Small incision external levator repair: Technique and early results

PURPOSE: To describe a new surgical technique and early results of external levator repair performed through a small skin incision. METHODS: A chart review of consecutive patients undergoing small incision e xternal levator repair was conducted. This modified external levator repair was performed through an 8-mm eyelid crease incision. Patients with unilat eral or bilateral aponeurogenic blepharoptosis were candidates for the tech nique. Patients with excessive horizontal upper eyelid laxity and those req uiring blepharoplasty in addition to blepharoptosis surgery did not undergo this technique. Patients who underwent previous upper eyelid surgery or co ncurrent brow surgery were excluded from the review. Preoperative measureme nts included upper eyelid margin reflex distance, levator function, and deg ree of dermatochalasis, as well as Goldmann visual field results. Outcome m easures included incidence and type of intraoperative complications, postop erative upper eyelid position (including margin reflex distance, eyelid con tour, and symmetry), incidence and type of postoperative complications, and revisions or additional necessary surgery. RESULTS: Twenty-eight eyelids of 17 patients met study inclusion criteria. Preoperative margin reflex distance +/- SD averaged 0.8 +/- 0.4 mm. Average length of follow-up was 28 +/- 5 weeks (range, 15 to 52 weeks). No signifi cant intraoperative complications occurred. Post operative margin reflex di stance averaged 3.7 +/- 0.3 mm. Two eyelids were mildly undercorrected, and one demonstrated moderately peaked contour postoperatively. Satisfactory e yelid position and contour were achieved in 25 of 28 treated eyelids. No pa tient elected reoperation. CONCLUSIONS: Early results demonstrated that small incision levator repair is safe and generally effective. This minimally invasive external levator r epair is useful for a carefully selected subset of patients with aponeuroge nic blepharoptosis, (Am J Ophthalmol 1999;127:637-644. (C) 1999 by Elsevier Science Inc. All rights reserved.).