced acute postoperative complications, including chemosis, conjunctival injection, and foreign body sensation, all of which were resolved after a month of observation. No asymmetries or recurrences were observed. Transconjunctival levator aponeurosis-Müller muscle complex plication is a minimally invasive, safe, and effective technique for correcting acquired ptosis following upper eyelid surgery.

Impact of Single Eyelid on Superior Visual Field

ABSTRACT

A puffy eyelid without a crease, also known as single eyelid, is a common characteristic in East Asians. Existence of a lid crease is generally considered an aesthetic concern for both patients and surgeons, and postoperative evaluations have mainly focused on the appearance of the eye. The aim of this study was to clarify the functionality of the superior visual field (SVF) with single eyelid.This prospective cohort study compared edge of the upper eyelid to central corneal light reflex distance (edge reflex distance [ERD]) preoperatively and postoperatively and examined the SVF, as measured by Goldmann perimetry, in single-eyelid patients who underwent blepharoplasty.Twenty patients (40 eyelids) with a median age of 21 years were examined. The median preoperative and postoperative ERDs were 1.45 and 3.4 mm, respectively. The median areas of the SVF preoperatively and postoperatively were 34,443 and 50,796 degrees2, respectively. Although a positive correlation existed between preoperative ERD and SVF, no correlation was observed between postoperative ERD and SVF.The SVF of the single eyelid is narrower than that of the double eyelid, even under circumstances of equivalent palpebral fissure height. The single eyelid commonly found in East Asian populations is associated with both cosmetic and functional issues.