Change in Lower Eyelid Position After Ptosis Repair in Patients With Unilateral Myogenic Versus Aponeurotic Blepharoptosiss

Purpose: To compare preoperative and postoperative lower eyelid scleral show in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis, analyze the factors correlated with them, and assess the rate of postoperative lower eyelid symmetry in both groups. Methods: Patients (older than 5 years old) with unilateral MP (58) and AP (20) were included from June 2015 to April 2017. Excluded were patients with previous eyelid surgery, strabismus, levator function of ≤3, and associated procedures. Margin reflex distance (MRD) 1 and 2 and levator function were measured by the same observer before and at least 6 months after the ptosis repair. Results: Lower scleral show was observed in 56.8% and 80% of MP and AP, respectively. Margin reflex distance 2 was significantly (r = −0.37, p = 0.002) associated with MRD1 in the MP group (multiple regression analysis). Both groups showed a significant improvement of MRD2, postoperatively resulting in symmetric MRD2 in 91.4% of MP and 80% of AP group. It was not changed in 43% of MP and 25% of AP group. Multiple regression analysis showed that preoperative MRD2 was the only significant factor associated with postoperative improvement of scleral show in the MP group. Conclusions: Lower scleral show was significantly improved after ptosis repair in both MP and AP. The more severe MP was significantly associated with more severe preoperative scleral show. Preoperative MRD2 was the only factor predicting postoperative improvement of scleral show in the MP. No factor was significantly associated with MRD2 in the AP group. Accepted for publication October 25, 2018. Supported by Iran University Eye Research Center which did not have any role in the design, execution, and presentation of results. The authors have no financial or conflicts of interest to disclose. Presented at annual meeting of European (Bucharest, September 14-15, 2018) and American (Chicago, October 25-26, 2018) Society of Ophthalmic Plastic and Reconstructive Surgery. Address correspondence and reprint requests to Mohsen Bahmani Kashkouli, M.D., Rassoul Akram Hospital, Sattarkhan Niayesh Street, Tehran 1455364, Iran. E-mail: mkashkouli2@gmanil.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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